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Observational Study
. 2025 Apr 10;24(1):135.
doi: 10.1186/s12944-025-02503-y.

Effects of remnant cholesterol on adverse renal outcomes in lupus nephritis

Xiaolei Shi #  1   2 , Xinxin Zhang #  1   2 , Yuewen Lu  1   2 , Wang Xiang  1   2 , Xin Wang  1   2 , Jianwen Yu  1   2 , Hongjian Ye  1   2 , Haishan Wu  1   2 , Ruihan Tang  3   4 , Xi Xia  5   6 , Wei Chen  7   8
Affiliations
Observational Study

Effects of remnant cholesterol on adverse renal outcomes in lupus nephritis

Xiaolei Shi et al. Lipids Health Dis. .

Abstract
in English, German

Background: Remnant cholesterol (RC) causes inflammation and promotes kidney diseases development. However, its role in lupus nephritis (LN) remains unclear. The purpose of this study was to investigate the association between RC and LN.

Methods: This observational study was conducted among patients enrolled between 2000 and 2018 in the High Quality Evidence of Guangzhou Lupus Nephritis Cohort. The study outcomes were defined as adverse renal outcomes, including serum creatinine doubled and end-stage renal disease. Patients were stratified into lower and higher RC groups based on the optimal cutoff RC value (86.88 mg/dL) for adverse renal outcomes. To explore the association between renal outcomes and RC, survival analyses, multivariate Cox regression analyses, and subgroup analyses were conducted.

Results: Overall, 909 individuals were enrolled. Over a median follow-up of 8.33 (interquartile range, 3.08-12.83) years, 134(14.74%) of them reached renal endpoints. Kaplan-Meier survival analyses indicated that patients with higher RC levels were more susceptible to adverse renal outcomes in LN (P < 0.001). After adjusting for confounding factors, higher RC levels exhibited significant correlations with adverse renal outcomes in LN [hazard ratio (HR):1.98, 95% confidence interval (CI):1.16-3.39; P = 0.012]. Subgroup analyses revealed a strong relationship between the higher RC and adverse renal outcomes, particularly in patients aged < 40 years, with an estimated glomerular filtration rate < 60 ml/min/1.73m2 or proliferative pathological changes or nephrotic syndrome (P < 0.05).

Conclusions: Higher RC levels were significantly associated with poor renal outcomes in LN, indicating that RC may become a non-invasive prognostic tool in clinical assessment of LN.

Keywords: End-stage renal disease (ESRD); Lipid profile; Lupus nephritis; Remnant cholesterol (RC); Renal outcomes.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study was performed in line with the principles of the Declaration of Helsinki and approved by the Human Ethics Committee of Sun Yat-sen University (No. 2016 − 215). Informed consent waivers from 2000 to 2016 were approved due to the retrospective nature of the study. Patients enrolled between 2017 and 2020 all signed written informed consent. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Correlation between baseline lipid fractions and disease characteristics in LN Abbreviations: HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; RC, remnant cholesterol; UA, urine acid; eGFR, estimated glomerular filtration rate; ESR, erythrocyte sedimentation rate; IgG, immunoglobulin G; SLEDAI, systemic lupus erythematosus disease activity index
Fig. 2
Fig. 2
Kaplan-Meier survival curves for adverse renal outcomes in the RC groups of LN patients
Fig. 3
Fig. 3
Results of adjusted three-knot RCS models. Adjusted three-knot RCS models for the association between RC and adverse renal outcomes (A) in subgroups of gender (B), age (C), and eGFR (D)
Fig. 4
Fig. 4
Subgroup analyses for the association between RC and renal outcomes of LN
See this image and copyright information in PMC

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