Multi-trajectories of serum uric acid/high density lipoprotein cholesterol ratio and fasting plasma glucose in chronic kidney disease

Background This study aimed to investigate the associations of longitudinal trajectories of the serum uric acid to high-density lipoprotein cholesterol ratio (UHR) and fasting plasma glucose (FPG) with chronic kidney disease (CKD) risk.Methods In this retrospective cohort study, we included 7,541 adults who underwent at least three annual health examinations. Cox proportional hazards models were used to evaluate associations of UHR and FPG (in quartiles) with incident CKD. Group-based multi-trajectory modeling (GBMTM) was subsequently applied to identify distinct joint trajectories of UHR and FPG.Results During follow-up, 558 participants developed CKD (incidence 7.40%). In fully adjusted Cox models, higher UHR quartiles remained independently associated with increased CKD risk. The association for FPG was attenuated after full adjustment.GBMTM identified four joint trajectory groups: Group 1(low UHR–low FPG), Group 2(moderate UHR–moderate FPG), Group 3(moderate–high UHR with fluctuating moderate FPG), and Group 4(high UHR with fluctuating moderate FPG). Compared to Group 1, the adjusted hazard ratios (95% CI) for CKD were 1.34 (1.05 ∼ 1.70) for Group 2, 2.31 (1.73 ∼ 3.09) for Group 3, and 4.21 (2.88 ∼ 6.15) for Group 4. Subgroup analyses generally supported these findings.Conclusions While elevated UHR is independently associated with the risk of developing CKD, the association for FPG was attenuated after full adjustment. The joint trajectory analysis highlights that their dynamic co-evolution is significantly associated with CKD risk, identifying a high-risk phenotype that may inform early risk stratification.