The Association between Uric Acid to High-Density Lipoprotein Cholesterol Ratio and Kidney Stones in White Americans: Evidence from NHANES 2011-2020

Abstract Background Kidney stones represent a prevalent urinary tract disorder, exhibiting notable racial disparities in incidence, resulting in substantial medical and economic burdens. The uric acid to high-density lipoprotein cholesterol ratio (UHR) is a comprehensive index reflecting metabolic and inflammatory abnormalities, yet its association with kidney stones remains unclear. This study evaluated the relationship between UHR and kidney stones in non-Hispanic white adults using nationally representative data. Methods A cross-sectional analysis of 8,629 non-Hispanic White participants from the National Health and Nutrition Examination Survey (NHANES) 2011–2020 was conducted. Multivariate logistic regression models were conducted to assess the association between UHR and kidney stones, while dose-response relationships were explored using smooth curve fitting. Stratified analyses were performed to evaluate the stability of the outcomes. Results The kidney stones incidence was 12.7% (1,100/8,629). Participants in the highest UHR tertile (>12.3%) exhibited significantly higher kidney stone prevalence (15.38%) compared to the lowest tertile (<8.4%) at 9.55%. In fully adjusted models, higher UHR was associated with increased risk of kidney stones (OR=1.02, 95% CI: 1.00–1.04, p=0.0206). Participants in the highest tertile had a 31% increased risk relative to the lowest tertile (OR=1.31, 95% CI: 1.03–1.67, p=0.03), with a significant positive dose-response trend (p for trend=0.0338). Associations remained consistent across subgroups without significant interaction effects. Conclusions The present study has demonstrated that UHR is positively associated with kidney stones in White Americans. This finding offers new perspectives for the assessment and prevention of kidney stones.