Work

Dysfunctional high-density lipoprotein predicts survival, renal recovery and the need for kidney replacement therapy in acute kidney injury

Year: 2026

Type: article

Abstract: Introduction: There is growing evidence that oxidative stress contributes not only to the pathophysiology of atherosclerosis but also to acute kidney injury (AKI). This study investigated the prognostic value of nHDLox (normalized high-density lipoprotein with reduced antioxidant function) in hospitalized patients with AKI.Methods: nHDLox was measured within 48 hours of AKI diagnosis. We assessed its performance in predicting thefollowing primary endpoints: in-hospital all-cause mortality, need for kidney replacement therapy (KRT), andrestoration of kidney function before discharge. Secondary endpoints included clinical markers of severe diseasecourse: intensive care treatment, ventilatory support, and vasopressor requirement.Results: Among 132 participants, 16.7% died in the hospital, 36.4% required KRT, and 31.1% had no restorationof kidney function. For all primary endpoints, nHDLox levels were significantly higher in non-survivors (2.00 vs.1.26; +58.7%; p = 0.009), in patients requiring KRT (1.66 vs. 1.23; +34.9%; p = 0.002), and in those without renalrecovery (1.71 vs. 1.23; +39.0%; p = 0.001). nHDLox was independently associated with death, KRT, and lack ofrenal recovery, with odds ratios for a twofold increase (95% CI) of 1.88 (1.19-2.98), 1.78 (1.17-2.69), and 2.09(1.34-3.26), respectively. Predictive performance was moderate, with AUC-ROC values (95% CI) of 0.68 (0.54-0.81),0.66 (0.56-0.76), and 0.67 (0.57-0.78). No differences were observed across secondary endpoints.Conclusions: Impaired antioxidant HDL function is closely associated with clinically relevant AKI outcomes.nHDLox, therefore, represents a significant risk factor in both cardiovascular and kidney disease.

Source: Journal of Circulating Biomarkers

DOI: 10.33393/jcb.2026.3584