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SummaryBackground and objectives Altered levels of atherogenic lipoproteins have been shown to be common in mild kidney dysfunction. This study sought to determine the associations between plasma lipids (including LDL particle distribution) and subclinical atherosclerosis measured by the common carotid intima-media thickness (IMT) across levels of estimated GFR (eGFR) and to assess whether inflammation modifies these associations. Results CKD, defined as eGFR ,60 ml/min per 1.73 m 2 , was present in 853 individuals (13.0%). Associations of total cholesterol and LDL cholesterol (LDL-C) with IMT were J shaped, particularly among participants with CKD (P value for interaction, P=0.01). HDL cholesterol (HDL-C) and small-dense LDL-C were consistently and linearly associated with IMT across levels of eGFR. The results showed differences in IMT of 221.41 (95% confidence interval, 241.00, 21.57) in eGFR $60 and 258.49 (2126.61, 9.63) in eGFR ,60 per unit difference in log-transformed HDL-C, and 4.83 (3.16, 6.50) in eGFR $60 and 7.48 (1.45, 13.50) in eGFR ,60 per 100 nmol/L difference in small-dense LDL. Among participants with CKD, inflammation significantly modified the associations of total cholesterol and LDL-C with IMT (P values for interaction, P,0.01 and P,0.001, respectively).Conclusions Compared with total cholesterol and LDL-C, abnormalities in HDL-C and small-dense LDL-C are more strongly and consistently associated with subclinical atherosclerosis in CKD. Inflammation modifies the association between total cholesterol and LDL-C with IMT.

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