A high triglyceride to high-density lipoprotein cholesterol ratio is associated with poor renal outcome in IgA nephropathy patients

Background: Dyslipidemia is common in patients with chronic kidney disease. However, whether markers of atherogenic dyslipidaemia correlate with outcomes in IgA nephropathy (IgAN) patients as in the general population is uncertain. The aim of this study was to explore the prognostic value of the serum triglyceride/high-density lipoprotein cholesterol (TG/HDL-C) ratio to predict ESRD in IgAN patients. Methods: A total of 1149 patients from West China Hospital of Sichuan University were retrospectively analysed between 2008 and 2018, with a median follow-up of 54.0 months. The demographic, clinical and pathological data of all patients at the time of biopsy were collected. Receiver operating curve (ROC) was used to determine the optimal threshold for the TG/HDL ratio at baseline to predict ESRD during follow-up. Prognostic values were assessed by univariate and multivariate Cox regression analyses and Kaplan–Meier curves. Results: The optimal cut-off value for the TG/HDL-C ratio was 1.495. The correlation analysis showed that the TG/HDL-C ratio was negatively correlated with the eGFR (r = 0.248, P < 0.001) but positively correlated with proteinuria (r = 0.229, P < 0.001) and serum uric (r =0.306, P < 0.001). Patients with a higher TG/HDL-C ratio tended to have hypertension [odds ratio (OR), 1.702; 95% CI, 1.298-2.233; P <0.001] and more severe pathologic lesions with tubular atrophy/interstitial fibrosis (OR, 3.593; 95% CI, 2.528-5.107; P <0.001). A high TG/HDL ratio was strongly correlated with worse renal survival in IgAN patients (log-rank: P <0.001). Multivariate Cox analysis demonstrated that an elevated TG/HDL-C ratio (HR 2.118, 95% CI 1.333-3.367, P =0.002) was an independent risk marker to predict ESRD. Conclusion: The TG/HDL-C ratio may serve as potential prognostic biomarkers in IgAN patients.