Relationship Between Uric Acid/HDL Ratio, Biochemical, and Hematological Parameters in Type 2 Diabetic Patients with and Without Nephropathy
-
Mohammed Fadhii Ajeel Alshammari
,
Fatemeh Sadat Hoseini
,
Hossein Mokhtari
,
Hadis Musavi
,
Abbas Khonakdar-Tarsi
Abstract
Objective: Diabetic nephropathy (DN) is a major complication of type 2 diabetes mellitus (T2DM). This study aims to evaluate the association of the uric acid-to-high-density lipoprotein cholesterol ratio (UHR) with biochemical parameters in patients with and without DN.
Methods: In this comparative cross-sectional study, 120 patients with T2DM (60 with DN and 60 without DN) were enrolled. Clinical, biochemical, lipid, renal, inflammatory, and hematological parameters were measured. Correlations between UHR and glycemic indices were analyzed, and receiver operating characteristic (ROC) analysis was performed.
Results: Patients with DN had higher triglyceride and creatinine levels, lower high-density lipoprotein cholesterol (HDL-C) levels, and borderline higher UHR (P=0.05) than those without DN. No significant differences were found for HbA1c, fasting blood glucose, postprandial glucose, mean plasma glucose, triglyceride-glucose index, or serum uric acid. UHR was not significantly correlated with any glycemic index (all P>0.05). ROC analysis showed poor discriminatory performance of UHR for DN (AUC=0.452, P=0.475).
Conclusion: Although UHR was borderline elevated in patients with DN, it was not associated with glycemic indices and showed poor diagnostic performance. These findings suggest that UHR has limited utility as an independent biomarker of diabetic nephropathy in T2DM.
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14. Aktas G, Yilmaz S, Kantarci DB, Duman TT, Bilgin S, Balci SB, Atak Tel BM. Is serum uric acid-to-HDL cholesterol ratio elevation associated with diabetic kidney injury? Postgrad Med. 2023;135(5):519-23. https://doi.org/10.1080/00325481.2023.2214058
15. Xuan Y, Zhang W, Wang Y, Wang B, Xia F, Zhang K, et al. Association between uric acid to HDL cholesterol ratio and diabetic complications in men and postmenopausal women. Diab Metab Syn Ob. 2023:167-77. https://doi.org/10.2147/dmso.s387726
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17. Kanbay M, Solak Y, Unal HU, Kurt YG, Gok M, Cetinkaya H, et al. Monocyte count/HDL cholesterol ratio and cardiovascular events in patients with chronic kidney disease. Int Urol Nephrol. 2014;46(8):1619-25. https://doi.org/10.1007/s11255-014-0730-1.
18. Sanchez-Lozada LG, Rodriguez-Iturbe B, Kelley EE, Nakagawa T, Madero M, Feig DI, et al. Uric Acid and Hypertension: An Update With Recommendations. Am J Hypertens. 2020;33(7):583-94. https://doi.org/10.1093/ajh/hpaa044.
19. Kanbay M, Segal M, Afsar B, Kang DH, Rodriguez-Iturbe B, Johnson RJ. The role of uric acid in the pathogenesis of human cardiovascular disease. Heart. 2013;99(11):759-66. https://doi.org/10.1136/heartjnl-2012-302535.
20. Aktas G. An overview of the role of serum uric acid to high-density lipoprotein cholesterol ratio in type 2 diabetes mellitus and in other inflammatory and metabolic conditions. Minerva Med. 2025;116(5):405-15. https://doi.org/10.23736/S0026-4806.25.09712-5.
21. Kosekli MA, Aktas G. Serum uric acid to HDL cholesterol ratio is associated with diabetic control in new onset type 2 diabetic population. Acta Clin Croat. 2023;62(2):277-82. https://doi.org/10.20471/acc.2023.62.02.04
22. Levin A, Ahmed SB, Carrero JJ, Foster B, Francis A, Hall RK, et al. Executive summary of the KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease: known knowns and known unknowns. Kidney Int. 2024;105(4):684-701. https://doi.org/10.1016/j.kint.2023.10.016.
23. ElSayed NA, Aleppo G, Bannuru RR, Bruemmer D, Collins BS, Ekhlaspour L, et al. 11. Chronic kidney disease and risk management: Standards of care in diabetes—2024. Diab Care. 2024;47. https://doi.org/10.2337/dc24-s011
24. Alicic RZ, Rooney MT, Tuttle KR. Diabetic Kidney Disease: Challenges, Progress, and Possibilities. Clinical Journal of the American Society of Nephrology. 2017;12(12):2032-45. https://doi.org/10.2215/cjn.11491116.
25. Gembillo G, Siligato R, Cernaro V, Satta E, Conti G, Salvo A, et al. Monocyte to HDL ratio: a novel marker of resistant hypertension in CKD patients. Int Urol Nephrol. 2022;54(2):395-403. https://doi.org/10.1007/s11255-021-02904-9.
26. Targher G, Bertolini L, Rodella S, Zoppini G, Lippi G, Day C, Muggeo M. Non-alcoholic fatty liver disease is independently associated with an increased prevalence of chronic kidney disease and proliferative/laser-treated retinopathy in type 2 diabetic patients. Diabetologia. 2008;51(3):444-50. https://doi.org/10.1007/s00125-007-0897-4
27. Thomas MC, MacIsaac RJ, Tsalamandris C, Molyneaux L, Goubina I, Fulcher G, et al. The burden of anaemia in type 2 diabetes and the role of nephropathy: a cross-sectional audit. Nephrol Dial Transplant. 2004;19(7):1792-7. https://doi.org/10.1093/ndt/gfh248.
2. Alicic RZ, Rooney MT, Tuttle KR. Diabetic Kidney Disease: Challenges, Progress, and Possibilities. Clin J Am Soc Nephrol. 2017;12(12):2032-45. https://doi.org/10.2215/CJN.11491116.
3. Jamal A, Abolfazl E, Narjes R, Zahra S. Cerium Oxide Nanoparticles Attenuate Diabetic Nephropathy in Rats by Reducing Oxidative Stress, Improving Dyslipidemia, and Modulating PKM2 and KIM-1. Acta Biochim Iran. 2024;2(4). https://doi.org/10.18502/abi.v2i4.19107.
4. Sagoo MK, Gnudi L. Diabetic nephropathy: an overview. Diabetic nephropathy: Methods and Protocols. 2019:3-7.
5. Selby NM, Taal MW. An updated overview of diabetic nephropathy: Diagnosis, prognosis, treatment goals and latest guidelines. Diabetes Obes Metab. 2020;22 Suppl 1:3-15. https://doi.org/10.1111/dom.14007.
6. Pegah G, Saeedeh M, Zahra Arab S, Mona N, Mitra N, Zeynab Y, Maryam R-A. Circulating miR-135b as a Biomarker of Obesity-Related Insulin Resistance and Dyslipidemia in Children and Adolescents. Acta Biochim Iran. 2025;3(4). https://doi.org/10.18502/abi.v3i4.21848.
7. Russo GT, De Cosmo S, Viazzi F, Pacilli A, Ceriello A, Genovese S, et al. Plasma Triglycerides and HDL-C Levels Predict the Development of Diabetic Kidney Disease in Subjects With Type 2 Diabetes: The AMD Annals Initiative. Diabetes Care. 2016;39(12):2278-87. https://doi.org/10.2337/dc16-1246.
8. Herman-Edelstein M, Scherzer P, Tobar A, Levi M, Gafter U. Altered renal lipid metabolism and renal lipid accumulation in human diabetic nephropathy. J Lipid Res. 2014;55(3):561-72. https://doi.org/10.1194/jlr.P040501.
9. Rosenson RS, Brewer HB, Jr., Ansell BJ, Barter P, Chapman MJ, Heinecke JW, et al. Dysfunctional HDL and atherosclerotic cardiovascular disease. Nat Rev Cardiol. 2016;13(1):48-60. https://doi.org/10.1038/nrcardio.2015.124.
10. Pammer A, Klobucar I, Stadler JT, Meissl S, Habisch H, Madl T, et al. Impaired HDL antioxidant and anti-inflammatory functions are linked to increased mortality in acute heart failure patients. Redox Biol. 2024;76:103341. https://doi.org/10.1016/j.redox.2024.103341.
11. Johnson RJ, Nakagawa T, Sanchez-Lozada LG, Shafiu M, Sundaram S, Le M, et al. Sugar, uric acid, and the etiology of diabetes and obesity. Diabetes. 2013;62(10):3307-15. https://doi.org/10.2337/db12-1814.
12. Kanbay M, Jensen T, Solak Y, Le M, Roncal-Jimenez C, Rivard C, et al. Uric acid in metabolic syndrome: From an innocent bystander to a central player. Eur J Intern Med. 2016;29:3-8. https://doi.org/10.1016/j.ejim.2015.11.026.
13. Kocak MZ, Aktas G, Erkus E, Sincer I, Atak B, Duman T. Serum uric acid to HDL-cholesterol ratio is a strong predictor of metabolic syndrome in type 2 diabetes mellitus. Rev Assoc Med Bras. 2019;65:9-15. https://doi.org/10.1590/1806-9282.65.1.9
14. Aktas G, Yilmaz S, Kantarci DB, Duman TT, Bilgin S, Balci SB, Atak Tel BM. Is serum uric acid-to-HDL cholesterol ratio elevation associated with diabetic kidney injury? Postgrad Med. 2023;135(5):519-23. https://doi.org/10.1080/00325481.2023.2214058
15. Xuan Y, Zhang W, Wang Y, Wang B, Xia F, Zhang K, et al. Association between uric acid to HDL cholesterol ratio and diabetic complications in men and postmenopausal women. Diab Metab Syn Ob. 2023:167-77. https://doi.org/10.2147/dmso.s387726
16. Jiang Q, Zhan G, Liu Y, Jiang C, Wang K, Zheng G, et al. Serum uric acid to high-density lipoprotein cholesterol ratio is associated with stroke in the elderly: a population-based study. Front Neurol 2025;16:1594080. https://doi.org/10.3389/fneur.2025.1594080
17. Kanbay M, Solak Y, Unal HU, Kurt YG, Gok M, Cetinkaya H, et al. Monocyte count/HDL cholesterol ratio and cardiovascular events in patients with chronic kidney disease. Int Urol Nephrol. 2014;46(8):1619-25. https://doi.org/10.1007/s11255-014-0730-1.
18. Sanchez-Lozada LG, Rodriguez-Iturbe B, Kelley EE, Nakagawa T, Madero M, Feig DI, et al. Uric Acid and Hypertension: An Update With Recommendations. Am J Hypertens. 2020;33(7):583-94. https://doi.org/10.1093/ajh/hpaa044.
19. Kanbay M, Segal M, Afsar B, Kang DH, Rodriguez-Iturbe B, Johnson RJ. The role of uric acid in the pathogenesis of human cardiovascular disease. Heart. 2013;99(11):759-66. https://doi.org/10.1136/heartjnl-2012-302535.
20. Aktas G. An overview of the role of serum uric acid to high-density lipoprotein cholesterol ratio in type 2 diabetes mellitus and in other inflammatory and metabolic conditions. Minerva Med. 2025;116(5):405-15. https://doi.org/10.23736/S0026-4806.25.09712-5.
21. Kosekli MA, Aktas G. Serum uric acid to HDL cholesterol ratio is associated with diabetic control in new onset type 2 diabetic population. Acta Clin Croat. 2023;62(2):277-82. https://doi.org/10.20471/acc.2023.62.02.04
22. Levin A, Ahmed SB, Carrero JJ, Foster B, Francis A, Hall RK, et al. Executive summary of the KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease: known knowns and known unknowns. Kidney Int. 2024;105(4):684-701. https://doi.org/10.1016/j.kint.2023.10.016.
23. ElSayed NA, Aleppo G, Bannuru RR, Bruemmer D, Collins BS, Ekhlaspour L, et al. 11. Chronic kidney disease and risk management: Standards of care in diabetes—2024. Diab Care. 2024;47. https://doi.org/10.2337/dc24-s011
24. Alicic RZ, Rooney MT, Tuttle KR. Diabetic Kidney Disease: Challenges, Progress, and Possibilities. Clinical Journal of the American Society of Nephrology. 2017;12(12):2032-45. https://doi.org/10.2215/cjn.11491116.
25. Gembillo G, Siligato R, Cernaro V, Satta E, Conti G, Salvo A, et al. Monocyte to HDL ratio: a novel marker of resistant hypertension in CKD patients. Int Urol Nephrol. 2022;54(2):395-403. https://doi.org/10.1007/s11255-021-02904-9.
26. Targher G, Bertolini L, Rodella S, Zoppini G, Lippi G, Day C, Muggeo M. Non-alcoholic fatty liver disease is independently associated with an increased prevalence of chronic kidney disease and proliferative/laser-treated retinopathy in type 2 diabetic patients. Diabetologia. 2008;51(3):444-50. https://doi.org/10.1007/s00125-007-0897-4
27. Thomas MC, MacIsaac RJ, Tsalamandris C, Molyneaux L, Goubina I, Fulcher G, et al. The burden of anaemia in type 2 diabetes and the role of nephropathy: a cross-sectional audit. Nephrol Dial Transplant. 2004;19(7):1792-7. https://doi.org/10.1093/ndt/gfh248.
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| Issue | Vol 2026 No 4 (2) | |
| Section | Original Articles | |
| Keywords | ||
| Type 2 Diabetes Diabetic Nephropathy Uric Acid-to-HDL Ratio HbA1c Glycemic Control | ||
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How to Cite
1.
Fadhii Ajeel Alshammari M, Hoseini FS, Mokhtari H, Musavi H, Khonakdar-Tarsi A. Relationship Between Uric Acid/HDL Ratio, Biochemical, and Hematological Parameters in Type 2 Diabetic Patients with and Without Nephropathy. ABI. 2026;2026(4):89-97.
