White Blood Cell-to-Hemoglobin Ratio, a Promising Indicator for Diabetic Kidney Disease: An Observational...

Diabetic kidney disease (DKD), a prevalent microvascular complication of type 2 diabetes (T2DM), is frequently diagnosed late with irreversible renal damage, underscoring the need for early-stage biomarkers. Anemia commonly occurs in DKD due to impaired erythropoiesis and reduced hemoglobin levels, while chronic inflammation also plays a key role in its progression. The white blood cell-to-hemoglobin ratio (WBCHR), derived from full blood examination (FBE), integrates inflammation and anemia signals in DKD. This study investigates WBCHR's role in early DKD risk stratification.

This observational cross-sectional study included 6257 patients with T2DM from Northwest China from 2013 to 2022 (1721 DKD, 4536 non-DKD). Demographic, metabolic, FBE indices, and renal function parameters were compared. Spearman correlation and logistic regression analysis were performed to assess the correlation between FBE indices of renal impairment, and the relationship between WBCHR and DKD occurrence. Receiver operating characteristic (ROC) analysis was used to calculate the discriminatory performance of WBCHR for DKD presence.

Age, male proportion, T2DM duration, insulin usage, blood pressure, fasting blood glucose and triglycerides were greater in patients with DKD (P < 0.05). Patients with DKD were more likely to exhibit lower hemoglobin levels and higher inflammatory FBE indices (P < 0.001). Among all the inflammatory indices, WBCHR showed the strongest association with DKD occurrence and positively correlated with multiple renal impairment indicators. After adjusting for confounding factors, WBCHR remained independently associated with DKD progression (OR: 3.669, 95% CI: 2.407-5.592, P<0,001). Moreover, ROC analysis identified WBCHR as a potential risk factor for DKD, particularly in patients with T2DM aged>40, with a cut-off value of 0.529 (AUC = 0.641, P<0.001).

WBCHR was significantly associated with an increased risk of DKD, suggesting its potential as a diagnostic and management indicator for DKD.

WBCHR was significantly associated with increased DKD risk in patients with T2DM and remained an independent factor after confounder adjustment. WBCHR could be adopted as a low-cost screening tool for early DKD risk in routine diabetes management.