Association of the serum uric acid-to-HDL-cholesterol ratio with kidney stones in U.S. adults: A cross-sectional study (NHANES 2007–2016)

Whether the serum uric acid-to-high-density lipoprotein cholesterol ratio (UHR) is associated with kidney-stone risk remains unknown. This study was a cross-sectional analysis of 11,073 adults aged ≥ 20 years from the National Health and Nutrition Examination Survey (NHANES) 2007 to 2016. Information on kidney stone history was obtained via a self-reported questionnaire. The UHR was calculated as follows: (uric acid mg/dL ÷ high-density lipoprotein cholesterol mg/dL) × 100%. Logistic regression was used to estimate the odds ratio (OR) and 95% confidence interval (95% CI) per one-unit UHR increase and across UHR tertiles, adjusting for sociodemographic factors, comorbidities, and metabolic covariates. Restricted cubic splines were used to determine the dose-response and potential breakpoints; subgroup analyses were conducted to test for interaction effects. The overall kidney stone prevalence was 10.6%. The median UHR was greater in patients with a history of kidney stones than in those without kidney stones (P < .001). After multivariable adjustment, each one-unit increase in the UHR was associated with a 2% greater risk of developing kidney stones (OR 1.02; 95% CI: 1.01-1.04). Compared with the lowest tertile, the middle and highest tertiles had 32% (OR 1.32; 95% CI: 1.02-1.71) and 41% (OR 1.41; 95% CI: 1.07-1.87) greater risks of developing kidney stones, respectively. A spline curve suggested a nonlinear relationship with an estimated breakpoint at a UHR of 12.27, but the likelihood-ratio test did not confirm a significant threshold (P = .142). Associations were consistent across sex, age, race, and metabolic subgroups (P-interaction > .05). In this cross-sectional analysis, a greater UHR was associated with a modestly greater prevalence of self-reported kidney stones.