Abstract
OBJECTIVE: This study aims to examine the association between the serum uric acid-to-high-density lipoprotein cholesterol ratio (UHR) and the presence of microalbuminuria in individuals diagnosed with type 2 diabetes mellitus (T2DM), and to evaluate the potential of UHR as a predictive marker for early diabetic nephropathy (DN). METHODS: A cross-sectional study was conducted at The First Hospital of Longyan City between 2022 and 2024, which included 563 individuals with T2DM (38.54% male, 61.46% female). The exposure variable was UHR, while the outcome variable was microalbuminuria, defined as a urinary albumin-to-creatinine ratio (UACR) ≥ 30 mg/g and < 300 mg/g. Covariates included age, sex, diabetes duration, blood pressure parameters, waist-to-height ratio, glycated hemoglobin (HbA1c), triglyceride-glucose body mass index (TyG-BMI index), and medication history. Multivariate logistic regression analysis was applied to evaluate the association between UHR and microalbuminuria. A generalized additive model (GAM) was employed to assess potential nonlinear associations. Receiver-operating characteristic (ROC) curves were generated to assess predictive performance. RESULTS: Following full adjustment for covariates, UHR demonstrated a significant association with microalbuminuria (odds ratio [OR] = 2.06, 95% confidence interval [CI]: 1.03-4.12, p = 0.041). GAM analysis revealed a positive linear association between UHR and the risk of microalbuminuria. In the sex-specific predictive model, the area under the curve (AUC) was 0.738 (95% CI 0.642-0.819) for female patients and 0.705 (95% CI 0.630-0.765) for male patients. CONCLUSION: UHR was identified as an independent risk factor for microalbuminuria in individuals with T2DM, demonstrating a dose-response relationship. Incorporating UHR into sex-specific predictive models improved the accuracy of microalbuminuria risk assessment, supporting its potential utility in the early identification and prevention of diabetic nephropathy.