Association Between Renal Dysfunction and Low HDL Cholesterol Among the Elderly in China

An enhanced machine learning approach for effective prediction of IgA nephropathy patients with severe proteinuria based on clinical data

IgA Nephropathy (IgAN) is a disease of the glomeruli that may eventually lead to chronic kidney disease or kidney failure. The signs and symptoms of IgAN nephropathy are usually not specific enough and are similar to those of other glomerular or inflammatory diseases. This makes a correct diagnosis more difficult. This study collected data from a sample of adult patients diagnosed with primary IgAN at the First Affiliated Hospital of Wenzhou Medical University, with proteinuria ≥1 g/d at the time of diagnosis. Based on these samples, we propose a machine learning framework based on weIghted meaN oF vectOrs (INFO). An enhanced COINFO algorithm is proposed by merging INFO, Cauchy Mutation (CM) and Oppositional-based Learning (OBL) strategies. At the same time, COINFO and Support Vector Machine (SVM) were integrated to construct the BCOINFO-SVM framework for IgAN diagnosis and prediction. Initially, the proposed enhanced COINFO is evaluated using the IEEE CEC2017 benchmark problems, with the outcomes demonstrating its efficient optimization capability and accuracy in convergence. Furthermore, the feature selection capability of the proposed method is verified on the public medical datasets. Finally, the auxiliary diagnostic experiment was carried out through IgAN real sample data. The results demonstrate that the proposed BCOINFO-SVM can screen out essential features such as High-Density Lipoprotein (HDL), Uric Acid (UA), Cardiovascular Disease (CVD), Hypertension and Diabetes. Simultaneously, the BCOINFO-SVM model achieves an accuracy of 98.56%, with sensitivity at 96.08% and specificity at 97.73%, making it a potential auxiliary diagnostic model for IgAN.

Correlates of normal and decreased HDL cholesterol levels in type 2 diabetes: a cohort-based cross-sectional study

BACKGROUND

The literature describes an inverse association between the values of triglyceride (TG) and high-density lipoprotein cholesterol (HDL-C). This survey was designed to exhibit the features of people with type 2 diabetes (T2D) who display this inverse association and identify potential contributing factors to having normal HDL-C values.

METHODS

A total of 6127 persons with T2D were assigned to the present survey. Demographic features and clinical status data were compared between subjects with a substantial inverse association of TG and HDL-C and those without. Logistic regressions were performed to ascertain the role of different factors related to normal HDL-C. Moreover, the restricted cubic spline (RCS) functions were conducted to scrutinize the underlying relationships between the studied variables and low HDL-C levels.

RESULTS

Patients with high TG (150 ≤ TG < 400) compared to patients with normal TG (TG < 150) were less likely to have normal HDL-C. Younger age, narrow hip, lower levels of blood pressure, two-hour postprandial glucose (2hPP), fasting blood sugar (FBS), hemoglobinA1C (HbA1C), low-density lipoprotein cholesterol (LDL-C), total cholesterol, and non-HDL-C, higher atherogenic index of plasma (AIP), and TG/HDL-C ratio correlate with an inverse connection between the values of HDL-C and TG (all P < 0.05). Age greater than 65 years (odds ratio (OR) 1.260, 95% confidence intervals (CI) 1.124-1.413) had a positive association, whereas female sex (OR 0.467, CI 0.416-0.523) , 25 kg/m2 < body mass index (BMI) (OR 0.786, CI 0.691-0.894), and higher serum creatinine levels (OR 0.481, CI 0.372-0.621) had an inverse association with having normal HDL-C.

CONCLUSIONS

Patients with an inverse connection between TG and HDL-C values had considerably different anthropometric features, lipid profiles, and glucose indices compared to those without this relationship. Furthermore, patients who aged less than 65 years, had female gender, BMI more than 25 kg/m2, and higher serum creatinine levels were less likely to exhibit normal HDL-C levels.

Consumption of Policosanol (Raydel®) Improves Hepatic, Renal, and Reproductive Functions in Zebrafish: In Vivo Comparison Study among Cuban, Chinese, and American Policosanol

The current study compared three policosanols from Cuba (sugarcane, Raydel®, policosanol (1), China (rice bran, Shaanxi, policosanol (2), and the USA (sugarcane, Lesstanol®, policosanol (3) in the treatment of dyslipidemia and protection of the liver, ovary, and testis in hypercholesterolemic zebrafish. After twelve weeks of supplementation of each policosanol (PCO, final 0.1% in diet, w/w) with a high cholesterol diet (HCD, final 4%, w/w), the Raydel policosanol (PCO1) group showed the highest survivability, approximately 89%. In contrast, Shaanxi policosanol (PCO2) and Lesstanol policosanol (PCO3) produced 73% and 87% survivability, respectively, while the HCD alone group showed 75% survivability. In the 12th week, the PCO1 group demonstrated the most modest increase in body weight along with significantly lower levels of total cholesterol (TC) and triglycerides (TG) in comparison to the HCD control group. Additionally, the PCO1 group exhibited the highest proportion of high-density lipoprotein (HDL)-cholesterol within TC. Notably, the PCO1 group displayed the lowest level of aspartate aminotransferase and alanine aminotransferase, minimal infiltration of inflammatory cells, reduced interleukin (IL)-6 production in the liver, a notable decline in reactive oxygen species (ROS) generation and mitigated fatty liver changes. HCD supplementation induced impairment of kidney morphology with the greatest extent of ROS production and apoptosis. On the other hand, the PCO 1 group showed a remarkably improved morphology with the least ROS generation and apoptosis. Within the ovarian context, the PCO1 group exhibited the most substantial presence of mature vitellogenic oocytes, accompanied by minimal levels of ROS and apoptosis. Similarly, in the testicular domain, the PCO1 group showcased optimal morphology for spermatogenesis, characterized by the least interstitial area and diminished production of ROS in testicular cells. At week 8, the PCO1 group showed the highest egg-laying ability, with around 244 eggs produced per mating. In contrast, the HCD alone, PCO2, and PCO3 groups showed significantly lower egg-laying ability (49, 59, and 86 eggs, respectively). The embryos from the PCO1 group exhibited the highest survivability with the fastest swimming ability and developmental speed. These results suggest that PCO1 consumption significantly enhanced the reproduction system, egg-laying ability, and embryo survivability. In conclusion, among the three policosanols, Cuban (Raydel®) policosanol had the strongest effect on survivability, improving dyslipidemia, liver protection, kidney, ovary, and testis with a restoration of the cell morphology, and the least ROS production and apoptosis-induced by HCD supplementation.

Associations of non-traditional cardiovascular risk factors and body mass index with metabolic syndrome in the Chinese elderly population

BACKGROUND

Metabolic syndrome (MetS), a clustering of traditional cardiovascular risk factors (CVRF), is currently one of the major global public health burdens. However, associations between MetS and non-traditional CVRF represented by uric acid (UA), homocysteine (HCY) and hypersensitive C-reactive protein (HsCRP) have not been well explored in the elderly population, especially when considering body mass index (BMI).

METHODS

Participants from the Shanghai Elderly Cardiovascular Health (SHECH) study cohort in 2017 were analyzed. MetS was defined using the modified American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Logistic regression models were used to assess associations of non-traditional CVRF, BMI with MetS.

RESULTS

Of the 4360 participants analyzed, 2378 (54.5%) had MetS, the mean (SD) UA was 331 (86) µmol/L, and the median (IQR) HCY and HsCRP were 15 (13-18) µmol/L and 1.0 (0.5-2.1) mg/L, respectively. Participants with higher non-traditional CVRF tended to have a higher significant risk of MetS (P < 0.001), which did not changed substantially in most population subgroups (P-interaction > 0.05). BMI mediated 43.89% (95%CI: 30.38-57.40%), 37.34% (95% CI: 13.86-60.83%) and 30.99% (95%CI: 13.16-48.83%) of associations of hyperuricemia (HUA), hyperhomocysteinemia (HHCY) and high HsCRP (HHsCRP) with MetS, respectively. Abnormal non-traditional CVRF combined with overweight/obesity greatly increased MetS risk (adjusted OR(95%CI): HUA + Overweight: 5.860(4.059-8.461); 6.148(3.707-10.194); HHCY + Overweight: 3.989(3.107-5.121); HHCY + Obese: 5.746(4.064-8.123); HHsCRP + Overweight: 4.026(2.906-5.580); HHsCRP + Obese: 7.717(4.508-13.210)).

CONCLUSIONS

In the Chinese elderly population, HUA, HHCY, and HHsCRP were all significantly and independently associated with MetS, supporting the potential of focusing on non-traditional CVRF interventions for preventing and controlling MetS. BMI played moderate mediating roles in associations between non-traditional CVRF and MetS, and abnormal non-traditional CVRF combined with overweight/obesity had significant synergistic effects on MetS risk, highlighting the importance of better weight management in the elderly population.

Effect of high density lipoprotein cholesterol (HDL-C) on renal outcome in patients with nephrotic syndrome complicated with steroid-induced diabetes mellitus(SIDM)

OBJECTIVE

We aimed to investigate the renal prognosis of patients with idiopathic nephrotic syndrome (INS) complicated with steroid-induced diabetes mellitus (SIDM), the association of high-density lipoprotein cholesterol (HDL-C) before glucocorticoid treatment with renal prognosis, and the risk for persistent diabetes among patients with INS who had withdrawn from steroid therapy.

MATERIALS AND METHODS

We retrospectively analyzed 239 patients with INS complicated with SIDM at the National Clinical Research Center of Kidney Diseases, Jinling Hospital, from January 2008 to December 2019. The primary endpoint was the composite renal outcome defined as the development of end-stage renal disease (ESRD) or a 50% decrease in estimated glomerular filtration rate (eGFR) for more than 24 months after glucocorticoid withdrawal. The secondary endpoint was persistent diabetes, defined as fulfilling the criteria for diagnosing diabetes or using antidiabetic medications for at least 24 months after glucocorticoid withdrawal.

RESULTS

After glucocorticoid withdrawal for over 24 months, 35 (14.6%) patients reached the composite renal endpoint: end-stage renal disease (n = 14) or a 50% decrease in eGFR (n = 21). Before glucocorticoid therapy, a level of HDL-C greater than 1.45 mmol/L worsened renal survival in patients with INS complicated with SIDM. The log₁₀ the level of HDL-C before glucocorticoid treatment was an independent risk factor for the renal outcome. A prediction model was generated: Hazard ratio (renal outcome) = 0.94 * hypertension before glucocorticoid therapy + 2.29 * log₁₀ level of HDL-C before glucocorticoid treatment + 0.90 * the grade of interstitial tubule injury (AUROC, 0.75; 95% CI, 0.63 to 0.87; P < 0.01). Meanwhile, a level of fasting plasma glucose (FPG) before glucocorticoid treatment greater than 5.2 mmol/L enhanced the likelihood of persistent diabetes for at least 24 months after glucocorticoid withdrawal.

CONCLUSIONS

Increased level of HDL-C before glucocorticoid therapy was independently associated with a higher risk for renal outcome and thus may be useful in the renal prognosis of patients with INS complicated with SIDM.

Chinese Visceral Adiposity Index Is Associated With Incident Renal Damage in Patients With Hypertension and Abnormal Glucose Metabolism: A Longitudinal Study

OBJECTIVE

To evaluate the association between Chinese visceral adiposity index (CVAI) and incident renal damage and compared its predictive power with that of other visceral obesity indices in patients with hypertension and abnormal glucose metabolism (AGM).

METHODS

This retrospective cohort consecutively included patients with hypertension and AGM who did not have renal damage at baseline. Renal damage was defined using the estimated glomerular filtration rate (eGFR) and urine protein. Multivariable Cox regression analysis was used to evaluate the association between CVAI and incident renal damage. Restricted cubic splines were used to determine the shape of the association. The predictive power of the CVAI was examined and directly compared with other indices, including the VAI, body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR), using the area under the receiver operating characteristic curve (AUC) and C-index.

RESULTS

In total, 2,033 patients with hypertension and AGM were included. During a median follow-up of 2.6 years, the incidence of renal damage was 31.5, 48.9, 56.8, and 67.5/1,000 person-years across the quartiles of CVAI. Compared with the first quartile, the risk of renal damage was higher in the second (hazard ratio (HR) = 1.36 [95% CI: 0.93-1.97]), third (HR = 1.57 [95% CI: 1.09-2.27]), and fourth (HR = 1.65 [95% CI: 1.11-2.44]) quartiles (p for trend = 0.011). A linear dose-response association was observed. Sensitivity and subgroup analyses confirmed the robustness and consistency of the results. In terms of predictive power, the CVAI had the highest AUC and C-index values.

CONCLUSIONS

CVAI is positively associated with renal damage risk in a linear dose-response pattern and has the best performance in predicting incident renal damage in patients with hypertension and AGM. The CVAI may serve as a reliable indicator for identifying patients at a high risk of renal damage.