The non-high-density lipoprotein to high-density lipoprotein cholesterol ratio (NHHR) showed a diabetes-specific association with urinary albumin-to-creatinine ratio (UACR) and varied across chronic kidney disease (CKD) stages. A cross-sectional analysis published in Diabetes Research and Clinical Practice evaluated the relationship between NHHR and UACR in 10,613 U.S. adults from the National Health and Nutrition Examination Survey (NHANES) 2015–2020.

Adults aged 20 to 70 years with an estimated glomerular filtration rate (eGFR) of at least 30 mL/min/1.73 m² were included. NHHR was calculated as the difference between total cholesterol and high-density lipoprotein cholesterol divided by high-density lipoprotein cholesterol. Multivariable logistic regression, smoothed curve fitting, and subgroup analyses were used to assess associations between NHHR and UACR.

Each 1-unit increase in NHHR was associated with a 4.46 mg/g higher UACR overall (95% confidence interval [CI] 1.13-7.78; P = 0.009). This association was observed in individuals with diabetes (β 23.56 mg/g; 95% CI 8.59-38.54; P < 0.001) but was not significant in those without diabetes, with a significant interaction between groups.

The relationship between NHHR and UACR demonstrated a nonlinear pattern that became more pronounced with declining kidney function. A linear association was observed in CKD stage 1, marginal nonlinearity in stage 2 (P = 0.031), and a marked nonlinear pattern in stage 3 (P < 0.001), with an accelerated increase in UACR beyond an NHHR of approximately 3.5.

Effect modification was observed by ethnicity and sex, with stronger associations in Non-Hispanic Black individuals (P = 0.016) and in females (P = 0.048). NHHR was associated with albuminuria in diabetes and showed stage-dependent nonlinear patterns across CKD stages.