Kosugi Takaaki, Eriguchi Masahiro, Yoshida Hisako, Tamaki Hiroyuki, Uemura Takayuki, Tasaki Hikari, Furuyama Riri, Fukata Fumihiro, Nishimoto Masatoshi, Matsui Masaru, Samejima Ken-Ichi, Iseki Kunitoshi, Fujimoto Shouichi, Konta Tsuneo, Moriyama Toshiki, Yamagata Kunihiro, Narita Ichiei, Kasahara Masato, Shibagaki Yugo, Kondo Masahide, Asahi Koichi, Watanabe Tsuyoshi, Tsuruya Kazuhiko
Department of Nephrology, Nara Medical University.
Department of Medical Statistics, Osaka Metropolitan University Graduate School of Medicine.
J Atheroscler Thromb. 2025 Apr 1;32(4):407-420. doi: 10.5551/jat.65107. Epub 2024 Sep 21.
Both low and high serum levels of high-density lipoprotein cholesterol (HDL-C) were reported to be associated with adverse kidney outcomes. However, this association has not been well investigated in the general Japanese population.
This nationwide longitudinal study used data from the Japan Specific Health Checkups Study conducted between 2008-2014. The association between serum HDL-C levels and 40% decline in estimated glomerular filtration rate (eGFR) was analyzed using Cox regression analysis. Trajectories of eGFR were compared using mixed-effects model.
Among 768,495 participants, 6,249 developed 40% decline in eGFR during the median follow-up period of 34.6 (interquartile range: 14.8-48.4) months. Using serum HDL-C levels of 40-59 mg/dL as a reference, the adjusted hazard ratios (95% confidence intervals) for the kidney outcome of serum HDL-C levels of ＜40, 60-79 and ≥ 80 mg/dL were 1.26 (1.14-1.39), 0.91 (0.86-0.96), and 0.86 (0.78-0.93), respectively. Restricted cubic spline analysis showed that HDL-C levels of less than approximately 60 mg/dL were associated with an increased risk of kidney outcomes. Subgroup analysis showed that baseline eGFR and proteinuria modified the effects of serum HDL-C levels on kidney outcomes. The mixed-effects model showed that the lower category of HDL-C level was associated with a higher eGFR decline rate (p for interaction ＜0.001).
Low HDL-C levels were associated with kidney function decline; however, high HDL-C levels were not associated with adverse kidney outcomes in the general Japanese population.
据报道，血清高密度脂蛋白胆固醇（HDL-C）水平过低或过高均与不良肾脏结局相关。然而，在日本普通人群中，这种关联尚未得到充分研究。
这项全国性纵向研究使用了2008年至2014年期间开展的日本特定健康检查研究的数据。采用Cox回归分析血清HDL-C水平与估计肾小球滤过率（eGFR）下降40%之间的关联。使用混合效应模型比较eGFR的轨迹。
在768495名参与者中，6249人在34.6（四分位间距：14.8 - 48.4）个月的中位随访期内eGFR下降了40%。以血清HDL-C水平40 - 59 mg/dL为参照，血清HDL-C水平＜40、60 - 79和≥80 mg/dL的肾脏结局校正风险比（95%置信区间）分别为1.26（1.14 - 1.39）、0.91（0.86 - 0.96）和0.86（0.78 - 0.93）。受限立方样条分析显示，HDL-C水平低于约60 mg/dL与肾脏结局风险增加相关。亚组分析显示，基线eGFR和蛋白尿改变了血清HDL-C水平对肾脏结局的影响。混合效应模型显示，HDL-C水平较低类别与较高的eGFR下降率相关（交互作用p＜0.001）。
低HDL-C水平与肾功能下降相关；然而，在日本普通人群中，高HDL-C水平与不良肾脏结局无关。
