Association between the triglyceride to high-density lipoprotein cholesterol ratio and diabetes mellitus likelihood in patients with chronic kidney disease

Abstract

Background: Patients with chronic kidney disease (CKD) are at an increased risk of diabetes mellitus (DM) and dyslipidemia, yet the specific relationship between lipid profiles, particularly triglyceride-to-high-density lipoprotein cholesterol ratio (TG/HDL-C ratio), and DM likelihood in this population has not been thoroughly elucidated. Methods: We conducted a cross-sectional analysis of 20,310 unselected patients with CKD enrolled from 2006 to 2015. The relationship between the TG/HDL-C ratio and the likelihood of DM was evaluated using binary logistic regression. Sensitivity and subgroup analyses were performed, and a generalized additive model with smooth curve fitting assessed potential non-linear associations. We also performed the receiver operating characteristic (ROC) curve and decision curve analysis to assess the determination and clinical use, respectively. Results: Among the participants (mean age 60.907 ± 10.044 years; 79.580% male), 1,758 (8.656%) had DM. The median TG/HDL-C ratio was 0.655(interquartile range 0.465–0.920). After adjusting for covariates, a significant positive association was found between the TG/HDL-C ratio and DM likelihood (odds ratio [OR], 1.494; 95% confidence interval [CI], 1.354–1.648; P < 0.001). A non-linear relationship was observed with an inflection point at a TG/HDL-C ratio of 1.030. The ORs below and above this point were 1.866 (95% CI, 1.472–2.365) and 1.297 (95% CI, 1.094–1.538), respectively. The area under curve (AUC) of the nomogram was of 0.580 (95% CI, 0.566–0.594). Subgroup analyses indicated a stronger association in patients without hypertension, in female and patients with AF. Conclusion: The TG/HDL-C ratio is independently associated with DM likelihood in patients with CKD, exhibiting a non-linear relationship particularly significant when the ratio is below 1.030. The TG/HDL-C ratio may serve as a useful marker for DM likelihood assessment in CKD patients, though prospective studies are needed to determine its role in prevention strategies. Clinical trial number: Not applicable.