Platelet-to-high-density lipoprotein cholesterol ratio as a potential mediator in the obesity-chronic kidney disease association among hypertensive patients

This study investigated the relationship between the platelet-to-high-density lipoprotein cholesterol ratio (PHR) and chronic kidney disease (CKD) in a hypertensive population, exploring its mediating role in the obesity–CKD association. Using data from the National Health and Nutrition Examination Survey (NHANES) 2009–2018 on 10,467 hypertensive adults, we observed a complex association. Overall, PHR was positively correlated with CKD (odds ratio [OR] = 1.08, 95% CI: 1.05–1.14). However, the relationship was nonlinear and U-shaped, with an inflection point at a PHR Z-score of −0.32 (PHR = 166). Below this point, the association was negative (OR = 0.78, 95% CI: 0.65–0.91), whereas above it, the association was strongly positive (OR = 1.24, 95% CI: 1.15–1.36), particularly among individuals with obesity (BMI ≥ 30 kg/m²). Furthermore, PHR significantly mediated the relationship between obesity and CKD, accounting for 21.46% of the effect from BMI and 18.01% from waist circumference. In conclusion, PHR exhibits a U-shaped relationship with CKD in hypertensive individuals, most prominently in those with obesity, and may serve as an accessible biomarker of obesity-related inflammation for CKD risk stratification.