Correlation of monocyte/high density lipoprotein cholesterol ratio with progression and prognosis of type 2 diabetic nephropathy

Methods  From January 1, 2017 to December 31, 2022, 269 type 2 DKD patients were selected as DKD group while 269 healthy medical check-ups during the same period as healthy group. And the differences in MHR levels of two groups were compared. According to median MHR, DKD group were assigned into low-level MHR and high-level MHR sub-groups. General profiles, clinical data, the incidence rate of endpoint events and cumulative renal survival were compared two groups. Cox regression analysis was performed for exploring the independent risk factors for poor renal prognosis in DKD patients and drawing receiver operator characteristic curve （ROC） for exploring the diagnostic efficacy of MHR for poor prognosis of DKD.

Results  MHR level was higher in DKD group than that in healthy group 0.4918（0.3788, 0.6818）×10⁹/mmol vs 0.2984（0.1867, 0.4112）×10⁹/mmol （P＜0.05）; high-level MHR group had higher levels of white blood cells （WBC） 7.70（6.40, 8.70）×10⁹/L vs 6.50（5.40, 8.00）×10⁹/L, neutrophils （Ne） 4.60（3.60, 5.53）×10⁹/L vs 3.99（3.18, 5.19）×10⁹/L and monocyte （Mono） 0.69（0.60, 0.70）×10⁹/L vs 0.50（0.40, 0.60）×10⁹/L, urinary albumin to creatinine ratio （UACR） 1214.59（373.48, 3410.02）mg/g vs 1050.96（180.26, 3341.06） mg/g, 24 h urine protein （24 hUP） 3.21（1.42, 5.51）g vs 2.66 （0.58, 4.56） g, low-density lipoprotein cholesterol （LDL-C） 2.72（2.06, 3.40）mmol/L vs 2.23（1.63, 2.80）mmol/L, serum creatinine （Scr） 152.10（95.20, 221.60）μmol/L vs 126.00（92.48, 186.55）μmol/L than those in low-level MHR group; lymphocyte （Lym） 1.60（1.27, 2.20）×10⁹/L vs 1.82（1.30, 2.40）×10⁹/L, high-density lipoprotein cholesterol （HDL-C） 0.94（0.83, 1.07）mmol/L vs 1.39（1.15, 1.65）mmol/L and estimated glomerular filtration rate （eGFR） 39.69（25.19, 65.10）mL·min⁻¹·（1.73 m²）⁻¹ vs 47.12（28.86, 73.60）mL·min⁻¹·（1.73 m²）⁻¹ were lower than those in low-level MHR group; high-level MHR group had a cumulative kidney survival time and it was shorter than that in low level MHR group 63（39, 72）month vs 72（46, 72）month （P＜0.05）; MHR was correlated positively with WBC, Ne, Mono, UACR, 24h UP, Scr and LDL-C （P＜0.05） and negatively with Lym, HDL-C, eGFR and cumulative renal survival time （P＜0.05）; the incidence of endpoint events was higher in high-level MHR group than that in low-level MHR group （52.59% vs 38.06%）（P＜0.05）; baseline MHR 0.5492（0.4030, 0.7235）×10⁹/mmol vs 0.4255（0.3117, 0.5134）×10⁹/mmol, UACR 2062.65（752.80, 4234.80）mg/g vs 608.56（88.63. 1912.44）mg/g, 24 hUP 3.79（2.54, 5.53）g vs 1.58（0.39, 4.85）g and Scr 178.40（134.00, 234.23）μmol/L vs 100.95（74.25, 152.10）μmol/L were higher than those in DKD patients without endpoint events; eGFR was lower than that in DKD patients without endpoint events 33.45（23.33, 46.41）mL·min⁻¹·（1.73 m²）⁻¹ vs 61.59（38.57, 95.98）mL·min⁻¹·（1.73 m²）⁻¹（P＜0.05）. The results of Cox regression analysis indicated that MHR was an independent risk factor for a poor prognosis of DKD; The results of ROC curve showed that the area under the curve of MHR was 0.747 with a sensitivity of 0.820 and a specificity of 0.605.

Conclusion  DKD patients tend to have higher levels of MHR as compared with healthy individuals. As an independent risk for the progression of renal function in DKD patients, MHR has some diagnostic value for a poor prognosis of DKD. However, its specificity is not high.