Remnant Cholesterol Flags CKD Severity, CV Death Risk on Dialysis

Remnant cholesterol (RC) may help identify patients with chronic kidney disease (CKD) at greatest risk, from those with more advanced disease to those receiving maintenance hemodialysis who face elevated cardiovascular mortality, according to 2 posters presented at American Society of Nephrology (ASN) Kidney Week 2026 in Denver, Colorado. Because RC can be calculated from a standard lipid panel, the findings point to a marker pharmacists can already see in many patients' existing laboratory results.^1-3

RC refers to the cholesterol carried in remnant lipoprotein particles. The calculated form is total cholesterol minus low-density lipoprotein cholesterol (LDL-C) minus high-density lipoprotein cholesterol, which requires no special testing equipment. Prospective studies have linked elevated nonfasting RC levels to a higher risk of developing atherosclerotic cardiovascular disease.³

RC and Cardiovascular Death on Hemodialysis

In the first study, investigators at Peking University Third Hospital in Beijing, China, enrolled 346 patients receiving maintenance hemodialysis between 2010 and 2025 and divided them by the median RC value into high RC (≥0.72 mmol/L) and low RC (<0.72 mmol/L) groups.¹

Over a median follow-up of about 7.1 years, there were 118 all-cause deaths, of which 64 were from cardiovascular disease (CVD). CVD mortality was significantly higher in the high RC group than in the low RC group (35.8% vs 1.16%; P < .001). In multivariate Cox regression, high RC was an independent risk factor for CVD mortality (HR, 26.642; P < .001), but it was not an independent risk factor for all-cause mortality.¹

The authors concluded that monitoring RC could improve cardiovascular risk stratification and help guide clinical management in this population.¹

RC-Based Index Tracks CKD Severity

The second poster, from a team at Peking University Health Science Center and Peking University Third Hospital that shared several investigators with the first, examined RC through an inflammatory lens. Researchers retrospectively analyzed 1644 patients with CKD treated from 2011 to 2020, comparing C-reactive protein (CRP) with 2 newer indicators: the remnant cholesterol inflammatory index (RCII) and the CRP-triglyceride-glucose index (CTI). Advanced risk was defined as CKD stages 2 to 3 and cardiovascular-kidney-metabolic (CKM) syndrome stages 3 to 4.²

All 3 indicators increased significantly across stages. CRP best discriminated CKM severity, with an area under the curve of 0.655 versus 0.636 for CTI and 0.607 for RCII. However, CRP was not significantly associated with CKD risk stratification (P = .379). In contrast, RCII (odds ratio [OR], 1.34; 95% CI, 1.13-1.59) and CTI (OR, 2.17; 95% CI, 1.28-3.79) both showed significant linear associations with advanced CKD risk.²

The authors concluded that RCII and CTI could provide superior assessment of CKD risk compared with CRP and called for further study of their prognostic value across kidney disease etiologies.²

What Pharmacists Should Know

Neither study establishes RC as a treatment target, and both are single-center analyses from China presented as abstracts, without peer-reviewed full-text publication. The hemodialysis study reported an unusually large hazard ratio without a confidence interval in the abstract, and its RC cutoff is expressed in mmol/L rather than the mg/dL units US laboratories typically report.^1,2

Still, the posters add to evidence that cholesterol beyond LDL-C may matter in patients with kidney disease. For pharmacists reviewing lipid panels for patients with CKD, RC is a value that can be derived at no added cost and may prompt closer attention to triglyceride-rich lipoproteins and overall cardiovascular risk.^1-3

REFERENCES

1. Bai Q, Deng Z, Wang S. Remnant cholesterol as an independent risk factor for cardiovascular mortality in patients on maintenance hemodialysis. Poster presented at: ASN Kidney Week 2026; October 24, 2026; Denver, Colorado. Accessed October 30, 2026. Abstract SA-PO1017. https://www.asn-online.org/education/kidneyweek/2026/program-abstract.aspx?controlId=4554801

2. Chen Z, Jiang S, Yu I, et al. Remnant cholesterol inflammatory index and C-reactive protein-triglyceride-glucose index surpass CRP in identifying CKD severity among patients with cardiovascular-kidney-metabolic syndrome. Poster presented at: ASN Kidney Week 2026; October 24, 2026; Denver, Colorado. Accessed October 30, 2026. Abstract SA-PO0430. https://www.asn-online.org/education/kidneyweek/2026/program-abstract.aspx?controlId=4559668

3. Wang K, Wang R, Yang J, et al. Remnant cholesterol and atherosclerotic cardiovascular disease: metabolism, mechanism, evidence, and treatment. Front Cardiovasc Med. 2022;9:913869. doi:10.3389/fcvm.2022.913869