Association Between Uric Acid to High-Density Lipoprotein Cholesterol Ratio (UHR) and Chronic Kidney Disease in Chinese Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Study

Xiangyu Chen Jie Zhang Feng Lu Ruying Hu Xiaofu Du Chunxiao Xu Mingbin Liang Lijin Chen Weiyuan Yao Zhimin Ma Jieming Zhong Meng Wang ^*

• Zhejiang Center for Disease Control and Prevention (Zhejiang CDC), Hangzhou, China

Objectives: To examine the association between uric acid (UA) to high-density lipoprotein cholesterol (HDL-C) ratio (UHR) and chronic kidney disease (CKD) in type 2 diabetes mellitus (T2DM) patients in China. Methods: The investigation stems from a survey conducted in the eastern Chinese province of Zhejiang, spanning from March to November 2018. A multivariable logistic regression model was employed to assess the relationship between UHR and CKD, while restricted cubic spline (RCS) analysis was used to evaluate the dose-response relationship. Receiver operating characteristic (ROC) curve analysis was performed to determine the optimal UHR cut-off value and assess its diagnostic performance for CKD. Subgroup analyses were performed across various demographic and clinical categories to examine the consistency of the UHR-CKD association.Results: This cross-sectional study included 1,756 Chinese patients with T2DM, among whom 485 (27.62%) were identified with CKD. Multivariable logistic regression analysis revealed a significant positive association between UHR and CKD. Per standard deviation (SD) increase in UHR was associated with a 40% higher odds of CKD (OR = 1.40, 95% CI: 1.23–1.60) after adjusting for potential covariates. When analyzed categorically, participants in the highest UHR tertile (T3) had 1.82-fold higher odds of CKD compared to the lowest tertile (T1) (95% CI: 1.32–2.50). RCS analysis demonstrated a consistent linear dose-response relationship between UHR and CKD across all models (all p for nonlinearity > 0.05). ROC curve analysis identified an optimal UHR cut-off value of 12.28 for CKD prediction, with an area under the curve (AUC) of 0.710 (95% CI: 0.683–0.737) in the fully adjusted model. Subgroup analyses confirmed the robustness of the UHR-CKD association across most demographic and clinical variables, except for younger age groups (18–44 and 45–59 years) and smokers. Notably, BMI significantly modified the UHR-CKD relationship, with a nonlinear association observed in individuals with lower BMI (<24 kg/m2) and a linear association in those with higher BMI (≥24 kg/m2).Conclusions: This study demonstrates a significant dose-response relationship between the UHR and CKD in Chinese patients with T2DM, highlighting UHR as a promising biomarker for CKD risk assessment.