Hemoglobin, albumin, lymphocyte, and platelet (HALP) score: A risk prediction tool for incidence and mortality in diabetic kidney disease patients with type 2 diabetes

Background The hemoglobin, albumin, lymphocyte, and platelet (HALP) score has been identified as a potential prognostic marker in various conditions. However, its relationship with the incidence and mortality of diabetic kidney disease (DKD) in type 2 diabetes patients remains unexplored. This study aims to explore the relationship between the HALP score and both the incidence and mortality of DKD in type 2 diabetes, as well as whether reversing the HALP score could reduce mortality outcomes. Methods This study included 25,750 type 2 diabetes patients from the National Health and Nutrition Examination Survey (NHANES) (1999–2018) and Southwest China (2013–2022). HALP score was calculated as [hemoglobin (g/L) × albumin (g/L)×lymphocytes (/L)]/platelets (/L). DKD was diagnosed based on urine albumin to creatinine ratio (ACR) ≥ 30 mg/g and/or estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73m². The relationship between HALP score and DKD was explored using logistic regression model, and Cox regression models were used to evaluate its association with all-cause and cause-specific mortality. Subgroup analyses explored the effects of dietary fiber intake and NSAIDs use on HALP score and mortality. Results Higher HALP score were significantly associated with a lower risk of DKD (NHANES, HR 0.502; Southwest China, HR 0.528) in an antagonist manner. Additionally, higher HALP score was related to decreased all-cause (HR 0.765, p  < 0.001) and cardiovascular disease(CVD)-related mortality(HR 0.667, p  < 0.001).We also discovered the same outcome in DKD patients with low dietary fiber intake (HR 0.695, p  < 0.001) or NSAIDs use (HR 0.733, p  < 0.001). The magnitude of associations was not materially altered in any of the sensitivity analyses. Conclusions High HALP score was independently associated with risk of DKD and its all-cause and cardiovascular mortality. Regular HALP monitoring could aid in risk stratification and clinical decisions for DKD in type 2 diabetes.