Uric acid to high-density lipoprotein cholesterol ratio in association with adverse health outcomes in patients with chronic kidney disease.

Background and aims: The ratio of uric acid to high-density lipoprotein cholesterol (UHR) has recently been identified as a new metabolic marker and has been shown to be associated with cardiovascular disease (CVD), chronic kidney disease (CKD), and diabetes. Nonetheless, the connection between UHR and negative health outcomes in CKD is still not well understood.

Method and results: We analyzed data from the 1999-2018 National Health and Nutrition Examination Survey (NHANES), including 8071 individuals with chronic kidney disease (CKD). Wighted logistic regression models and weighted Cox proportional hazards models were employed to explore the association of UHR with health outcomes in CKD patients. A restricted cubic spline (RCS) regression model was applied to investigate potential nonlinear relationships. Additionally, subgroup analyses were conducted to examine potential interactions between UHR and other covariates. One unit increase in UHR was linked to a 4 % higher risk of cardiovascular disease (CVD), a 2 % increased risk of all-cause mortality, and a 3 % greater risk of CVD-related mortality (all P < 0.001). The RCS regression model demonstrated linear positive associations between UHR and these outcomes. The Kaplan-Meier curve revealed that individuals in the highest UHR quartile had significantly poorer outcomes in terms of both all-cause and CVD mortality. Subgroup analyses indicated that age, gender, and alcohol consumption might modulate the relationships between UHR and the three outcomes.

Conclusion: UHR significantly positively correlates to CVD, all-cause mortality and CVD mortality in CKD population. Monitoring UHR at relatively low levels may protect long-term outcomes for CKD patients.