Higher sdLDL-C Linked to Lower Kidney Stone Risk in Two Cohorts

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Frontiers in Medicine Published April 29, 2026 Medically reviewed April 29, 2026 DOI ↗ By Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

Key Takeaway

Interpret these inverse associations cautiously; cross-sectional data cannot establish causality between sdLDL-C and kidney stone risk.

This cross-sectional study investigated the association between serum small dense LDL cholesterol (sdLDL-C) levels and kidney stone prevalence in two independent cohorts: a Chinese hospital-based cohort (757 adults, 229 stone cases and 528 controls) and the NHANES cohort (9,721 adults). In the Chinese cohort, higher sdLDL-C concentrations were independently associated with lower kidney stone risk (OR = 0.53, 95% CI: 0.38–0.74). In the NHANES cohort, a negative and linear association was observed (OR = 0.68, 95% CI: 0.50–0.91).

No safety or tolerability data were reported, as this was an observational study without interventions. The study did not report funding sources or conflicts of interest.

Key limitations include the cross-sectional design, which precludes determination of causality. The authors note that prospective studies are required to confirm these findings. Additionally, the study populations may not be generalizable to other ethnic groups or settings.

Clinically, these results suggest an unexpected inverse relationship between sdLDL-C and kidney stones, but given the observational nature, clinicians should not alter lipid management based on this data. Further prospective research is needed before any practice changes can be considered.

Study Details

Study typeCohort

EvidenceLevel 3

PublishedApr 2026

View Original Abstract ↓

This study investigated the association between serum small dense low-density lipoprotein cholesterol (sdLDL-C) levels and kidney stone formation in adults using two independent datasets. A hospital-based cross-sectional cohort included 757 participants (229 stone cases and 528 controls) from March 2022 to September 2025, with clinical data on blood biochemical markers and histories of hypertension and diabetes collected for analysis. Between-group comparisons were conducted using chi-square or Kruskal–Wallis tests, and the association between sdLDL-C and kidney stones was examined through multivariable logistic regression, subgroup analyzes. To evaluate the robustness and generalizability of the findings, data from 9,721 adults in the 2007–2016 National Health and Nutrition Examination Survey (NHANES) were also analyzed. In the Chinese cohort, higher sdLDL-C concentrations were independently associated with a lower risk of kidney stones (OR = 0.53, 95% CI: 0.38–0.74), with a non-linear inverse dose–response pattern. The NHANES cohort showed similar results, revealing a negative and linear association between sdLDL-C and stone risk (OR = 0.68, 95% CI: 0.50–0.91). Subgroup analyzes indicated that the protective association was most evident among individuals over 40 years and in both sexes in the Chinese cohort, whereas in NHANES it was more pronounced among participants aged 20–39 or 60–85 years and among females. These findings suggest that sdLDL-C is inversely associated with kidney stone risk across populations; however, prospective studies are required to determine causality.