Hypertriglyceridemia is associated with decline of estimated Glomerular filtration rate and risk of end-stage kidney disease in a real-word Italian cohort: Evidence from the TG-RENAL Study

Background: This analysis investigated the role of hypertriglyceridemia on renal function decline and development
of end-stage kidney disease (ESKD) in a real-world clinical setting.
Methods: A retrospective analysis using administrative databases of 3 Italian Local Health Units was performed
searching patients with at least one plasma triglyceride (TG) measurement between 2013 and June 2020,
followed-up until June 2021. Outcome measures included reduction in estimated glomerular filtration rate
(eGFR) ≥30% from baseline and ESKD onset. Subjects with normal (normal-TG), high (HTG) and very high TG
levels (vHTG) (respectively <150 mg/dL, 150–500 mg/dL and >500 mg/dL) were comparatively evaluated.
Results: Overall 45,000 subjects (39,935 normal-TGs, 5,029 HTG and 36 vHTG) with baseline eGFR of 96.0 ±
66.4 mL/min were considered. The incidence of eGFR reduction was 27.1 and 31.1 and 35.1 per 1000 personyears,
in normal-TG, HTG and vHTG subjects, respectively (P<0.01). The incidence of ESKD was 0.7 and 0.9 per
1000 person-years, in normal-TG and HTG/vHTG subjects, respectively (P<0.01). Univariate and multivariate
analyses revealed that HTG subjects had a risk of eGFR reduction or ESKD occurrence (composite endpoint)
increased by 48% compared to normal-TG subjects (adjusted OR:1.485, 95%CI 1.300–1.696; P<0.001). Moreover,
each 50 mg/dL increase in TG levels resulted in significantly greater risk of eGFR reduction (OR:1.062, 95%
CI 1.039–1.086 P<0.001) and ESKD (OR:1.174, 95%CI 1.070–1.289, P = 0.001).
Conclusions: This real-word analysis in a large cohort of individuals with low-to-moderate cardiovascular risk
suggests that moderate-to-severe elevation of plasma TG levels is associated with a significantly increased risk of
long-term kidney function deterioration.