Lipid metabolism-related inflammatory indices and diabetic kidney disease in patients with type 2 diabetes mellitus: a cross-sectional study
6 affiliations
- 1Department of Endocrinology, Guang’anmen Hospital, China Academy of Chinese Medical Sciences
- 2Clinical Medical College, Beijing University of Chinese Medicine
- 3Department of Geriatrics, Affiliated Hospital of Shandong University of Traditional Chinese Medicine
- 4Department of Endocrinology, Fuzhou Hospital of Traditional Chinese Medicine
- 5Integrated Traditional Chinese and Western Medicine Diagnosis and Treatment Center, Chongqing General Hospital, Chongqing University
- 6Department of Nephrology, Xiyuan Hospital, China Academy of Chinese Medical Sciences
Abstract
Background: Improving the prognosis of diabetic kidney disease (DKD) requires early diagnosis and treatment. This study examined the associations of lipid metabolism-related inflammatory indices (LMIIs)—the platelet-, neutrophil-, monocyte-, and lymphocyte-to-high-density lipoprotein cholesterol ratios (PHR, NHR, MHR, and LHR, respectively)—with DKD in patients with type 2 diabetes mellitus (T2DM).
Methods: A total of 3,468 T2DM patients were enrolled in this cross-sectional study. Logistic regression models were employed to assess the association between LMIIs and DKD. Restricted cubic splines (RCS) were used to evaluate nonlinear relationships, and threshold effect analysis identified inflection points. Subgroup analyses and sensitivity analyses, including inverse probability of treatment weighting, were performed to test the robustness of the findings. Mediation analysis was conducted to explore indirect associations through selected markers. The candidate mediator was not included as a conventional covariate in the corresponding model. Receiver operating characteristic (ROC) curves were used to evaluate the discriminative performance of models incorporating the four LMIIs.
Results: After multivariate adjustment, all four LMIIs showed significant positive associations with DKD ( P for overall < 0.05). RCS analysis revealed substantial nonlinear dose - response relationships for PHR, NHR, and MHR ( P for nonlinear = 0.009, 0.014, and 0.030, respectively), with inflection points at 2.65, 4.78, and 6.07, respectively. Subgroup analyses confirmed the robustness of these associations. However, lipid-lowering agent use significantly attenuated the NHR - DKD and MHR - DKD relationships ( P for interaction = 0.032 and 0.007, respectively). Sensitivity analyses yielded consistent results. TG and ALB showed statistically significant indirect associations in exploratory mediation analyses. ROC analysis showed that the model incorporating NHR had a slightly higher area under the curve (AUC) than those incorporating PHR and LHR ( P = 0.002 and 0.003, respectively).
Conclusion: LMIIs were significantly associated with DKD and exhibited distinct nonlinear dose–response relationships with threshold effects. Lipid-lowering agent use attenuated the associations of NHR and MHR with DKD. NHR may provide modestly improved discrimination compared with PHR and LHR, while showing comparable performance to MHR. These findings highlight the potential relevance of lipid–inflammation interactions in DKD and warrant further prospective studies to clarify the underlying mechanisms and clinical implications.
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BibTeX
@article{liu2026lipid,
title = {{Lipid metabolism-related inflammatory indices and diabetic kidney disease in patients with type 2 diabetes mellitus: a cross-sectional study}},
author = {Jing Liu and Xiaochan Tian and Mingjun Xu and Yao Xiao and Shuwu Wei and Xinyu Pan and Yue Shi and Hangyu Duan and Yu Zhang and Junping Wei},
journal = {Frontiers in Endocrinology},
year = {2026},
month = oct,
doi = {10.3389/fendo.2026.1934556},
url = {https://www.frontiersin.org/articles/10.3389/fendo.2026.1934556/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Lipid metabolism-related inflammatory indices and diabetic kidney disease in patients with type 2 diabetes mellitus: a cross-sectional study
AU - Jing Liu
AU - Xiaochan Tian
AU - Mingjun Xu
AU - Yao Xiao
AU - Shuwu Wei
AU - Xinyu Pan
AU - Yue Shi
AU - Hangyu Duan
AU - Yu Zhang
AU - Junping Wei
PY - 2026
DA - 2026/10/13
JO - Frontiers in Endocrinology
DO - 10.3389/fendo.2026.1934556
UR - https://www.frontiersin.org/articles/10.3389/fendo.2026.1934556/full
AB - Background: Improving the prognosis of diabetic kidney disease (DKD) requires early diagnosis and treatment. This study examined the associations of lipid metabolism-related inflammatory indices (LMIIs)—the platelet-, neutrophil-, monocyte-, and lymphocyte-to-high-density lipoprotein cholesterol ratios (PHR, NHR, MHR, and LHR, respectively)—with DKD in patients with type 2 diabetes mellitus (T2DM). Methods: A total of 3,468 T2DM patients were enrolled in this cross-sectional study. Logistic regression models were employed to assess the association between LMIIs and DKD. Restricted cubic splines (RCS) were used to evaluate nonlinear relationships, and threshold effect analysis identified inflection points. Subgroup analyses and sensitivity analyses, including inverse probability of treatment weighting, were performed to test the robustness of the findings. Mediation analysis was conducted to explore indirect associations through selected markers. The candidate mediator was not included as a conventional covariate in the corresponding model. Receiver operating characteristic (ROC) curves were used to evaluate the discriminative performance of models incorporating the four LMIIs. Results: After multivariate adjustment, all four LMIIs showed significant positive associations with DKD ( P for overall < 0.05). RCS analysis revealed substantial nonlinear dose - response relationships for PHR, NHR, and MHR ( P for nonlinear = 0.009, 0.014, and 0.030, respectively), with inflection points at 2.65, 4.78, and 6.07, respectively. Subgroup analyses confirmed the robustness of these associations. However, lipid-lowering agent use significantly attenuated the NHR - DKD and MHR - DKD relationships ( P for interaction = 0.032 and 0.007, respectively). Sensitivity analyses yielded consistent results. TG and ALB showed statistically significant indirect associations in exploratory mediation analyses. ROC analysis showed that the model incorporating NHR had a slightly higher area under the curve (AUC) than those incorporating PHR and LHR ( P = 0.002 and 0.003, respectively). Conclusion: LMIIs were significantly associated with DKD and exhibited distinct nonlinear dose–response relationships with threshold effects. Lipid-lowering agent use attenuated the associations of NHR and MHR with DKD. NHR may provide modestly improved discrimination compared with PHR and LHR, while showing comparable performance to MHR. These findings highlight the potential relevance of lipid–inflammation interactions in DKD and warrant further prospective studies to clarify the underlying mechanisms and clinical implications.
SN - 1664-2392
ER -