Research Article

Investigation of Uric Acid/HDL-Cholesterol Ratio as an Independent Risk Factor for Diabetic Nephropathy: A Cross-Sectional Study

Volume: 52 July 22, 2026
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Investigation of Uric Acid/HDL-Cholesterol Ratio as an Independent Risk Factor for Diabetic Nephropathy: A Cross-Sectional Study

Abstract

Diabetic nephropathy (DN) is a major microvascular complication requiring early markers for risk stratification. We investigated the clinical utility of the uric acid (UA) to high density lipoprotein cholesterol (HDL-C) ratio (UHR) as a practical proinflammatory-prooxidative marker for DN. In this retrospective cross-sectional study, records of 934 patients with diabetes mellitus (DM) were analyzed. UHR was calculated as [UA/HDL] x 100. DN was defined based on the albumin-to-creatinine ratio (ACR) and/or estimated glomerular filtration rate (eGFR) criteria. Patients were evaluated according to the presence of nephropathy, stage of nephropathy, and albuminuria categories. ROC analysis was performed for UHR, UA and HDL-C. Factors associated with DN were evaluated using logistic regression analysis. UHR was significantly higher in patients with DN compared to those without DN (p<0.001). UHR showed a significant increase across nephropathy stages and albuminuria categories (p<0.001). In the ROC analysis, UA demonstrated the highest performance in distinguishing DN (AUC=0.763; 95% CI: 0.733–0.794; p<0.001). The AUC value for UHR was 0.740 (95% CI: 0.709–0.771; p<0.001), and for HDL-C, it was 0.591 (95% CI:0.555–0.627; p<0.001). The optimal cutoff value for UHR was determined to be 13.07. In the multivariate logistic regression analysis, UHR was found to be independently associated with DN after adjusting for age, sex, systolic blood pressure, HbA1c, and triglycerides (OR=1.221; 95% CI: 1.179–1.265; p<0.001). In the component-based model, UA showed a strong positive association with DN (OR=1.971; 95% CI: 1.766–2.200; p<0.001), while HDL-C showed a significant inverse association (OR=0.983; 95% CI: 0.969–0.997; p=0.018). UHR was found to be significantly associated with the presence of DN, stage of nephropathy, and albuminuria categories. However, the fact that UA demonstrates slightly higher discriminatory performance compared to UHR suggests that UHR should be interpreted as an easily calculable complementary biomarker rather than a superior standalone marker in the assessment of DN. These findings require validation in prospective studies.

Keywords

Ethical Statement

Our study was approved by the Ethics Committee of Health Sciences Research at Sivas Cumhuriyet University on July 10, 2025, with decision number 2025-07/32. Due to the retrospective nature of the study, informed consent forms were not obtained with the knowledge of the ethics committee. Our study was conducted in accordance with the principles of the Declaration of Helsinki.

References

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Details

Primary Language

English

Subjects

​Internal Diseases

Journal Section

Research Article

Publication Date

July 22, 2026

Submission Date

March 29, 2026

Acceptance Date

July 5, 2026

Published in Issue

Year 2026 Volume: 52

APA
Keskin, Z., Büyüktekeli, O., & Aşkın, M. F. (2026). Investigation of Uric Acid/HDL-Cholesterol Ratio as an Independent Risk Factor for Diabetic Nephropathy: A Cross-Sectional Study. Journal of Uludağ University Medical Faculty, 52. https://doi.org/10.32708/uutfd.1918355
AMA
1.Keskin Z, Büyüktekeli O, Aşkın MF. Investigation of Uric Acid/HDL-Cholesterol Ratio as an Independent Risk Factor for Diabetic Nephropathy: A Cross-Sectional Study. Journal of Uludağ University Medical Faculty. 2026;52. doi:10.32708/uutfd.1918355
Chicago
Keskin, Zekeriya, Onur Büyüktekeli, and Muhammed Faruk Aşkın. 2026. “Investigation of Uric Acid HDL-Cholesterol Ratio As an Independent Risk Factor for Diabetic Nephropathy: A Cross-Sectional Study”. Journal of Uludağ University Medical Faculty 52 (July). https://doi.org/10.32708/uutfd.1918355.
EndNote
Keskin Z, Büyüktekeli O, Aşkın MF (July 1, 2026) Investigation of Uric Acid/HDL-Cholesterol Ratio as an Independent Risk Factor for Diabetic Nephropathy: A Cross-Sectional Study. Journal of Uludağ University Medical Faculty 52
IEEE
[1]Z. Keskin, O. Büyüktekeli, and M. F. Aşkın, “Investigation of Uric Acid/HDL-Cholesterol Ratio as an Independent Risk Factor for Diabetic Nephropathy: A Cross-Sectional Study”, Journal of Uludağ University Medical Faculty, vol. 52, July 2026, doi: 10.32708/uutfd.1918355.
ISNAD
Keskin, Zekeriya - Büyüktekeli, Onur - Aşkın, Muhammed Faruk. “Investigation of Uric Acid HDL-Cholesterol Ratio As an Independent Risk Factor for Diabetic Nephropathy: A Cross-Sectional Study”. Journal of Uludağ University Medical Faculty 52 (July 1, 2026). https://doi.org/10.32708/uutfd.1918355.
JAMA
1.Keskin Z, Büyüktekeli O, Aşkın MF. Investigation of Uric Acid/HDL-Cholesterol Ratio as an Independent Risk Factor for Diabetic Nephropathy: A Cross-Sectional Study. Journal of Uludağ University Medical Faculty. 2026;52. doi:10.32708/uutfd.1918355.
MLA
Keskin, Zekeriya, et al. “Investigation of Uric Acid HDL-Cholesterol Ratio As an Independent Risk Factor for Diabetic Nephropathy: A Cross-Sectional Study”. Journal of Uludağ University Medical Faculty, vol. 52, July 2026, doi:10.32708/uutfd.1918355.
Vancouver
1.Zekeriya Keskin, Onur Büyüktekeli, Muhammed Faruk Aşkın. Investigation of Uric Acid/HDL-Cholesterol Ratio as an Independent Risk Factor for Diabetic Nephropathy: A Cross-Sectional Study. Journal of Uludağ University Medical Faculty. 2026 Jul. 1;52. doi:10.32708/uutfd.1918355

ISSN: 1300-414X, e-ISSN: 2645-9027

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