Liu Qi, Zheng Danna, Shen Xiaobo, Jin Juan, He Qiang
Department of Nephrology, the First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, 310000, Zhejiang, China.
Urology & Nephrology Center, Department of Nephrology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China.
Int Urol Nephrol. 2025 Apr;57(4):1297-1309. doi: 10.1007/s11255-024-04308-x. Epub 2024 Dec 2.
Previous research has demonstrated a correlation between uric acid to high-density lipoprotein cholesterol ratio (UHR) and chronic kidney disease (CKD), yet the evidence remains unclear in individuals with abnormal glucose metabolism. The objective of this research was to investigate the correlation between UHR and the occurrence of CKD, as well as the rapid kidney function decline among individuals aged over 45 years with abnormal glucose metabolism, using data from the China Health and Retirement Longitudinal Study (CHARLS).
This study employed K-means clustering to categorize individuals based on UHR control levels into four classes. Subsequently, multivariate logistic regression analyses were utilized to explore the relationships between UHR and the occurrence of CKD as well as rapid kidney function decline. To examine the potential nonlinear relationship, restricted cubic spline (RCS) analyses were employed. Subgroup analyses and various sensitivity analyses were applied to validate the reliability of the results.
This study encompassed 3902 participants, all of whom had prediabetes or diabetes. In the fully adjusted logistic regression model assessing the risk of CKD development, the odds ratios (ORs) for Class 2, Class 3, and Class 4, versus Class 1, were 1.08 (0.71 to 1.67), 1.71 (1.06 to 2.77), and 2.13 (1.02 to 4.35), respectively. For every 1 standard deviation (SD) increase in cumulative UHR exposure, there was a 32% elevation in the risk of CKD incidence (OR: 1.32, 95% CI 1.12 to 1.56). RCS curves suggested a linear association between cumulative UHR (CumUHR) and CKD occurrence, but a nonlinear association with rapid renal function progression. Subgroup analysis indicated an interaction between age and UHR on the development of CKD. The application of multiple sensitivity analyses yielded consistent outcomes, suggesting the robustness of the findings.
In individuals with abnormal glucose metabolism, suboptimal control of UHR signifies an elevated risk of rapid kidney function decline and the incidence of CKD in the future. Therefore, close monitoring of long-term variations in UHR can facilitate early identification of the risk for CKD development.
先前的研究已证明尿酸与高密度脂蛋白胆固醇比值（UHR）和慢性肾脏病（CKD）之间存在关联，但在糖代谢异常个体中，证据仍不明确。本研究的目的是利用中国健康与养老追踪调查（CHARLS）的数据，探讨45岁以上糖代谢异常个体中UHR与CKD发生以及肾功能快速下降之间的相关性。
本研究采用K均值聚类法，根据UHR控制水平将个体分为四类。随后，利用多因素逻辑回归分析探讨UHR与CKD发生以及肾功能快速下降之间的关系。为检验潜在的非线性关系，采用了受限立方样条（RCS）分析。进行亚组分析和各种敏感性分析以验证结果的可靠性。
本研究纳入了3902名参与者，他们均患有糖尿病前期或糖尿病。在评估CKD发生风险的完全调整逻辑回归模型中，与第1类相比，第2类、第3类和第4类的比值比（OR）分别为1.08（0.71至1.67）、1.71（1.06至2.77）和2.13（1.02至4.35）。累积UHR暴露每增加1个标准差（SD），CKD发病风险升高32%（OR：1.32，95%CI 1.12至1.56）。RCS曲线表明累积UHR（CumUHR）与CKD发生之间存在线性关联，但与肾功能快速进展存在非线性关联。亚组分析表明年龄与UHR在CKD发生方面存在交互作用。多种敏感性分析的应用产生了一致的结果，表明研究结果具有稳健性。
在糖代谢异常个体中，UHR控制不佳意味着未来肾功能快速下降和CKD发生风险升高。因此，密切监测UHR的长期变化有助于早期识别CKD发生风险。
