Oxidative stress promotes acute kidney injury (AKI). Higher concentrations of HDL cholesterol are associated with less AKI. To test the hypothesis that HDL antioxidant activity is associated with AKI after cardiac surgery, we quantified HDL particle size and number, paraoxonase-1 activity, and isofuran concentrations in 75 patients who developed AKI and 75 matched control patients. Higher preoperative concentrations of HDL particles were associated with lower odds of AKI (OR: 0.80; 95% CI, 0.71-0.91; p=0.001), higher paraoxonase-1 activity (R=0.36, p<0.001), and lower plasma concentrations of isofurans immediately after surgery (p=0.02). Similarly, higher preoperative small HDL particle concentrations were associated with less AKI, higher paraoxonase-1 activity, and lower isofuran concentrations. Circulating HDL particle concentrations changed rapidly during the perioperative period. Higher intraoperative particle losses were associated with lower odds of AKI (OR: 0.79; 95% CI 0.67-0.93; p=0.005), and increased paraoxonase-1 activity strengthened this association (p=0.006). Intraoperative particle loss was also associated with decreased postoperative isofuran concentrations (p=0.04). Additionally, higher preoperative small HDL particle concentrations and increased intraoperative small particle loss were associated with improved renal function 3-12 months after surgery (p=0.003, 0.01, respectively). In conclusion, a higher preoperative concentration of HDL particles, particularly small particles, is associated with lower oxidative damage and less AKI. Perioperative changes in HDL particle concentrations are also associated with AKI. Small HDL particles may represent a novel modifiable risk factor for AKI.

中文翻译：

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围手术期高密度脂蛋白、氧化应激和心脏手术后的肾损伤。


氧化应激会促进急性肾损伤（AKI）。高密度脂蛋白胆固醇浓度越高，AKI 越少。为了检验 HDL 抗氧化活性与心脏手术后 AKI 相关的假设，我们量化了 75 名发生 AKI 的患者和 75 名匹配对照患者的 HDL 颗粒大小和数量、对氧磷酶 1 活性和异呋喃浓度。术前 HDL 颗粒浓度较高与 AKI 发生率较低（OR：0.80；95% CI，0.71-0.91；p=0.001）、较高的对氧磷酶 1 活性（R=0.36，p<0.001）和较低的风险相关。手术后立即血浆异呋喃浓度（p=0.02）。同样，较高的术前小 HDL 颗粒浓度与较少的 AKI、较高的对氧磷酶 1 活性和较低的异呋喃浓度相关。围手术期循环 HDL 颗粒浓度变化迅速。术中颗粒损失较高与 AKI 发生率较低相关（OR：0.79；95% CI 0.67-0.93；p=0.005），而对氧磷酶 1 活性的增加则强化了这种关联（p=0.006）。术中颗粒损失也与术后异呋喃浓度降低相关（p=0.04）。此外，术前较高的小 HDL 颗粒浓度和术中小颗粒丢失增加与术后 3-12 个月肾功能的改善相关（分别为 p=0.003、0.01）。总之，术前较高浓度的 HDL 颗粒（尤其是小颗粒）与较低的氧化损伤和较少的 AKI 相关。围手术期 HDL 颗粒浓度的变化也与 AKI 相关。小 HDL 颗粒可能代表 AKI 的一种新的可改变危险因素。