ArticleMedicine2026
Association between the uric acid to high-density lipoprotein cholesterol ratio and diabetic kidney disease in U.S. adults with type 2 diabetes: A cross-sectional study of NHANES 2009 to 2018.
Article in Medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
The uric-acid-to- high-density lipoprotein-cholesterol ratio (UHR) combines 2 circulating biomarkers related to metabolic and inflammatory processes. Its association with prevalent diabetic kidney disease (DKD) was examined in U.S. adults with type 2 diabetes mellitus. This study aimed to examine the cross-sectional association between UHR and prevalent DKD and assess its incremental discrimination beyond the specified covariate model. We analyzed 4010 adults with type 2 diabetes mellitus from NHANES 2009 to 2018 using the complex survey design. DKD was defined as urinary albumin-to-creatinine ratio ≥30 mg/g and/or estimated glomerular filtration rate <60 mL/min/1.73 m2, calculated using the 2009 chronic kidney disease epidemiology collaboration equation without its race coefficient. Strict DKD required both abnormalities; severe DKD required urinary albumin-to-creatinine ratio ≥300 mg/g. Model 3 was the primary confounder-adjusted model, and model 4 added laboratory indicators as an extended sensitivity analysis. Supplementary analyses assessed nonlinearity, discrimination and graphical calibration. Exploratory unweighted category-based net reclassification improvement used 500 bootstrap replicates and percentile confidence intervals. Of 4010 participants, 1576 had study-defined DKD; the weighted prevalence was 35.4%. In model 3, the highest versus lowest ln-UHR quartile had an odds ratio of 2.43 (95% confidence interval 1.75-3.38) for original DKD, 4.55 (2.81-7.35) for strict DKD and 2.82 (1.57-5.06) for severe DKD. Estimates were attenuated in model 4, with the severe-DKD contrast no longer meeting the 0.05 threshold. The laboratory-adjusted spline indicated nonlinearity (P < .001). In the separate laboratory-inclusive discrimination analysis, adding ln-UHR increased apparent area under the curve from 0.75 to 0.76; the unweighted net reclassification improvement was 1.9% (95% confidence interval 0.8%-3.1%). Higher UHR was associated with prevalent DKD after adjustment for the selected potential confounders. Supplementary analyses showed a small increase in apparent discrimination. These cross-sectional findings require prospective investigation and independent external validation before use for future risk prediction or clinical screening.
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