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. 2024 Jan 24:15:1322646.
doi: 10.3389/fendo.2024.1322646. eCollection 2024.

Defining the threshold: triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio's non-linear impact on tubular atrophy in primary membranous nephropathy

Mijie Guan  1   2 , Liling Wu  1   2 , Yuan Cheng  1   2 , Dongli Qi  1   2 , Jia Chen  1   2 , Haiying Song  1   2 , Haofei Hu  1   2 , Qijun Wan  1   2
Affiliations

Defining the threshold: triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio's non-linear impact on tubular atrophy in primary membranous nephropathy

Mijie Guan et al. Front Endocrinol (Lausanne). .

Abstract

Background: Hyperlipidemia is common in primary membranous nephropathy (PMN) patients, and tubular atrophy (TA) is an unfavorable prognostic factor. However, the correlation between the triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio and TA is controversial. Therefore, our study aimed to investigate the association between the TG/HDL-C ratio and TA in PMN patients.

Methods: We conducted a cross-sectional study and collected data from 363 PMN patients at Shenzhen Second People's Hospital from January 2008 to April 2023. The primary objective was to evaluate the independent correlation between the TG/HDL-C ratio and TA using binary logistic regression model. We used a generalized additive model along with smooth curve fitting and multiple sensitivity analyses to explore the relationship between these variables. Additionally, subgroup analyses were conducted to delve deeper into the results.

Results: Of the 363 PMN patients, 75 had TA (20.66%). The study population had a mean age of 46.598 ± 14.462 years, with 217 (59.78%) being male. After adjusting for sex, age, BMI, hypertension, history of diabetes, smoking, alcohol consumption, UPRO, eGFR, HB, FPG, and ALB, we found that the TG/HDL-C ratio was an independent risk factor for TA in PMN patients (OR=1.29, 95% CI: 1.04, 1.61, P=0.0213). A non-linear correlation was observed between the TG/HDL-C ratio and TA, with an inflection point at 4.25. The odds ratios (OR) on the left and right sides of this inflection point were 1.56 (95% CI: 1.17, 2.07) and 0.25 (95% CI: 0.04, 1.54), respectively. Sensitivity analysis confirmed these results. Subgroup analysis showed a consistent association between the TG/HDL-C ratio and TA, implying that factors such as gender, BMI, age, UPRO, ALB, hypertension and severe nephrotic syndrome had negligible effects on the link between the TG/HDL-C ratio and TA.

Conclusion: Our study demonstrates a non-linear positive correlation between the TG/HDL-C ratio and the risk of TA in PMN patients, independent of other factors. Specifically, the association is more pronounced when the ratio falls below 4.25. Based on our findings, it would be advisable to decrease the TG/HDL-C ratio below the inflection point in PMN patients as part of treatment strategies.

Keywords: cross-sectional study; non-linear; primary membranous nephropathy; triglyceride to high-density lipoprotein cholesterol ratio; tubular atrophy.

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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
Flowchart of study participants. Figure 1 showed the inclusion of participants. 445 participants were assessed for eligibility in the original study. We excluded patients with missing values of lupus nephritis (n=15), hepatitis B-associated nephritis (n=13), atypical membranous nephropathy (n=17), membranoproliferative nephritis (n=1), combined tumor (n=3), combined tumor (n=1), lack of TA on renal biopsy (n=1), missed HDL and TG (n=15), unreasonable abnormal values of TG/HDL-C (n=13), ESRD at the time of renal biopsy (n=2). The final analysis included 363subjects in the present study.
Figure 2
Figure 2
The non-linear relationship between TG/HDL-c ratio and the risk of TA.
Figure 3
Figure 3
The non-linear relationship between TG/HDL-c ratio and the risk of TA in participants with normal kidney function.
See this image and copyright information in PMC

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