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 nHDL(ox) (normalized high-density lipoprotein with reduced antioxidant function) in hospitalized patients with AKI. METHODS: nHDL(ox) was measured within 48 hours of AKI diagnosis. We assessed its performance in predicting the following primary endpoints: in-hospital all-cause mortality, need for kidney replacement therapy (KRT), and restoration of kidney function before discharge. Secondary endpoints included clinical markers of severe disease course: 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 restoration of kidney function. For all primary endpoints, nHDL(ox) 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 renal recovery (1.71 vs. 1.23; +39.0%; p = 0.001). nHDL(ox) was independently associated with death, KRT, and lack of renal 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. nHDL(ox), therefore, represents a significant risk factor in both cardiovascular and kidney disease.