Association of High-Density Lipoprotein Cholesterol With GFR Decline in a General Nondiabetic Population

Melsom, Toralf; Norvik, Jon Viljar; Enoksen, Inger Therese; Stefansson, Vidar Tor Nyborg; Rismo, Renathe; Jenssen, Trond; Solbu, Marit Dahl; Eriksen, Bjørn Odvar

doi:10.1016/j.ekir.2021.05.007

Cited by 8 publications

(6 citation statements)

References 52 publications

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“…In addition, we also indicated associations between eGFR (negative association) and the CKD273 classifier (positive association) with HDL-C. Similar findings were reported in middle-aged (58 ± 3.8 years) nondiabetic individuals with pre-existing CKD, in which elevated HDL-C levels were associated with an accelerated decline in eGFR [43]. These results are further supported by studies in the general population [44] and in individuals with nondialysis CKD [45], that indicate a U-shaped relationship between HDL-C and the progression of kidney disease.…”

Section: Discussionsupporting

confidence: 87%

Cardiovascular risk and kidney function profiling using conventional and novel biomarkers in young adults: the African-PREDICT study

et al. 2023

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Background Low- and middle-income countries experience an increasing burden of chronic kidney disease. Cardiovascular risk factors, including advancing age, may contribute to this phenomenon. We (i) profiled cardiovascular risk factors and different biomarkers of subclinical kidney function and (ii) investigated the relationship between these variables. Methods We cross-sectionally analysed 956 apparently healthy adults between 20 and 30 years of age. Cardiovascular risk factors such as high adiposity, blood pressure, glucose levels, adverse lipid profiles and lifestyle factors were measured. Various biomarkers were used to assess subclinical kidney function, including estimated glomerular filtration rate (eGFR), urinary albumin, uromodulin and the CKD273 urinary proteomics classifier. These biomarkers were used to divide the total population into quartiles to compare extremes (25th percentiles) on the normal kidney function continuum. The lower 25th percentiles of eGFR and uromodulin and the upper 25th percentiles of urinary albumin and the CKD273 classifier represented the more unfavourable kidney function groups. Results In the lower 25th percentiles of eGFR and uromodulin and the upper 25th percentile of the CKD273 classifier, more adverse cardiovascular profiles were observed. In multi-variable adjusted regression analyses performed in the total group, eGFR associated negatively with HDL-C (β= -0.44; p < 0.001) and GGT (β= -0.24; p < 0.001), while the CKD273 classifier associated positively with age and these same risk factors (age: β = 0.10; p = 0.021, HDL-C: β = 0.23; p < 0.001, GGT: β = 0.14; p = 0.002). Conclusion Age, lifestyle and health measures impact kidney health even in the third decade.

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Section: Discussionsupporting

confidence: 87%

Cardiovascular risk and kidney function profiling using conventional and novel biomarkers in young adults: the African-PREDICT study

et al. 2023

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“…The unique sample weighting procedures outlined in the NHANES survey methods and analytic guidelines allowed us to extrapolate our findings to the greater US population, increasing generalizability and power in our study. While our results are similar to recent findings by Melsom et al [19], our study included both metabolically healthy and unhealthy individuals from a racially and ethnically diverse sample. Our study was limited by the cross-sectional nature of the data, which reduces our understanding of HDL-c's role in the progression of CKD.…”

Section: Strengths and Limitationssupporting

confidence: 90%

“…The relationship was attenuated when considering the middle 50% of HDL-c values for the total and healthy samples yet persisted in the MetS sample. Prior research findings linking HDL-c and eGFR have produced mixed results, with studies reporting a broad range of associations including a positive relationship between HDL-c and eGFR [11][12][13][14], a U-shaped, or biphasic, relationship between HDL-c and eGFR [16], and a negative relationship, similar to the findings of the present study [18,19]. While most research in this area has been conducted in populations free of metabolic disease, our study demonstrates a negative relationship between HDL-c and eGFR in the overall sample, as well as in the metabolically healthy and unhealthy subsamples.…”

Section: Discussionsupporting

confidence: 69%

“…However, contradictory results have also been published which demonstrate U-shaped associations between HDL-c and eGFR [16] as well as HDL-c and all-cause mortality in those with and without CKD [17]. Other authors have demonstrated an inverse, or negative, relationship between HDL-c and eGFR, indicating that lower levels of HDL-c were associated with higher levels of eGFR [18,19]. Several hypotheses have been established to explain these conflicting findings, including a rare impairment of scavenger receptor BI [20], the ratio of HDL-c subtypes [21], and the age and quality of the HDL-c molecules themselves [22][23][24], but none have definitively identified the reason for these mixed findings.…”

Section: Introductionmentioning

confidence: 99%

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Association of High-Density Lipoprotein Cholesterol, Renal Function, and Metabolic Syndrome: An Assessment of the 2013–2018 National Health and Nutrition Examination Surveys

Adair

Richardson

Bowden

2022

Kidney and Dialysis

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Previous findings assessing the relationship between high-density lipoprotein cholesterol (HDL-c) and kidney function have demonstrated contradictory results including positive, negative, and U-shaped relationships. Many prior studies in this area have been conducted in healthy populations, but few have considered the influence of metabolic health status. In the present study, a cross-sectional analysis was conducted using complex survey sample weighting in the assessment of 6455 subjects from the 2013–2018 National Health and Nutrition Examination Surveys (NHANES), representative of 94,993,502 United States citizens. Subjects were classified as metabolically healthy or unhealthy and linear regression analyses were performed to evaluate the influence of HDL-c on estimated glomerular filtration rate (eGFR). HDL-c was found to be negatively associated with eGFR in the metabolically healthy, unhealthy, and combined groups (B = −0.16, p < 0.0001, B = −0.21, p < 0.0001, and B = −0.05, p = 0.0211, respectively). This relationship persisted after adjustment for confounding variables (B = −0.24, p < 0.0001, B = −0.17, p < 0.001, and B = −0.18, p < 0.0001, respectively). The relationship between HDL-c and eGFR was found to be a negative linear association, rather than a U-shaped association, and it persisted in all models tested, despite statistical adjustment for confounding variables. After controlling the samples for outliers, the negative relationship between HDL-c and eGFR was attenuated in the healthy and total groups but remained significant in the MetS group, indicating a stronger relationship between HDL-c and eGFR in those with poorer health.

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“…In the general middle-aged nondiabetic population, higher HDL-C levels (> 1.6 mmol/L) were independently associated with rapid loss of eGFR. Elevated HDL-C levels are associated with an increased risk of sharp declines in GFR and rapid declines in GFR [ 30 ]. In contrast to high HDL-C, a low serum HDL-C level (0.99 ± 0.14 mmol/L) was significantly associated with a greater than 30% decrease in eGFR or ESRD (HR 4.80, P < 0.01).…”

Section: Discussionmentioning

confidence: 99%

Effect of high density lipoprotein cholesterol (HDL-C) on renal outcome in patients with nephrotic syndrome complicated with steroid-induced diabetes mellitus(SIDM)

Ding

Liu

et al. 2023

BMC Nephrol

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Objective We aimed to investigate the renal prognosis of patients with idiopathic nephrotic syndrome (INS) complicated with steroid-induced diabetes mellitus (SIDM), the association of high-density lipoprotein cholesterol (HDL-C) before glucocorticoid treatment with renal prognosis, and the risk for persistent diabetes among patients with INS who had withdrawn from steroid therapy. Materials and methods We retrospectively analyzed 239 patients with INS complicated with SIDM at the National Clinical Research Center of Kidney Diseases, Jinling Hospital, from January 2008 to December 2019. The primary endpoint was the composite renal outcome defined as the development of end-stage renal disease (ESRD) or a 50% decrease in estimated glomerular filtration rate (eGFR) for more than 24 months after glucocorticoid withdrawal. The secondary endpoint was persistent diabetes, defined as fulfilling the criteria for diagnosing diabetes or using antidiabetic medications for at least 24 months after glucocorticoid withdrawal. Results After glucocorticoid withdrawal for over 24 months, 35 (14.6%) patients reached the composite renal endpoint: end-stage renal disease (n = 14) or a 50% decrease in eGFR (n = 21). Before glucocorticoid therapy, a level of HDL-C greater than 1.45 mmol/L worsened renal survival in patients with INS complicated with SIDM. The log10 the level of HDL-C before glucocorticoid treatment was an independent risk factor for the renal outcome. A prediction model was generated: Hazard ratio (renal outcome) = 0.94 * hypertension before glucocorticoid therapy + 2.29 * log10 level of HDL-C before glucocorticoid treatment + 0.90 * the grade of interstitial tubule injury (AUROC, 0.75; 95% CI, 0.63 to 0.87; P < 0.01). Meanwhile, a level of fasting plasma glucose (FPG) before glucocorticoid treatment greater than 5.2 mmol/L enhanced the likelihood of persistent diabetes for at least 24 months after glucocorticoid withdrawal. Conclusions Increased level of HDL-C before glucocorticoid therapy was independently associated with a higher risk for renal outcome and thus may be useful in the renal prognosis of patients with INS complicated with SIDM.

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Association of High-Density Lipoprotein Cholesterol With GFR Decline in a General Nondiabetic Population

Cited by 8 publications

References 52 publications

Cardiovascular risk and kidney function profiling using conventional and novel biomarkers in young adults: the African-PREDICT study

Cardiovascular risk and kidney function profiling using conventional and novel biomarkers in young adults: the African-PREDICT study

Association of High-Density Lipoprotein Cholesterol, Renal Function, and Metabolic Syndrome: An Assessment of the 2013–2018 National Health and Nutrition Examination Surveys

Effect of high density lipoprotein cholesterol (HDL-C) on renal outcome in patients with nephrotic syndrome complicated with steroid-induced diabetes mellitus(SIDM)

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