Key result
Higher neutrophil-to-HDL ratio linked to ~22% higher diabetic nephropathy odds per unit increase.
Why the study?
Is a higher neutrophil-to-HDL cholesterol ratio associated with diabetic nephropathy in adults with diabetes mellitus?
Cross-Sectional (n=2,005)
Is a higher neutrophil-to-HDL cholesterol ratio associated with diabetic nephropathy in adults with diabetes mellitus?
Odds Ratio: 1.2248 (95% CI 1.1533–1.3017)
p-value: p=<.001
A higher neutrophil-to-HDL cholesterol ratio is independently associated with an increased risk of diabetic nephropathy in US adults, suggesting its potential utility as a readily available risk stratification biomarker.
Renal complications in diabetes impose substantial morbidity globally, yet early risk stratification remains challenging. The neutrophil-to-HDL cholesterol ratio (NHR) represents an integrated biomarker reflecting both immune activation and dyslipidemia, with neutrophilia promoting renal inflammation and low HDL-C impairing renoprotective mechanisms. We evaluated whether NHR is associated with diabetic nephropathy (DN) in a population-based cross-sectional study. We analyzed 2005 diabetic adults from six NHANES cycles (2007-2018). DN was defined as microalbuminuria (UACR ≥ 30 mg/g) or reduced eGFR (<60 mL/min/1.73m2) calculated via CKD-EPI 2021. NHR was computed as the ratio of neutrophil count to HDL-C concentration. Multivariable logistic regression with sequential covariate adjustment (demographics, socioeconomic factors, and comorbidities) was used to examine NHR-DN associations. Quartile-based dose-response analysis and restricted cubic spline modeling were additionally performed to characterize the association shape. DN prevalence reached 37.31% (n = 748). Individuals with nephropathy exhibited 15% higher median NHR (3.691 vs. 3.211, P < .001). Fully adjusted models revealed that per-unit NHR elevation increased DN odds by 22.48% (OR 1.2248, 95%CI 1.1533-1.3017, P < .001). Quartile analysis demonstrated dose-response relationships: top quartile participants showed 2.70-fold higher nephropathy risk versus bottom quartile (OR 2.6967, 95%CI 1.9965-3.6556, p-trend < 0.001). Higher NHR independently correlates with diabetic nephropathy presence in US adults. This readily calculated index combining inflammatory and metabolic dimensions may enhance clinical risk assessment. These observational findings suggest that NHR may serve as a complementary marker to support kidney disease risk stratification in diabetic patients, pending confirmation by prospective studies.
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Zhou et al. (2026) conducted a cross-sectional in Diabetes mellitus (n=2,005). Neutrophil-to-HDL cholesterol ratio (NHR) vs. Lower NHR was evaluated on Diabetic nephropathy (microalbuminuria [UACR ≥ 30 mg/g] or reduced eGFR [<60 mL/min/1.73m2]) (OR 1.2248, 95% CI 1.1533-1.3017, p=<.001). Higher neutrophil-to-HDL cholesterol ratio was independently associated with increased odds of diabetic nephropathy in US adults (OR 1.2248 per unit increase; 95% CI 1.1533-1.3017; P<0.001).
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