The ratio of LDL-C to HDL-C can effectively predict the prognosis of IgA nephropathy.

BACKGROUND

Abnormal lipid metabolism affects IgA nephropathy (IgAN) prognosis, but the prognostic value of LDL-C/HDL-C ratio in IgAN remains unclear.

METHODS

A bicenter retrospective cohort study enrolled 1,405 IgAN patients with a median follow-up of 50.1 months. Patients were divided into four quartiles based on LDL-C/HDL-C ratio (Q1: lowest quartile, Q4: highest quartile). Kaplan-Meier, Cox regression, and restricted cubic spline (RCS) analyses were used to explore the association between LDL-C/HDL-C ratio and end-stage renal disease (ESRD) risk.

RESULTS

ESRD occurred in 110 patients (8.45%). The ESRD-free survival rate decreased significantly with increasing LDL-C/HDL-C quartiles (log-rank p < 0.001). Multivariate Cox regression analysis demonstrated that, compared with the first quartile (Q1, reference), the hazard ratios for Q2, Q3, and Q4 were 2.542 (95% CI: 0.679-9.523, p = 0.166), 2.499 (95% CI: 0.707-8.830, p = 0.155), and 6.384 (95% CI: 1.840-22.154, p = 0.003), respectively. Each 1-unit increase in the LDL-C/HDL-C ratio was independently associated with a 45.2% elevated risk (HR = 1.452, 95% CI: 1.159-1.818, p = 0.001). Restricted cubic splines (RCS) analysis confirmed a linear dose-response relationship (overall p = 0.0196, nonlinear p = 0.2199). Subgroup analysis revealed that the association was amplified in patients with elevated serum creatinine (sCr), hypertension, hyperuricemia, M1, and T2 (all p < 0.05). However, the LDL-C/HDL-C ratio exhibited no correlation with renal IgA deposition intensity (r = 0.013, p = 0.624).

CONCLUSION

Elevated LDL-C/HDL-C ratio constitutes an independent risk factor for end-stage renal disease (ESRD) in patients with IgA nephropathy (IgAN), demonstrating a linear dose-response relationship and serving as a reliable prognostic biomarker independent of IgA deposition.