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Peer-reviewedCC BY-NC-NDBMC nephrology

ApoB/ApoA-I ratio and all-cause mortality in maintenance hemodialysis: a cohort study.

  • Zhen Zhang1,2
  • Fangfang Xiang1,2
  • Wuhua Jiang1,2
  • Xuesen Cao1,2
  • Xiaoqiang Ding3,4
  • Bo Shen5,6
6 affiliations
  1. 1Department of Nephrology, Zhongshan Hospital, Fudan University, No 180 Fenglin Road, Shanghai, China.
  2. 2Shanghai Key Laboratory of Kidney and Blood Purification, No 180 Fenglin Road, Shanghai, China.
  3. 3Department of Nephrology, Zhongshan Hospital, Fudan University, No 180 Fenglin Road, Shanghai, China. [email protected].
  4. 4Shanghai Key Laboratory of Kidney and Blood Purification, No 180 Fenglin Road, Shanghai, China. [email protected].
  5. 5Department of Nephrology, Zhongshan Hospital, Fudan University, No 180 Fenglin Road, Shanghai, China. [email protected].
  6. 6Shanghai Key Laboratory of Kidney and Blood Purification, No 180 Fenglin Road, Shanghai, China. [email protected].
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Abstract

Background

Traditional lipid markers have limited and inconsistent prognostic value in maintenance hemodialysis (MHD), a phenomenon often described as the lipid paradox. We evaluated whether lipid and apolipoprotein-related markers, particularly the ApoB/ApoA-I ratio, were associated with mortality in MHD patients.Methods

This single-center retrospective cohort study included 409 MHD patients. Lipid and apolipoprotein-related markers were analyzed as standardized continuous variables. Cox regression was used for all-cause mortality, and cause-specific Cox and Fine-Gray models were used for cardiovascular mortality.Results

During a median follow-up of 55.7 months, 148 all-cause deaths occurred, including 61 cardiovascular deaths. ApoB/ApoA-I was not associated with all-cause mortality in the unadjusted model, but was independently associated with all-cause mortality in Model 3 (hazard ratio [HR] 1.23, 95% confidence interval [CI] 1.05-1.44; p = 0.012). The association was similar in sensitivity analyses. ApoB/ApoA-I was not significantly associated with cardiovascular mortality in exploratory Fine-Gray regression (subdistribution hazard ratio [SHR] 1.12, 95% CI 0.89-1.43; p = 0.337) and did not improve discrimination beyond the base clinical model.Conclusions

These findings suggest that ApoB/ApoA-I may contribute to risk characterization and etiologic understanding in MHD, but do not support its use as a stand-alone clinical prediction marker.

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Cite

BibTeXRIS
BibTeX
@article{zhang2026apobapoai,
  title = {{ApoB/ApoA-I ratio and all-cause mortality in maintenance hemodialysis: a cohort study.}},
  author = {Zhen Zhang and Fangfang Xiang and Wuhua Jiang and Xuesen Cao and Xiaoqiang Ding and Bo Shen},
  journal = {BMC nephrology},
  year = {2026},
  month = jul,
  doi = {10.1186/s12882-026-05224-1},
  url = {https://europepmc.org/article/MED/42907969},
  note = {CC BY-NC-ND},
}
RIS
TY  - JOUR
TI  - ApoB/ApoA-I ratio and all-cause mortality in maintenance hemodialysis: a cohort study.
AU  - Zhen Zhang
AU  - Fangfang Xiang
AU  - Wuhua Jiang
AU  - Xuesen Cao
AU  - Xiaoqiang Ding
AU  - Bo Shen
PY  - 2026
DA  - 2026/07/01
JO  - BMC nephrology
DO  - 10.1186/s12882-026-05224-1
UR  - https://europepmc.org/article/MED/42907969
AB  - Background  Traditional lipid markers have limited and inconsistent prognostic value in maintenance hemodialysis (MHD), a phenomenon often described as the lipid paradox. We evaluated whether lipid and apolipoprotein-related markers, particularly the ApoB/ApoA-I ratio, were associated with mortality in MHD patients.Methods  This single-center retrospective cohort study included 409 MHD patients. Lipid and apolipoprotein-related markers were analyzed as standardized continuous variables. Cox regression was used for all-cause mortality, and cause-specific Cox and Fine-Gray models were used for cardiovascular mortality.Results  During a median follow-up of 55.7 months, 148 all-cause deaths occurred, including 61 cardiovascular deaths. ApoB/ApoA-I was not associated with all-cause mortality in the unadjusted model, but was independently associated with all-cause mortality in Model 3 (hazard ratio [HR] 1.23, 95% confidence interval [CI] 1.05-1.44; p = 0.012). The association was similar in sensitivity analyses. ApoB/ApoA-I was not significantly associated with cardiovascular mortality in exploratory Fine-Gray regression (subdistribution hazard ratio [SHR] 1.12, 95% CI 0.89-1.43; p = 0.337) and did not improve discrimination beyond the base clinical model.Conclusions  These findings suggest that ApoB/ApoA-I may contribute to risk characterization and etiologic understanding in MHD, but do not support its use as a stand-alone clinical prediction marker.
SN  - 1471-2369
ER  -