What question did this study set out to answer?

This study aims to evaluate the white blood cell-to-hemoglobin ratio (WBCHR) as a potential early biomarker for diabetic kidney disease (DKD) in patients with type 2 diabetes.

April 11, 2026Open Access

White Blood Cell-to-Hemoglobin Ratio, a Promising Indicator for Diabetic Kidney Disease: An Observational Cross-Sectional Study

MZMeng ZhangFirst Affiliated Hospital of Xi'an Jiaotong University LWLing WangFirst Affiliated Hospital of Xi'an Jiaotong University YLYuxuan LinHohai University

Key Points

This study aims to evaluate the white blood cell-to-hemoglobin ratio (WBCHR) as a potential early biomarker for diabetic kidney disease (DKD) in patients with type 2 diabetes.
Conducted an observational cross-sectional study involving 6257 patients with type 2 diabetes from Northwest China.
Compared demographic, metabolic, and full blood examination (FBE) indices between patients with and without DKD.
Used Spearman correlation, logistic regression, and ROC analysis to assess WBCHR's association with DKD occurrence.
Patients with DKD had significantly lower hemoglobin levels and higher inflammatory indices compared to non-DKD patients (P < 0.001).
WBCHR showed the strongest association with DKD and positively correlated with renal impairment indicators.
After adjustment for confounders, WBCHR was independently associated with DKD progression (Odds Ratio: 3.669, P < 0.001).
ROC analysis identified WBCHR as having potential for risk stratification in DKD, especially in those over 40 years, with a cut-off value of 0.529 (AUC = 0.641).

Abstract

Background: Diabetic kidney disease (DKD), a prevalent microvascular complication of type 2 diabetes (T2DM), is frequently diagnosed late with irreversible renal damage, underscoring the need for early-stage biomarkers. Anemia commonly occurs in DKD due to impaired erythropoiesis and reduced hemoglobin levels, while chronic inflammation also plays a key role in its progression. The white blood cell-to-hemoglobin ratio (WBCHR), derived from full blood examination (FBE), integrates inflammation and anemia signals in DKD. This study investigates WBCHR’s role in early DKD risk stratification. Materials and Methods: This observational cross-sectional study included 6257 patients with T2DM from Northwest China from 2013 to 2022 (1721 DKD, 4536 non-DKD). Demographic, metabolic, FBE indices, and renal function parameters were compared. Spearman correlation and logistic regression analysis were performed to assess the correlation between FBE indices of renal impairment, and the relationship between WBCHR and DKD occurrence. Receiver operating characteristic (ROC) analysis was used to calculate the discriminatory performance of WBCHR for DKD presence. Results: Age, male proportion, T2DM duration, insulin usage, blood pressure, fasting blood glucose and triglycerides were greater in patients with DKD ( P 40, with a cut-off value of 0.529 (AUC = 0.641, P < 0.001). Conclusion: WBCHR was significantly associated with an increased risk of DKD, suggesting its potential as a diagnostic and management indicator for DKD. Highlights: WBCHR was significantly associated with increased DKD risk in patients with T2DM and remained an independent factor after confounder adjustment. WBCHR could be adopted as a low-cost screening tool for early DKD risk in routine diabetes management. Keywords: diabetic kidney disease, complete blood count, white blood cell-to-hemoglobin ratio

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