Uric Acid-to-HDL Ratio Independently Predicts In-Hospital Mortality in AKI Patients: Study

A new research published in the journal of Frontiers in Endocrinology showed that the uric acid-to-high-density lipoprotein cholesterol ratio (UHR) has emerged as an independent predictor of in-hospital mortality among patients with acute kidney injury (AKI). The findings highlight the potential value of uric acid-to-high-density lipoprotein cholesterol ratio (UHR) as a simple and readily available biomarker for risk stratification in this patient population. However, further studies are required to better understand the underlying mechanisms linking elevated UHR to adverse outcomes in AKI.

Acute kidney injury is a common and serious condition characterized by a sudden decline in kidney function. Despite advances in supportive care, AKI continues to carry a high rate of in-hospital mortality, particularly among critically ill and elderly patients. Identifying reliable prognostic markers remains a priority for healthcare providers seeking to recognize high-risk patients early and optimize treatment strategies.

This retrospective cohort study analyzed data from 500 adult patients diagnosed with AKI according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria between January 2021 and January 2024. After excluding patients with dialysis-dependent CKD, transfers to other healthcare facilities, and incomplete medical records, the final analysis included 435 survivors and 65 patients who died during hospitalization.

This research examined demographic characteristics, medical history, vital signs, laboratory findings, and clinical outcomes extracted from electronic medical records. Comparisons between survivors and non-survivors revealed that patients who died were generally older and more likely to have hypertension and diabetes. They also exhibited more severe kidney dysfunction and greater systemic inflammation, reflected by higher serum creatinine, blood urea nitrogen, and C-reactive protein (CRP) levels.

Statistical analyses identified several factors significantly associated with in-hospital mortality, including age, serum creatinine, blood urea nitrogen, urine output, estimated glomerular filtration rate, CRP, and UHR. However, after adjusting for potential confounding variables in multivariate analyses, UHR remained an independent predictor of mortality. The study found that every one-unit increase in UHR was associated with a 55% increase in the hazard of in-hospital death (hazard ratio: 1.55; 95% confidence interval: 1.18–2.01; p=0.002).

Overall, uric acid-to-high-density lipoprotein cholesterol ratio is a promising predictor of in-hospital mortality among patients with AKI. Larger prospective studies are imperative to validate the findings, clarify the biological pathways involved, and determine whether UHR-guided management strategies which can improve survival outcomes in patients with AKI.

Source:

Zhang, D., Li, G., Xu, G., Yin, L., Guo, J., & Lv, J. (2026). Association of the serum uric acid to high-density lipoprotein cholesterol ratio with in-hospital mortality in patients with acute kidney injury: a retrospective cohort study. Frontiers in Endocrinology, 17(1798688), 1798688. https://doi.org/10.3389/fendo.2026.1798688