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Despite extensive knowledge about abnormal lipid patterns in patients with end-stage renal disease, the association between cholesterol and the development of renal dysfunction is unclear. We evaluated this association in a prospective cohort study among 4,483 initially healthy men participating in the Physicians’ Health Study who provided blood samples in 1982 and 1996. Main outcome measures were elevated creatinine, defined as≥ 1.5 mg/dl (133 μmol/L), and reduced estimated creatinine clearance, defined as≤ 55 ml/min. Cholesterol parameters included total cholesterol (< 200, 200 to 239, and≥ 240 mg/dl), HDL (< 40 or≥ 40 mg/dl), total non-HDL cholesterol, and the ratio of total cholesterol to HDL. We used logistic regression to calculate age-and multivariable adjusted odds ratios as a measure for the relative risk. After 14 yr, 134 men (3.0%) had elevated creatinine and 244 (5.4%) had reduced …