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The study aims to examine the relationship between the non-high-density lipoprotein cholesterol-to-high-density lipoprotein cholesterol ratio (NHHR) and CKD in patients with DM.
The study will include adult participants recruited from outpatient clinics and inpatient departments. Participants will be classified into the following groups:
Diabetes Mellitus without Diabetic Nephropathy (DM group) :
Patients with diabetes mellitus who have no evidence of diabetic nephropathy will be defined by a normal urinary albumin-to-creatinine ratio (UACR) and preserved renal function.
Diabetic Nephropathy group (DN group) :
Patients with diabetes mellitus and diabetic nephropathy will be defined by the presence of elevated UACR and/or impaired renal function as assessed by estimated glomerular filtration rate (eGFR).
Subgroup Analysis :
Within the diabetic nephropathy group, further subgroup analyses will be performed to assess differences in NHHR according to:
Type of diabetes (Type 1 vs. Type 2 diabetes mellitus) Stages of chronic kidney disease (CKD) are classified based on KDIGO definitions of CKD based on estimated GFR and albuminuria.
Type of the study: Comparative cross-sectional study
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Diabetes Mellitus without Diabetic Nephropathy (DM group) | Patients with diabetes mellitus who have no evidence of diabetic nephropathy will be defined by a normal urinary albumin-to-creatinine ratio (UACR) and preserved renal function. | ||
| Diabetic Nephropathy group (DN group) | Patients with diabetes mellitus and diabetic nephropathy will be defined by the presence of elevated UACR and/or impaired renal function as assessed by estimated glomerular filtration rate (eGFR). And within the diabetic nephropathy group, further subgroup analyses will be performed to assess differences in NHHR according to:
|
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| Measure | Description | Time Frame |
|---|---|---|
| Association between the non-high-density lipoprotein cholesterol-to-high-density lipoprotein cholesterol ratio (NHHR) and the presence of diabetic nephropathy. | Diabetic nephropathy defined as urinary albumin-to-creatinine ratio (UACR) ≥30 mg/g and/or estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m², measured at enrollment. The non-HDL cholesterol to HDL cholesterol ratio (NHHR) will be calculated from fasting lipid profile obtained at the same visit. | At baseline |
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Inclusion Criteria:
Exclusion Criteria:
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Adult patients with DM attending the internal medicine outpatient clinics and inpatient department.
| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Ragaey Edward Riad | Contact | +20 1206503994 | ragaeyedward@gmail.com |
| Name | Affiliation | Role |
|---|---|---|
| Ahmed Mohamed Ashmawy, Professor | Assiut University | Principal Investigator |
| Noha Gamal Abdel-Malek, Assistant lecturer | Assiut University | Principal Investigator |
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| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 39602386 | Background | Zhang L, Fan D, Zhu T, Geng L, Gan L, Ou S, Yin D. The ratio of non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol is associated with diabetic kidney disease: A cross-sectional study. PLoS One. 2024 Nov 27;19(11):e0311620. doi: 10.1371/journal.pone.0311620. eCollection 2024. | |
| 38773578 | Background |
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| Tan MY, Weng L, Yang ZH, Zhu SX, Wu S, Su JH. The association between non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio with type 2 diabetes mellitus: recent findings from NHANES 2007-2018. Lipids Health Dis. 2024 May 21;23(1):151. doi: 10.1186/s12944-024-02143-8. |
| 39972003 | Background | Su X, Rao H, Zhao C, Wu J, Zhang X, Li D. Association between the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio and mortality among hypertension patients. Sci Rep. 2025 Feb 19;15(1):6012. doi: 10.1038/s41598-025-88539-7. |
| 35784566 | Background | Pan X, Lin X, Huang X, Xu J, Ye L, Zhang T, Hu S, Jiang H, Ren Y, Shan PF. The Burden of Diabetes-Related Chronic Kidney Disease in China From 1990 to 2019. Front Endocrinol (Lausanne). 2022 Jun 15;13:892860. doi: 10.3389/fendo.2022.892860. eCollection 2022. |
| 36046539 | Background | Lokpo SY, Laryea R, Osei-Yeboah J, Owiredu WKBA, Ephraim RKD, Adejumo EN, Ametepe S, Appiah M, Peter N, Affrim P, Kwadzokpui PK, Abeka OK. The pattern of dyslipidaemia and factors associated with elevated levels of non-HDL-cholesterol among patients with type 2 diabetes mellitus in the Ho municipality: A cross sectional study. Heliyon. 2022 Aug 17;8(8):e10279. doi: 10.1016/j.heliyon.2022.e10279. eCollection 2022 Aug. |
| 35583863 | Background | Liu C, Dhindsa D, Almuwaqqat Z, Ko YA, Mehta A, Alkhoder AA, Alras Z, Desai SR, Patel KJ, Hooda A, Wehbe M, Sperling LS, Sun YV, Quyyumi AA. Association Between High-Density Lipoprotein Cholesterol Levels and Adverse Cardiovascular Outcomes in High-risk Populations. JAMA Cardiol. 2022 Jul 1;7(7):672-680. doi: 10.1001/jamacardio.2022.0912. |
| 19414839 | Background | Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, Kusek JW, Eggers P, Van Lente F, Greene T, Coresh J; CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration). A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009 May 5;150(9):604-12. doi: 10.7326/0003-4819-150-9-200905050-00006. |
| 36507639 | Background | ElSayed NA, Aleppo G, Aroda VR, Bannuru RR, Brown FM, Bruemmer D, Collins BS, Hilliard ME, Isaacs D, Johnson EL, Kahan S, Khunti K, Leon J, Lyons SK, Perry ML, Prahalad P, Pratley RE, Seley JJ, Stanton RC, Gabbay RA, on behalf of the American Diabetes Association. 1. Improving Care and Promoting Health in Populations: Standards of Care in Diabetes-2023. Diabetes Care. 2023 Jan 1;46(Supple 1):S10-S18. doi: 10.2337/dc23-S001. |
| 40218883 | Background | Chen X, Liang M, Zhang J, Xu C, Chen L, Hu R, Zhong J. The Non-High-Density Lipoprotein Cholesterol (Non-HDL-C) to HDL-C Ratio (NHHR) and Its Association with Chronic Kidney Disease in Chinese Adults with Type 2 Diabetes: A Preliminary Study. Nutrients. 2025 Mar 24;17(7):1125. doi: 10.3390/nu17071125. |
| 33189186 | Background | Chan JCN, Lim LL, Wareham NJ, Shaw JE, Orchard TJ, Zhang P, Lau ESH, Eliasson B, Kong APS, Ezzati M, Aguilar-Salinas CA, McGill M, Levitt NS, Ning G, So WY, Adams J, Bracco P, Forouhi NG, Gregory GA, Guo J, Hua X, Klatman EL, Magliano DJ, Ng BP, Ogilvie D, Panter J, Pavkov M, Shao H, Unwin N, White M, Wou C, Ma RCW, Schmidt MI, Ramachandran A, Seino Y, Bennett PH, Oldenburg B, Gagliardino JJ, Luk AOY, Clarke PM, Ogle GD, Davies MJ, Holman RR, Gregg EW. The Lancet Commission on diabetes: using data to transform diabetes care and patient lives. Lancet. 2021 Dec 19;396(10267):2019-2082. doi: 10.1016/S0140-6736(20)32374-6. Epub 2020 Nov 12. No abstract available. |
| 35368036 | Background | Achila OO, Fessahye N, Mengistu ST, Habtemikael NT, Werke WY, Zemichael FT, Leghese HN, Weldegegish TA, Tekeste TH, Garoy EY. A community based cross sectional study on the prevalence of dyslipidemias and 10 years cardiovascular risk scores in adults in Asmara, Eritrea. Sci Rep. 2022 Apr 2;12(1):5567. doi: 10.1038/s41598-022-09446-9. |
| ID | Term |
|---|---|
| D003928 | Diabetic Nephropathies |
| D050171 | Dyslipidemias |
| D051436 | Renal Insufficiency, Chronic |
| D003922 | Diabetes Mellitus, Type 1 |
| D003924 | Diabetes Mellitus, Type 2 |
| ID | Term |
|---|---|
| D007674 | Kidney Diseases |
| D014570 | Urologic Diseases |
| D052776 | Female Urogenital Diseases |
| D005261 | Female Urogenital Diseases and Pregnancy Complications |
| D000091642 | Urogenital Diseases |
| D052801 | Male Urogenital Diseases |
| D048909 | Diabetes Complications |
| D003920 | Diabetes Mellitus |
| D004700 | Endocrine System Diseases |
| D052439 | Lipid Metabolism Disorders |
| D008659 | Metabolic Diseases |
| D009750 | Nutritional and Metabolic Diseases |
| D051437 | Renal Insufficiency |
| D002908 | Chronic Disease |
| D020969 | Disease Attributes |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D044882 | Glucose Metabolism Disorders |
| D001327 | Autoimmune Diseases |
| D007154 | Immune System Diseases |
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