Albumin‐to‐Non‐High‐Density Lipoprotein Cholesterol Ratio and Prevalent Coronary Artery Stenosis at Hemodialysis Initiation

ABSTRACT Background Coronary artery stenosis (CAS) is common at hemodialysis (HD) initiation, even in asymptomatic patients. Because malnutrition, inflammation, and dyslipidemia may contribute to coronary atherosclerosis in advanced kidney disease, we evaluated whether the albumin‐to‐non‐high‐density lipoprotein cholesterol ratio (ANHR) was associated with prevalent CAS and provided incremental information beyond the nutritional risk index for Japanese hemodialysis patients (NRI‐JH). Methods This single‐center cross‐sectional study included patients who initiated HD between 2015 and 2023 and underwent screening coronary computed tomography within ±30 days of HD initiation. CAS was defined as ≥ 75% stenosis on computed tomography or coronary angiography. Results Among 255 patients, 124 (49%) had CAS. ANHR was lower in the CAS group [2.7 (2.2–3.4) vs. 3.1 (2.3–4.0)], whereas NRI‐JH was higher [6 (4–8) vs. 4 (3–8)]. Adding ANHR to the model containing NRI‐JH significantly improved the fit and the ANHR model had the lowest Akaike's information criterion (341.2). NRI‐JH was associated with higher odds of CAS (OR 1.34, 95% CI 1.02–1.76; p = 0.036), whereas ANHR was associated with lower odds of CAS (OR 0.64, 95% CI 0.48–0.84; p = 0.002). In the combined model, ANHR remained associated with CAS (OR 0.67, 95% CI 0.50–0.89; p = 0.006). Conclusion In patients initiating HD, lower ANHR was associated with prevalent CAS. However, the improvement in discrimination was modest and not statistically significant. ANHR may provide adjunctive information regarding prevalent CAS, but its clinical utility as a screening marker requires further validation.