The relationship between the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio and tubular atrophy/interstitial fibrosis in patients with IgA nephropathy.
Elevated NHHR is associated with an increased risk of tubular atrophy/interstitial fibrosis in patients with IgA nephropathy, but the clinical implications of this finding need further investigation.
Where it sits
this study against the rest of the erythropoietin (epo) corpusSummary and findings
This study examined the relationship between the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and tubular atrophy/interstitial fibrosis (T) lesions in 400 patients with biopsy-proven IgA nephropathy (IgAN). The highest NHHR quartile showed significantly adverse clinical profiles and a higher prevalence of T1/T2 lesions. NHHR was positively correlated with T lesions.
Abstract
Background: The tubular atrophy/interstitial fibrosis (T) lesions of the Oxford Classification is a key prognostic determinant in IgA nephropathy (IgAN). The non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) is an emerging lipid marker, but its link with renal histologic damage in IgAN is unknown.Methods: This cross-sectional and retrospective study investigated the relationship between NHHR and T lesions in 400 biopsy-proven IgAN patients. Participants were divided into NHHR quartiles. The association between NHHR and T lesions was assessed using Spearman's rank correlation analysis, binary logistic regression analysis, restricted cubic spline (RCS) analysis, receiver operating characteristic (ROC) curve analysis, and subgroup analysis.Results: Compared to the lowest quartile (Q1), the highest NHHR quartile (Q4) showed significantly adverse clinical profiles and a higher prevalence of T1/T2 lesions (p < 0.05). NHHR was positively correlated with T lesions (r = 0.229, p < 0.001). Multivariate logistic regression analysis identified elevated NHHR and reduced estimated glomerular filtration rate (eGFR) as independent risk factors for T1/T2 lesions. RCS analysis demonstrated a linear association between NHHR and the risk of T1/T2 lesions (p for nonlinearity = 0.343). The ROC curve analysis yielded an area under the curve (AUC) of 0.635 for NHHR alone (optimal cutoff value = 3.54, sensitivity = 58.2%, specificity = 63.6%), and the composite NHHR+eGFR model achieved an AUC of 0.814. Subgroup analysis showed a consistent association between NHHR and the risk of T1/T2 lesions across all subgroups, with no significant interaction effects.Conclusion: Elevated NHHR is an independent risk factor for the progression of T lesions in patients with IgAN.
Background
This paper addresses the relationship between NHHR and renal histologic damage in IgA nephropathy (IgAN), a condition where tubular atrophy and interstitial fibrosis are key prognostic determinants. Prior studies have not established a link between NHHR and T lesions in IgAN, making this investigation relevant for understanding potential risk factors for disease progression. The findings could have implications for risk stratification in patients with IgAN.
Methods
This cross-sectional and retrospective study included 400 biopsy-proven IgAN patients. Participants were divided into NHHR quartiles, and the relationship between NHHR and T lesions was assessed using various statistical analyses including Spearman's rank correlation, binary logistic regression, and ROC curve analysis.
Results
The primary finding indicated that NHHR was positively correlated with T lesions (r = 0.229, p < 0.001). The highest NHHR quartile (Q4) showed significantly adverse clinical profiles and a higher prevalence of T1/T2 lesions compared to the lowest quartile (Q1) (p < 0.05). The ROC curve analysis yielded an AUC of 0.635 for NHHR alone, with an optimal cutoff value of 3.54, sensitivity of 58.2%, and specificity of 63.6%.
Interpretation
The study finds a statistically significant correlation between NHHR and T lesions, but the clinical significance of the effect size remains uncertain. While the AUC of 0.814 for the composite model suggests a better predictive capability, the findings are limited by the cross-sectional design and potential confounding factors. This implies that while NHHR may be a marker of risk, its practical utility in clinical settings requires further validation.
Key findings
- NHHR was positively correlated with T lesions (r = 0.229, p < 0.001).
- Compared to the lowest quartile (Q1), the highest NHHR quartile (Q4) showed significantly adverse clinical profiles and a higher prevalence of T1/T2 lesions (p < 0.05).
- The ROC curve analysis yielded an area under the curve (AUC) of 0.635 for NHHR alone (optimal cutoff value = 3.54, sensitivity = 58.2%, specificity = 63.6%).
- The composite NHHR+eGFR model achieved an AUC of 0.814.
- Multivariate logistic regression identified elevated NHHR and reduced estimated glomerular filtration rate (eGFR) as independent risk factors for T1/T2 lesions.
Limitations
- cross-sectional and retrospective design limits causal inferences
- single biopsy assessment may not capture disease progression accurately
- small sample size may limit generalizability