Abstract
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/1.73m(2) 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.