HALP score and risk of renal progression in diabetic kidney disease

Abstract

Aim

Immunonutritional impairment driven by chronic inflammation and metabolic dysregulation plays a significant role in the progression of diabetic kidney disease (DKD). The hemoglobin–albumin–lymphocyte–platelet (HALP) score is a biomarker reflecting immunonutritional status; however, its prognostic value in patients with advanced DKD remains uncertain.

Method

In this retrospective cohort study, 348 patients with stage 3–4 chronic kidney disease (CKD) secondary to type 2 diabetes mellitus (eGFR 15–59 mL/min/1.73 m²) were included after screening 769 individuals (2012–2024). The primary endpoint was renal progression, defined as a ≥ 40% decline in eGFR or initiation of renal replacement therapy. HALP was initially categorized into tertiles to evaluate baseline differences. Subsequently, a ROC-derived cutoff was used to dichotomize patients into low- and high-HALP groups, followed by Kaplan–Meier and Cox regression analyses. Predictive performance was assessed using ROC analysis, and robustness was evaluated through subgroup analyses and 1:1 propensity score (PS) matching.

Results

Renal progression occurred in 181 patients. HALP components and urine protein creatinine ratio (UPCR) differed significantly across tertile groups (p < 0.001 for components; p = 0.025 for UPCR). The ROC-derived cutoff was 34.15 (AUC 0.602; p = 0.001). After PS matching (n = 278), low-HALP group remained independently associated with an increased risk of renal progression (HR 1.627; p = 0.005). Subgroup analyses revealed no significant interaction, supporting the consistency of the findings across clinical strata.

Conclusion

The HALP score may serve as a simple, cost-effective and widely available adjunctive tool for risk stratification in patients with advanced DKD.