A high serum uric acid to high-density lipoprotein cholesterol (HDL) ratio predicts an increased risk for chronic kidney disease (CKD), a new study finds.

In an adjusted analysis of data from 19,458 individuals (57.7% male; median age 50 years) who underwent an annual health check-up in 2019 in Nanjing, China, higher serum uric acid to HDL cholesterol ratios correlated with lower estimated glomerular filtration rate (eGFR) based on the Modification of Diet in Renal Disease study equation. Patients in the highest vs lowest quartile of the serum uric acid to HDL ratio had significant 9.3-fold increased odds of CKD, Donghua Yin of Jiangsu Province Geriatric Hospital in Nanjing, China, and colleagues reported in BMJ Open. The highest quartile group had 9.1-fold and 32-fold increased odds of stage G3 and G4-5 CKD, respectively, compared with the lowest quartile group.

Quartile 1 of the ratio was 10.96% or less in men and 6.47% or less in women. Quartile 4 of the ratio was 17.06% or more in men and 10.39% or more in women.

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In an analysis, a serum uric acid to HDL ratio greater than 11.7% had 55.2% sensitivity and 74.2% specificity for predicting CKD.

The investigators explained that the serum uric acid to HDL C ratio (both in mg/dL) reflects relative concentrations of inflammatory to anti-inflammatory substances.

“Our study showed that [serum uric acid to HDL ratio] is positively associated with the risk of CKD, reflecting chronic inflammation,” Yin’s team wrote. “Accordingly, increased [serum uric acid to HDL ratio] may serve as a novel and reliable indicator for CKD in the preclinical stage.”

In the study’s limitations, the investigators acknowledged that, despite adjustment of analyses for various factors, residual confounding cannot be ruled out.


Cheng Y, Zhang H, Zheng H, et al. Association between serum uric acid/HDL-cholesterol ratio and chronic kidney disease: a cross-sectional study based on a health check-up population. BMJ Open. doi:10.1136/bmjopen-2022-066243