Lp(a) of 30 mg/dL or more predicts CKD progression and cardiovascular death, nationwide Chinese cohort study (J Clin Lipidol 2026)

Background: The role of lipoprotein(a) [Lp(a)] in chronic kidney disease (CKD) remains incompletely defined.

Objective: This study aimed to investigate the association of Lp(a) with renal and cardiac outcomes in CKD.

Methods: Patients with CKD were identified from the China Renal Data System, a joint initiative of the National Clinical Research Center for Kidney Disease and the China Center for Disease Control and Prevention. The primary outcome was a composite of CKD progression (kidney failure, >40% estimated glomerular filtration rate [eGFR] decline, or kidney replacement therapy). The secondary outcome was cardiovascular (CV) mortality.

Results: Among 27,037 and 52,895 participants assessed for renal and cardiac outcomes, 4608 (12.4%) and 4768 (9.0%) experienced the renal and cardiac outcome, respectively, over a median follow-up of 24 and 47 months. Positive and linear relationships were observed between log-Lp(a) and CKD progression and between Lp(a) and CV mortality. Lp(a) ≥30 mg/dL was associated with an elevated risk of CKD progression (adjusted hazard ratio [aHR], 1.13, 95%CI, 1.06, 1.21) and CV mortality (aHR, 1.14, 95%CI, 1.08, 1.22); these associations persisted after adjusting for time-varying covariates and were evident in individuals with low LDL-C levels. High Lp(a) levels were associated with both increased risk of end-stage kidney disease and faster decline in eGFR. Incorporating Lp(a) into the established prediction models enhances predictive performance and risk stratification capability for renal and cardiac outcomes.

Conclusion: Elevated Lp(a) may potentially serve as a target for kidney and CV protection. It is recommended that future interventional studies be conducted in this high-risk population.