High-Density Lipoprotein Anti-Inflammatory Capacity and Acute Kidney Injury After Cardiac and Vascular Surgery: A...

Area of Science:

• Cardiovascular Surgery
• Nephrology
• Immunology

Background:

• Acute kidney injury (AKI) is a significant predictor of mortality following major cardiac and vascular surgery.
• Elevated preoperative high-density lipoprotein (HDL) levels have been linked to a reduced incidence of postoperative AKI.
• In preclinical models, HDL's anti-inflammatory properties, specifically its ability to suppress endothelial cell adhesion molecule expression, mitigate kidney damage from ischemia and shock.

Purpose of the Study:

• To investigate the statistical association between the anti-inflammatory capacity of HDL and the occurrence of AKI in patients undergoing major cardiac and vascular surgery.
• To determine if HDL's functional capacity, rather than its concentration, is a key determinant of AKI risk.
• To explore the relationship between long-term statin therapy and HDL's anti-inflammatory function.

Main Methods:

• A prospective observational study was conducted at a quaternary medical center.
• One hundred adult patients with chronic kidney disease on long-term statin therapy undergoing elective cardiac or vascular surgery were enrolled.
• HDL's anti-inflammatory capacity was assessed by measuring its ability to suppress intercellular adhesion molecule-1 (ICAM-1) expression in vitro, alongside measurements of apolipoprotein A-I and soluble ICAM-1.

Main Results:

• HDL concentration did not correlate with its capacity to suppress ICAM-1.
• Twelve percent of patients exhibited dysfunctional, pro-inflammatory HDL, associated with a higher AKI rate.
• Higher preoperative HDL anti-inflammatory capacity was independently linked to lower AKI odds (OR, 0.88; 95% CI, 0.80-0.98; p=0.016), independent of HDL concentration.
• Increased long-term statin dose correlated with enhanced HDL anti-inflammatory capacity (p=0.045).

Conclusions:

• Dysfunctional, pro-inflammatory HDL significantly increases the risk of postoperative AKI in patients with chronic kidney disease undergoing major surgery.
• A greater HDL anti-inflammatory capacity is associated with a reduced risk of AKI, irrespective of HDL concentration.
• Long-term statin use may improve HDL's anti-inflammatory function, potentially contributing to reduced AKI risk.