High-density Lipoprotein Cholesterol Concentration and acute kidney injury after noncardiac surgery

Background: Abnormal High-density Lipoprotein Cholesterol Concentration is closely related to postoperative acute kidney injury (AKI) after cardiac surgeries. The purpose of this study was to analyze the relationship between High-density Lipoprotein Cholesterol Concentration and acute kidney injury after non-cardiac surgeries. Method: This was a single-center cohort study for elective non-cardiac non-kidney surgery from January 1, 2012, to December 31, 2017. The endpoint was the occurrence of acute kidney injury (AKI) 30 days postoperatively in hospital. Preoperative serum High-density Lipoprotein Cholesterol Concentration was examined by multivariate logistic regression models before and after propensity score weighting analysis. Results: Of the 74284 surgeries, 4.2% (3159 cases) suffered acute kidney injury. Preoperative serum HDL was associated with postoperative AKI, with odds ratio (0.96-1.14 as reference, <0.96, 1.14-1.35, >1.35 mmol/L, Quartile) 1.27 (1.15~1.39), P <.001; 0.90 (0.80~1.01), P= .086; 0.75 (0.65~0.85), P <.001, respectively. Preoperative serum HDL <1.03 mmol/L was associated with increased risk of postoperative AKI, with odds ratio 1.32 (1.21~1.46), P<0.001 before propensity score weighting, and 1.32 (1.18~1.48), P<0.001 after propensity score weighting. Sensitivity analysis with other cut values of HDL showed similar results. Conclusions: Postoperative acute kidney injury occurred in 4.2 % of patients undergoing elective non-cardiac non-kidney surgery. This study found that low HDL cholesterol levels were independent risk factors for AKI after non-cardiac surgery.