Association between uric acid to high-density lipoprotein cholesterol ratio and chronic kidney disease in middle-aged and older adults: results from two nationally representative population-based study

Uric acid to high-density lipoprotein cholesterol ratio (UHR) is considered a novel marker of inflammation. The aim of this study was to investigate the association between the UHR and chronic kidney disease (CKD) in middle-aged and older adults. This study used data from the National Health and Nutrition Examination Survey (NHANES) and the China Health and Retirement Longitudinal Study (CHARLS). The association between UHR and CKD prevalence was analyzed using weighted multivariable logistic regression models. Restricted cubic spline (RCS) models were used to analyze nonlinear relationships. Weighted subgroup analyses were performed to validate the robustness of the findings. The diagnostic performance of UHR for CKD was evaluated using receiver operating characteristic (ROC) curves. This study included 10,968 participants from NHANES and 9,012 participants from CHARLS. The mean age of NHANES participants was 59.60 years (standard deviation [SD] = 10.97), with 5,575 men (50.83%). CHARLS participants had a mean age of 59.58 years (SD = 9.40), and 4,203 (46.64%) were men. Weighted logistic regression analysis revealed a positive association between UHR and CKD prevalence (CHARLS: OR = 1.83, 95% CI = 1.44–2.32, <i>p</i> &lt; 0.001; NHANES: OR = 1.81, 95% CI = 1.58–2.07, <i>p</i> &lt; 0.001). The RCS regression models demonstrated a significant nonlinear relationship between UHR and CKD. ROC analysis indicated that UHR demonstrated moderate CKD discrimination (CHARLS: AUC = 0.707; NHANES: AUC = 0.645). UHR is positively associated with an increased prevalence of CKD in middle-aged and older adults, and this association exhibits cross-ethnic consistency. Utilized two nationally representative population-based cohorts CHARLS and NHANES, revealing a cross-ethnic consistency between UHR and CKD.Employed weighted statistical analyses to correct for selection bias and standardized quality control procedures in both CHARLS and NHANES.Used external data validation to confirm the generalizability of this association.The cross-sectional design may be unable to verify the causal relationship of UHR and CKD.Omitting the medications affecting uric acid metabolism, which may introduce residual confounding bias. Utilized two nationally representative population-based cohorts CHARLS and NHANES, revealing a cross-ethnic consistency between UHR and CKD. Employed weighted statistical analyses to correct for selection bias and standardized quality control procedures in both CHARLS and NHANES. Used external data validation to confirm the generalizability of this association. The cross-sectional design may be unable to verify the causal relationship of UHR and CKD. Omitting the medications affecting uric acid metabolism, which may introduce residual confounding bias.