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. 2023 Feb 10:14:1037773.
doi: 10.3389/fendo.2023.1037773. eCollection 2023.

Prognostic value of low-density lipoprotein cholesterol in IgA nephropathy and establishment of nomogram model

Zhang-Yu Tian  1 , Ai-Mei Li  1 , Ling Chu  2 , Jing Hu  1 , Xian Xie  1 , Hao Zhang  1
Affiliations

Prognostic value of low-density lipoprotein cholesterol in IgA nephropathy and establishment of nomogram model

Zhang-Yu Tian et al. Front Endocrinol (Lausanne). .

Abstract

Background: Dyslipidemia is closely related to kidney disease. We aimed to investigate the relationship between low-density lipoprotein cholesterol (LDL-C) and prognosis of IgA nephropathy (IgAN) and build a nomogram prognostic model.

Methods: 519 IgAN patients with 61 months median follow-up were enrolled and divided into two groups based on the cut-off value of baseline LDL-C (2.60 mmol/L): the high group (n=253) and the low group (n=266). Renal survival was assessed by Kaplan⁃Meier (KM) survival curve. Risk factors were identified by COX regression analysis. The area under the receiver operating characteristic (ROC) curves (AUC), concordance index (C-index), and calibration curves were applied to evaluate the nomogram model.

Results: KM survival curve analysis showed that the high LDL-C group had worse renal survival than the low LDL-C group (χ2 = 8.555, p=0.003). After adjusting for confounding factors, Cox regression analysis showed the baseline LDL-C level was an independent risk factor of end-stage renal disease (ESRD) in IgAN (HR=3.135, 95% CI 1.240~7.926, p =0.016). LDL-C, segmental sclerosis, tubular atrophy/interstitial fibrosis, the prevalence of cardiovascular disease, 24-hour proteinuria were identified and entered into the nomogram models, with AUC of 0.864, 0.827, and 0.792 respectively to predict the 5-, 8-, and 10-year risk of ESRD in IgAN. The C-index of this prediction model was respectively 0.862, 0.838, and 0.800 and was well-calibrated.

Conclusion: Elevated LDL-C level is a predictive factor for the prognosis of IgAN. We developed a nomogram model that can predict the risk of ESRD in IgAN by using LDL-C ≥ 2.60 mmol/L.

Keywords: ESRD; IgA nephropathy; low-density lipoprotein cholesterol; nomogram prognostic model; prognosis.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
The selection process for patients in a flow chart. IgAN, IgA nephropathy; LDL-C, low-density lipoprotein cholesterol.
Figure 2
Figure 2
Survival rate of patients in the high LDL-C group compared to the low LDL-C group with IgAN (Kaplan-Meier survival curve).
Figure 3
Figure 3
Nomogram predicts 5-, 8-, and 10-year risk of ESRD in IgAN. Calculation method: The value of each predictive parameter corresponds upward to the value on the Point axis, and then the “Point” values of all parameters are summed to correspond to the value on the “total point” axis, and downward to the 5-, 8-, and 10-year risk of ESRD in IgAN.
Figure 4
Figure 4
Receiver operating characteristic curve for the prediction model. Receiver operating characteristic curves for the 5-year prediction models. (A) Receiver operating characteristic curves for the 8-year prediction models. (B) Receiver operating characteristic curves for the 10-year prediction models. (C).
Figure 5
Figure 5
Calibration of the nomogram for Risk of ESRD in IgAN. The x-axis shows the predicted probability of risk of ESRD in IgAN, and the y-axis shows the observed probability of risk of ESRD in IgAN. (A) Nomogram of 5-year calibrated risk of ESRD in IgAN. C-index:0.862; (B) Nomogram of 8-year calibrated risk of ESRD in IgAN. C-index:0.838; (C) Nomogram of 10-year calibrated risk of ESRD in IgAN. C-index: 0.800.
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