Editorial
HDL Cholesterol Concentration may Become One of the Predictors for Future Renal Dysfunction in JAPAN
2025 年 32 巻 4 号 p. 405-406
詳細
2025 年 32 巻 4 号 p. 405-406
See article vol. 32: 407-420
Approximately 10% of the adult population worldwide is affected by chronic kidney disease (CKD)1). CKD has been shown to be a risk for the development of cardiovascular disease (CVD) and mortality. Therefore, it is important that conventional blood tests can detect prospective renal dysfunction early in the general population. Previous studies have shown that low high-density lipoprotein (HDL) cholesterol (-C) concentration is an independent prognostic marker for CVD2). Similarly, the J-LIT study showed an association between low HDL-C levels and high coronary artery disease events in Japan3). In addition to CVD, the large-scale studies in recent years revealed the association with HDL-C level and all-cause mortality in the world4, 5). However, the relationship between the HDL-C levels and future renal dysfunction due to the lack of large population data in Japan is still unclear. The excellent study by Kosugi et al.6) clarified, for the first time, and added new evidence that low HDL-C concentration is a predictor of future renal dysfunction in a large-scale general population in Japan. Especially, the real-world data from more than 760,000 participants, including Japanese citizens aged 40–74 years based on annual health examinations, are valuable for application to general medicine.
Furthermore, this large-scale study has several implications. There are sex differences in the HDL-C concentration, with higher HDL levels in females7). Racial differences have also been reported in the estimation of CVD risk based on the HDL-C levels8). However, in this study, the HDL-C concentrations ＜40 mg/dL in both sexes were associated with adverse renal outcomes, despite apparent sex differences in the HDL-C levels. The HDL-C concentration (40 mg/dL) used to estimate the risk of future renal dysfunction was consistent with the level used to predict CVD. Whereas, it is recently reported that extremely high HDL-C levels are paradoxically related to increased all-cause mortality and CVD4, 5). This means that the association between the HDL-C levels and all-cause mortality or CVD is U-shaped. However, the association between the HDL-C levels and future renal dysfunction was reverse J-shaped in the present study. Compared to all-cause mortality and CVD, the adverse kidney outcomes may be as follows: “The lower the HDL-C concentration, the worse the outcome becomes for future renal dysfunction.”
New and effective drugs have been developed for renal protection in the clinical setting. One of these new drugs, sodium–glucose cotransporter 2 (SGLT2) inhibitor, has been reported to have beneficial effects on both cardiac and renal dysfunction9). SGLT2 inhibitors have also been shown to partially affect the lipid profile of patients with type 2 diabetes mellitus, including increased HDL-C levels10). In the future, the HDL-C value may change because the present article was written before the era of treatment with new drugs. However, this large-scale general population-based analysis may play an additional role in the estimation of future renal dysfunction.
YU has contracted with RAYDEL Australia Pty. Ltd. as Research Consultant, and YU received research grants from Asahi Kasei Co. LTD., Mizuno Co. LTD., Scuba diving・Air. LTD. and Raydel Korea Co. Ltd.
