The ratio of non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol is associated with diabetic kidney disease: A cross-sectional study

1. Each one-unit increase in Non-High-Density Lipoprotein Cholesterol to High-Density Lipoprotein Cholesterol Ratio (NHHR) was associated with an overall increase in diabetic kidney disease (DKD) prevalence of 6%

Evidence Rating Level: 2 (Good) 

A significant indicator of atherosclerosis is the Non-High-Density Lipoprotein Cholesterol to High-Density Lipoprotein Cholesterol Ratio (NHHR) and is used in monitoring diabetes. One major complication of diabetes is diabetic kidney disease (DKD). The relationship between NHHR and DKD is unclear. This study aims to identify a relationship between NHHR and DKD in adults in the U.S. 8,329 diabetic participants were included in the analysis. Covariates were assessed using the NHANES questionnaires. Diabetic individuals were categorized as either DKD or non-DKD groups based on diagnostic criteria for DKD. After adjusting for variables, there was a positive correlation between NHHR and DKD. Each one-unit increase in NHHR was associated with a 22% increase in DKD prevalence (95% CI: 1.06, 1.40, P = 0.004). Quartiles of NHHR confirmed this with a positive trend (p < 0.001). A smooth curve fit showed a J-shaped relationship between NHHR and DKD prevalence showing a less pronounced relationship until NHHR score hit 1.75 at which point every unit increase in NHHR increased the risk of DKD by 7%. A subgroup analysis showed this relationship remained within most subpopulations. The greatest association was in subpopulations without coronary heart disease and those that did not currently smoke. Therefore, there are significant differences in NHHR in DKD and non-DKD populations. Each one-unit increase in NHHR was associated with an overall increase in DKD prevalence of 6% (95% CI: 1.03–1.09, P < 0.001). The cross-sectional nature of the study design makes finding a causal relationship impossible and can limit the generalizability of the findings. 

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