Abstract Objective This study aimed to investigate the relationship between the Small Dense Low-Density Lipoprotein Cholesterol/Large Buoyant Low-Density Lipoprotein Cholesterol Ratio (SLR) and the risk of Chronic Kidney Disease (CKD) in the U.S. population. Methods Data were recruited from the National Health and Nutrition Examination Survey (NHANES) database from 2009 to 2018. Restricted cubic spline (RCS) plots were used to assess the dose-effect relationship between SLR and the risk of CKD. Multiple logistic regression analysis was conducted to explore the relationship between SLR and the risk of CKD. Stratified analysis was performed to evaluate the consistency of the results. Mediation analysis explores the mediating roles of inflammatory indices Systemic Immune-Inflammation Index and Systemic Inflammation Response Index in SLR associated with the risk of CKD. Results A total of 11,905 participants were enrolled. The RCS showed an increased risk of CKD with higher SLR levels (nknot=5, Non-line P value <0.01). Multiple logistic regression analysis revealed that individuals in the T3 group had a 54% higher risk of CKD compared to the T1 group (OR = 1.54; 95% CI, 1.16, 2.06; P = 0.004). Additionally, per standard deviation (per-SD) increase in SLR, the risk of CKD increased by 16% (OR = 1.16; 95% CI, 1.05-1.29; P = 0.005). The relationship between SLR and the risk of CKD exerts a significant mediating effect through SII or SIRI. Conclusion In the general population, an elevated SLR is associated with a higher risk of CKD, and inflammatory plays a significant role in this process.

The authors have declared no competing interest.

The Science and technology fund of Chengdu Medical College (CYZYB22-02). The research fund of Sichuan Medical and Health Care Promotion institute (KY2022QN0309). The Sichuan Provincial Medical Association Youth Innovation Project (Q23021). Project of Sichuan Provincial Science and Technology Department (2023-4-763).

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