Association between the uric acid-to-HDL-cholesterol ratio and diabetic kidney disease in individuals with type 2 diabetes and NAFLD: evidence from NHANES and an external hospital cohort

BACKGROUND: Diabetic kidney disease (DKD) is a major microvascular complication of type 2 diabetes mellitus (T2DM). Nonalcoholic fatty liver disease (NAFLD) frequently coexists with T2DM and may increase metabolic and renal vulnerability. The uric acid-to-high-density lipoprotein cholesterol ratio (UHR) is a composite metabolic marker, but its association with DKD in T2DM with NAFLD remains unclear. RESEARCH DESIGN AND METHODS: We analyzed 797 adults with T2DM and CAP-defined NAFLD from NHANES 2017-2018 and 202 hospitalized adults with ultrasound-confirmed NAFLD. Kidney outcome was defined as eGFR <60 mL/min/1.73 m² in NHANES and as eGFR <60 mL/min/1.73 m² and/or albuminuria/proteinuria in the hospital cohort. Multivariable logistic regression and restricted cubic spline models were used. RESULTS: <0.001). Highest vs lowest quartile showed higher odds (NHANES: OR=7.93; hospital cohort: OR=4.03). RCS suggested an approximately linear association. CONCLUSIONS: Higher UHR was associated with higher odds of DKD in T2DM with NAFLD. Findings should be interpreted cautiously and confirmed in prospective studies.