Introduction: There are discrepant findings regarding the effect of dyslipidemia on disease progression in adult patients with chronic kidney disease (CKD).

Methods: In a prospective cohort study of children with stage 3 to 5 (predialysis) CKD, triglycerides (TGs), total cholesterol (CHOL), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) were measured semiannually. We investigated whether CKD progression is associated with serum lipid levels at baseline and with lipid trajectories during follow-up. CKD progression was defined as the time to a composite event of 50% reduction in estimated glomerular filtration rate (eGFR), eGFR < 10 ml/min per 1.73 m², or start of kidney replacement therapy. By semiparametric group-based trajectory modeling (GBTM), 2 trajectories were defined for each lipid, termed "high" and "low."

Results: A total of 681 patients aged 12.2 ± 3.3 years with a mean eGFR of 26.9 ± 11.6 ml/min per 1.73 m² were included. Kidney diagnosis was classified as congenital anomalies of the kidneys and urinary tracts (CAKUT) in 69%, glomerulopathy in 8.4%, and other disorders in 22.6% of patients. During a median of 5.1 years of follow-up, 59% of patients reached the composite end point. Kidney survival was significantly different for HDL-C (P = 0.0128), but not for other lipid trajectories in the Kaplan-Meier analysis. There was no significant association of any of the lipid trajectories with CKD progression in Cox proportional hazard models. Variables consistently associated with CKD progression in models for each lipid at baseline and for lipid trajectories included age, a diagnosis other than CAKUT, eGFR at baseline, albuminuria, the serum albumin level, and diastolic blood pressure (BP).

Conclusions: These data do not support an important role for lipids in the progression of CKD in children.

Keywords: children; chronic kidney disease; dyslipidemia; progression; proteinuria.

© 2025 International Society of Nephrology. Published by Elsevier Inc.

简介：关于血脂异常对慢性肾脏病（CKD）成人患者疾病进展的影响存在不同的研究结果。

方法：在一项针对3至5期（透析前）CKD儿童的前瞻性队列研究中，每半年测量一次甘油三酯（TGs）、总胆固醇（CHOL）、低密度脂蛋白胆固醇（LDL-C）和高密度脂蛋白胆固醇（HDL-C）。我们调查了基线血清脂质水平以及随访期间脂质轨迹是否与CKD进展相关。CKD进展定义为估计肾小球滤过率（eGFR）降低50%，或eGFR低于10 ml/min/1.73 m²，或者开始肾脏替代治疗的时间。通过半参数分组轨迹模型（GBTM），每种脂质分为两个轨迹，分别称为“高”和“低”。

结果：共有681名年龄为12.2 ± 3.3岁的儿童参与研究，平均eGFR为26.9 ± 11.6 ml/min/1.73 m²。肾脏诊断分为先天性泌尿系统异常（CAKUT）占69%，肾小球病变占8.4%，其他疾病占22.6%的患者。在中位5.1年的随访期间，59%的儿童达到了复合终点。HDL-C轨迹在卡普兰-迈耶生存分析中显著不同（P = 0.0128），而其他脂质轨迹则没有显著差异。在Cox比例风险模型中，任何脂质轨迹与CKD进展均无显著关联。基线时每种血脂水平和脂质轨迹的模型中一致相关的变量包括年龄、非CAKUT诊断、基线eGFR、蛋白尿、血清白蛋白水平以及舒张压。

结论：这些数据不支持脂质在儿童CKD进展中的重要作用。

关键词：儿童；慢性肾脏病；血脂异常；疾病进展；蛋白尿。

© 2025 国际肾病学会。由爱思唯尔出版。