Association Between High-Density Lipoprotein to Low-Density Lipoprotein Ratio and Contrast-Induced AKI Based on the In-Hospital AKI Electronic Monitoring System

Background: The objective of this study was to investigate the relationship between the High-Density Lipoprotein (HDL) to Low-Density Lipoprotein (LDL) ratio and the risk of Contrast-Induced Acute Kidney Injury (CI-AKI). Methods: A real-time, in-hospital AKI electronic monitoring system was designed based on current KDIGO AKI criteria. Based on the system, data were automatically collected from patients who underwent elective angiography and interventional therapy at Ningbo No. 2 Hospital between June 1, 2019, and May 31, 2024. Results: A total of 3,139 patients were included in the study, of whom 2,177 were male (69.35%), with a median age of 68 years. Among these patients, 300(9.56%) were diagnosed with CI-AKI. The HDL to LDL ratio in the CI-AKI group was 0.40 [0.32, 0.53], while the ratio in the non-AKI group was 0.44 [0.35, 0.57] (P < 0.001). Restricted cubic splines (RCS) indicated the nonlinear correlation between the HDL-to-LDL ratio and AKI (nonlinear, P=0.047, Figure 1). HDL to LDL ratio <0.43 is associated with an increased risk of AKI(OR=1.41,95%CI=1.11-1.79, P=0.005). In the stratified analysis, significant interactions were observed between the HDL-to-LDL ratio and the use of vasoactive drugs, spironolactone, ACEI/ ARB,NSAIDs and baseline eGFR (Figure 2). Conclusion: The decreased HDL-to-LDL ratio was closely correlated with the incidence of CI-AKI, suggesting that this ratio could potentially serve as a new predictor for CI-AKI.Figure 1 RCS curve associations between the HDL-to-LDL ratio and AKISubgroup analysis of the association between HDL-to-LDL ratio and AKI