Association between serum uric acid/HDL-cholesterol ratio and chronic kidney disease: a cross-sectional study based on a health check-up population

Association Between Uric Acid to High-Density Lipoprotein Cholesterol Ratio and Kidney Function in Patients With Primary Aldosteronism: A Cross-Sectional Study

The relationship between the uric acid to high-density lipoprotein cholesterol ratio (UHR) and kidney function in patients with primary aldosteronism (PA) is unclear. Therefore, this research explored the link between the UHR and kidney function in PAs. This research was conducted at the 2nd Affiliated Hospital of Nanchang University and involved PA individuals hospitalized between October 2017 and April 2022. A total of 653 eligible participants were included in the analysis for this research. The kidney function was assessed by the estimated glomerular filtration rate (eGFR), which is calculated using the modification of diet in renal disease (MDRD) equation. Chronic kidney disease (CKD) was defined as an eGFR <60 mL/min per 1.73 m2 or the ratio of urine microalbumin to creatinine (UACR) ≥30 mg/g. The study used multivariable-adjusted linear regression analyses to investigate the association between log-transformed UHR levels and, eGFR and CKD. After multivariable adjustments, the results indicated an inverse association between Lg-UHR and eGFR (per SD increment; β: -9.02; 95% CI: -11.59, -6.46). Compared to PA patients with the lowest level of Lg-UHR (T1), patients with the highest level of Lg-UHR (T3) had a lower eGFR (β: -20.14, 95% CI: -26.25, -14.04). Conversely, Lg-UHR and CKD showed a positive association cross-sectionally (per SD increment; OR: 1.67; 95% CI: 1.26, 2.23). Compared to PA patients in T1 level, patients in T3 level had a higher prevalence of CKD (OR: 2.52, 95% CI: 1.26, 5.05). In patients with PA, UHR is inversely associated with eGFR and positively associated with CKD.

Association of serum Metrnl levels and high-density lipoprotein cholesterol in patients with type 2 diabetes mellitus: a cross-sectional study

Purpose

Meteorin-like (Metrnl) is a novel adipokine which is highly expressed in adipose tissue and has a beneficial effect on glucose and lipid metabolism. High density lipoprotein cholesterol (HDL-C) is well recognized to be inversely associated with cardiovascular events. However, the relationship between serum Metrnl levels and HDL-C in the type 2 diabetes mellitus (T2DM) remains unclear. Therefore, the present study aimed to evaluate the association of serum Metrnl with HDL-C levels in T2DM.

Materials and Methods

Eighty participants with T2DM were included in this cross-sectional study. They were divided into two groups according to HDL-C levels: Group1 (lower HDL-C group): HDL-C < 1.04 mmol/L; Group2 (higher HDL-C group): HDL-C ≥ 1.04 mmol/L. Serum Metrnl levels were measured by enzyme-linked immunosorbent assay (ELISA).

Results

As compared with lower HDL-C levels groups, serum Metrnl levels were significantly higher in the group with higher HDL-C. Binary logistic regression analysis showed serum Metrnl levels were positively associated with HDL-C group after adjustment with sex, age, body mass index (BMI), mean arterial pressure (MAP), fasting blood glucose (FPG), triglyceride (TG). Furthermore, serum Metrnl levels were inversely correlated with insulin resistance index (HOMA-IR). HDL-C levels were lowest in the group with the lowest Metrnl levels group and remained positively associated with Metrnl after adjustment for sex, age, BMI, TG, and HOMA-IR by using multivariate logistic regression analysis.

Conclusion

Serum Metrnl levels were positively associated with HDL-C levels in patients with T2DM.This suggests that increasing serum Metrnl levels maybe a candidate for improving lipid metabolism and preventing cardiovascular events in T2DM.

Registry and the Registration No of the Study/Trial

The study was registered in the Chinese clinical trial registry (ChiCTR- 2100047148).

Changes in metabolic overweight phenotypes over time and risk of nephrolithiasis: a cohort study

BACKGROUND

Overweight/obesity is considered an independent risk factor for nephrolithiasis, but little is known about its effect on nephrolithiasis according to metabolic health status.

OBJECTIVES

We aimed to investigate the association between various metabolic overweight phenotypes and the occurrence of nephrolithiasis. It also explores whether changes in these phenotypes over time influence the risk of nephrolithiasis.

MATERIALS AND METHODS

A total of 10,315 participants free of nephrolithiasis who underwent an annual health checkup from 2017 to 2022 were included in our prospective cohort study. They were categorized into four groups according to the presence of overweight and metabolic abnormalities (MA). The primary endpoint was the occurrence of renal stones. Multivariable Cox analysis was conducted to elucidate the relationship between metabolic overweight phenotypes and incident nephrolithiasis.

RESULTS

During a median follow-up duration of 4.02 years, nephrolithiasis occurred in 1,468 (14.23%) participants. In the full cohort, we observed that the 5-year cumulative incidences of nephrolithiasis were highest in the metabolically healthy overweight (MHO) and metabolically abnormal overweight (MAO) groups. The hazard ratios (HRs) for nephrolithiasis, relative to metabolically healthy normal weight (MHNW), ranged from 1.19 (95% CI:1.03-1.37; MHO) to 1.32 (95% CI:1.15-1.51; MAO). Furthermore, individuals with persistent MHO throughout follow-up were at a 1.42-fold increased risk of nephrolithiasis (P < 0.001), and 32.17% of individuals experienced changes in phenotype during follow-up. Among MAO subjects, those who transitioned to MHO and MHNW had a 26% and 45% lower risk of incident nephrolithiasis, respectively, compared to those who persisted in the MAO phenotype.

CONCLUSION

Individuals in the MHO and MAO groups exhibit an elevated risk of incident nephrolithiasis in this prospective cohort study. A significant proportion of nephrolithiasis cases may be potentially preventable through the appropriate management of metabolic risk factors for MAO subjects.

Correlation between serum uric acid to high-density lipoprotein cholesterol ratio and atrial fibrillation in patients with NAFLD

BACKGROUND

Non-alcoholic fatty liver disease (NAFLD) is independently associated with atrial fibrillation (AF) risk. The uric acid (UA) to high-density lipoprotein cholesterol (HDL-C) ratio (UHR) has been shown to be closely associated with cardiovascular disease (CVD) and NAFLD. The aim of this study is to clarify whether elevated UHR is associated with the occurrence of AF in patients with NAFLD and to determine whether UHR predicted AF.

METHODS

Patients diagnosed with NAFLD in the Department of Cardiovascular Medicine of the Second Hospital of Shanxi Medical University from January 1, 2020, to December 31, 2021, were retrospectively enrolled in this study. The study subjects were categorized into AF group and non-AF group based on the presence or absence of combined AF. Logistic regression was performed to evaluate the correlation between UHR and AF. Sensitivity analysis and subgroup interaction analysis were performed to verify the robustness of the study results. Receiver operating characteristic (ROC) curve analysis was used to determine the optimal cutoff value for UHR to predict the development of AF in patients with NAFLD.

RESULTS

A total of 421 patients with NAFLD were included, including 171 in the AF group and 250 in the non-AF group. In the univariate regression analysis, NAFLD patients with higher UHR were more likely to experience AF, and the risk of AF persisted after confounding factors were adjusted for (OR: 1.010, 95%CI: 1.007-1.013, P<0.001). AF risk increased with increasing UHR quartile (P for trend < 0.001). Despite normal serum UA and HDL-C, UHR was still connected with AF in patients with NAFLD. All subgroup variables did not interact significantly with UHR in the subgroup analysis. The ROC curve analysis showed that the areas under the curve for UA, HDL-C, and UHR were 0.702, 0.606, and 0.720, respectively, suggesting that UHR has a higher predictive value for AF occurrence in NAFLD patients compared to HDL-C or UA alone.

CONCLUSION

Increased UHR level was independently correlated with a high risk of AF in NAFLD patients.

Intersecting pathways: evaluating inflammatory markers and metabolism in chronic spontaneous urticaria with a multi-marker approach

BACKGROUND

Chronic spontaneous urticaria (CSU) is an inflammatory skin disease with intricate mechanisms. This study comprehensively assessed markers from diverse metabolic pathways, including novel inflammatory indicators, to evaluate their potential for diagnosing and monitoring CSU.

MATERIALS AND METHODS

In the study involving 90 CSU patients and 90 healthy controls, the levels of albumin, high-density lipoprotein (HDL), fibrinogen, uric acid, D-dimer, C-reactive protein (CRP), and white blood cells (WBC) values were analyzed. The D-dimer/albumin ratio (DAR), fibrinogen/albumin ratio (FAR), and uric acid/HDL ratio (UHR), considered novel inflammatory markers, were calculated. The Urticaria Activity Score 7 (UAS7) was also calculated. Pearson chi-squared test, Mann-Whitney U test, Spearman correlation coefficient, and univariate logistic regression analysis were employed for data analysis.

RESULTS

In the patient group, significant elevations were observed in DAR, FAR, fibrinogen, CRP, D-dimer, and UHR values. Additionally, albumin, HDL, and uric acid values exhibited significant decreases. HDL and albumin provided the most accurate results in the univariate logistic regression analysis. CRP had less accuracy, FAR exhibited greater accuracy than fibrinogen, and DAR demonstrated higher accuracy than D-dimer. There was no statistically significant correlation between the UAS7 and parameters. The considerable correlation of CRP with other parameters, except D-dimer, was also remarkable.

CONCLUSIONS

Indicators from diverse metabolic pathways, including albumin, HDL, uric acid, fibrinogen, D-dimer, and CRP, can be valuable in assessing CSU. In particular, FAR and DAR are emerging as potential markers to consider in the assessment of CSU.

The Relationship Between UA/HDL and Diabetic Peripheral Neuropathy: A Cross-Sectional Analysis

Purpose

This study was designed to analyze correlations between the uric acid to high-density lipoprotein cholesterol ratio (UHR) and peripheral nerve conduction velocity (NCV) among type 2 diabetes mellitus (T2DM) patients.

Patients and Methods

This was a single-center cross-sectional analysis of 324 T2DM patients. All patients were separated into a group with normal NCV (NCVN) and a group with abnormal NCV (NCVA). Patients were also classified into groups with low and high UHR values based on the median UHR in this study cohort. Neurophysiological data including motor and sensory conduction velocity (MCV and SCV, respectively) were measured for all patients.

Results

Relative to patients with low UHR values, those in the high UHR group presented with greater NCVA prevalence (P = 0.002). UHR remained negatively correlated with bilateral superficial peroneal nerve SCV, bilateral common peroneal nerve MCV, bilateral ulnar nerve SCV, and bilateral right median nerve MCV even after adjustment for confounding factors. UHR was identified as an NCVA-related risk factor, with a 1.370-fold increase in NCVA prevalence for every unit rise in UHR (P < 0.001).

Conclusion

These results identify UHR as a risk factor associated with NCVA that was independently negatively associated with NCV among T2DM patients.

Association between cumulative uric acid to high-density lipoprotein cholesterol ratio and the incidence and progression of chronic kidney disease

Objective

The ratio of uric acid to high-density lipoprotein cholesterol (UHR) was related to the risk of chronic kidney disease (CKD), we aimed to investigate the association of cumulative UHR (cumUHR) with incidence and progression of CKD.

Methods

Our study included a total of 49,913 participants (mean age 52.57 years, 77% males) from the Kailuan Study conducted between 2006 and 2018. Participants who completed three consecutive physical examinations were included. Cumulative UHR (cumUHR) was computed as the summed average UHR between two consecutive physical examinations, multiplied by the time between the two examinations. Participants were then categorized into four groups based on cumUHR quartiles. Subsequently, participants were further divided into a CKD group and a non-CKD group. The associations between cumUHR and CKD and it's progression were assessed by Cox proportional hazards regression models. The cumulative incidence of endpoint events was compared between the cumUHR groups using the log-rank test. The C-index, net reclassification improvement (NRI) and integrated discrimination improvement (IDI) were calculated to assess the predictive performance of cumUHR.

Results

After a mean follow-up of 8.0 ± 1.7 years, there were 4843 cases of new-onset CKD, 2504 of low eGFR, and 2617 of proteinuria in the non-CKD group. Within the CKD group, there were 1952 cases of decline in eGFR category, 1465 of >30% decline in eGFR, and 2100 of increased proteinuria. In the non-CKD group, the adjusted hazard ratios (HRs) and confidence intervals (CIs) in the fourth quartile were 1.484 (1.362-1.617), 1.643 (1.457-1.852), and 1.324 (1.179-1.486) for new-onset CKD, low eGFR, and proteinuria, respectively. In the CKD group, the adjusted HRs in the fourth quartile were 1.337 (1.164-1.534), 1.428 (1.216-1.677), and 1.446 (1.267-1.651) for decline in eGFR category, >30% decline in eGFR, and increase in proteinuria, respectively. In addition, we separately added a single UHR measurement and cumUHR to the CKD base prediction model and the CKD progression base prediction model, and found that the models added cumUHR had the highest predictive value.

Conclusion

High cumUHR exposure was an independent risk factor for the incidence and progression of CKD, and it was a better predictor than a single UHR measurement.

Investigation of the applicability of the zebrafish model for the evaluation of aristolochic acid-related nephrotoxicity

BACKGROUND

The risk of compounds/drugs, including aristolochic acid-induced nephrotoxicity remains high and is a significant public health concern. Therefore, it is particularly important to select reasonable animal models for rapid screening and evaluation of different samples with complex chemical systems. The zebrafish (Danio rerio) has been used to study chemical-induced renal toxicity. However, most of the published literature was performed on individual components or drugs, and the key evidence confirming the applicability of zebrafish larvae for the evaluation of aristolochic acid-related nephrotoxicity in complex chemical systems, such as in traditional Chinese medicine (TCM), was insufficient.

METHODS

High-performance liquid chromatography (HPLC) was used to determine the content of aristolochic acid (AA) in herbs and Chinese patent medicines. The zebrafish larvae at 4 days post-fertilization (dpf) were used to evaluate the nephrotoxicity of various samples, respectively, based on the phenotype of the kidney and histological, and biochemical. Transcriptome technology was used to investigate the related signaling pathways and potential mechanisms after treatment with AA, which was verified by RT-PCR technology.

RESULTS

The results showed that the total amounts of AAI, AAII, and ALI ranged from 0.0004 to 0.1858 g·g-1( %) from different samples, including Aristolochia debilis, Fibraurea recisa, Asarum, Wantongjingu tablets, Jiuweiqianghuo granules, and Xiaoqinglong granules in descending order. Moreover, compared with the negative/blank control, substantial changes in phenotype, histomorphology and biochemical parameters of renal function were observed in the groups challenged with the sublethal concentration of drugs. The transcriptomics results showed the upregulation of most genes in PERK/ATF4/CHOP, ATM/Chk2/p53, Caspase/Bax/Bcl-2a, TGF/Smad/ERK, PI3K/Akt, induced by aristolochic acid analogues, which were essentially consistent with those of the q-RT-PCR experiments, highlighting the similar toxicity response to the previously published article with the other traditional evaluation model.

CONCLUSION

The stability, accuracy and feasibility of the zebrafish larval model in screening and evaluating the nephrotoxicity of TCM were validated for the first time on the AAs-related drugs in a unified manner, confirming and promoting the applicability of zebrafish in assessing nephrotoxicity of samples with complex chemical character.

Could serum uric acid to HDL cholesterol ratio predict sacroiliitis?

Recently, several inflammatory markers, including the uric acid to HDL cholesterol ratio (UHR), triglyceride/HDL cholesterol ratio (THR), systemic inflammatory index (SII), and C-reactive protein to albumin ratio (CAR), have been reported to be associated with inflammatory conditions. However, their collective role in sacroiliitis has not been extensively studied. This study aims to investigate the general characteristics and inflammatory markers in patients with and without sacroiliitis, and to observe any differences in these parameters in subjects with active and chronic sacroiliitis. Patient with sacroiliitis who showed up in the Radiology Department of Abant Izzet Baysal University Hospital were enrolled. Patients diagnosed with sacroiliitis based on clinical symptoms, physical examination, and conventional radiography or MRI findings were included in the sacroiliitis group. Patients without sacroiliitis who present with back pain or hip pain but have normal radiographic findings were included in the control group. General characteristics, including age, sex, body mass index (BMI), medical history, and disease duration, were collected from all participants. Blood samples were collected to measure inflammatory markers, including UHR, THR, SII, and CAR. The collected data were compared between sacroiliitis and control groups. Subgroup analysis was also performed to compare the inflammatory markers between subjects with active and chronic sacroiliitis. The median UHR of the sacroiliitis and control subjects were 11% (3-20%) and 7% (3-13%), respectively (p<0.001). Serum UHR was significantly and positively correlated with CRP (r: 0.4, p = 0.001) and ferritin (r: 0.17, p = 0.045) levels. In ROC analysis, a UHR level higher than 8% has an 81% sensitivity and 64% specificity in detecting sacroiliitis (AUC: 0.8, p<0.001, 95% CI: 0.72-0.84). In conclusion, we suggest that UHR could provide useful data as an additional diagnostic tool in patients with sacroiliitis.

A comprehensive investigation of novel and traditional inflammatory and metabolic markers as predictive indicators in psoriasis

BACKGROUND

Psoriasis is a chronic inflammatory and papulosquamous dermatological disorder. While previous studies have discussed certain inflammatory markers for diagnosing and monitoring psoriasis, there is an absence of comprehensive research encompassing both novel and traditional inflammatory markers, as well as metabolic markers, in relation to psoriasis.

METHODS

A total of 209 individuals participated, including 54 psoriasis patients and 155 controls. Psoriasis Area Severity Index (PASI) was calculated for the patient group. Potential predictive markers for psoriasis were identified: Uric acid/HDL ratio (UHR), D-dimer/albumin ratio (DAR), fibrinogen/albumin ratio (FAR), erythrocyte sedimentation rate, CRP, WBC, HOMA-IR, and vitamin D levels. Differences between groups and correlations with PASI and each other were analyzed using the Mann-Whitney U test and Spearman correlation coefficient.

RESULTS

The results indicate that the patient group exhibited statistically significantly higher levels of UHR, FAR, CRP, WBC, and HOMA-IR. Upon analyzing the correlations between PASI and the identified markers, statistically significant positive correlation with WBC and negative correlation with vitamin D were observed. The correlations of PASI with other markers did not reach statistical significance. It should be underlined that our study was conducted in a predominantly mild-to-moderate patient population.

CONCLUSIONS

The absence of specificity of these markers for psoriasis limits their practical application. However, the development of new objective measures by using them in combination with specific data such as PASI will provide significant benefits in terms of disease diagnosis, follow-up, and treatment.

The Relationship Between Diabetic Neuropathy and Uric Acid/High-Density Lipoprotein Ratio in Patients With Type-2 Diabetes Mellitus

BACKGROUND

We aimed to investigate whether there was a relationship between diabetic peripheral distal neuropathy (DPDN), one of the most common chronic complications in patients with type 2 diabetes mellitus (T2DM), and the uric acid/HDL ratio, which can be used as an indicator of poor metabolic status.

METHODOLOGY

The study consisted of a total of 150 subjects, including 50 patients with T2DM (group 1) who were determined to have diabetic peripheral distal neuropathy with electroneuromyography (ENMG), 50 patients with T2DM who were determined to not have DPDN in their ENMG (group 2), and 50 healthy individuals (group 3). Participants' serum fasting blood glucose (FBG), glycosylated hemoglobin (HbA1c), uric acid, total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglyceride levels were analyzed. The uric acid/HDL-C ratio (UHR) was calculated. The relationship between UHR and other parameters was evaluated in all three groups.

RESULTS

Patients with T2DM who had diabetic neuropathy (group 1), did not have diabetic neuropathy (group 2), and healthy subjects (group 3) were similar in terms of age and gender (p=0.066, p=0.185). Groups 1 and 2 were similar in terms of the duration of diabetes and FBG values (p=0.825, p=0.572), but these values were lower in group 3 than in groups 1 and 2 (p<0.05). HbA1c did not differ significantly between groups 1 and 2 (p=0.607). Creatinine levels were similar in the three groups. Uric acid levels were significantly higher in group 1 than in group 2 (p=0.040), but there was no significant difference between groups 1 and 3 or between groups 2 and 3 (p>0.05). UHR was significantly lower in group 1 than in groups 2 and 3 (p<0.001), but no significant difference was found between groups 2 and 3.

CONCLUSION

In our study, we found that the UHR level of the group with diabetic neuropathy was statistically significant compared to the levels of the other two groups. However, no significant difference was found between the patients with diabetes who did not have neuropathy and the healthy group. Based on the findings of our study, we can say that the UHR level is a predictor of the microvascular complications of diabetes.