A risk prediction model for kidney disease in type 2 diabetes mellitus based on the ratio of fibrinogen to prealbumin

Objective The relationship between the fibrinogen to prealbumin ratio (FPR) and diabetic kidney disease (DKD) in patients with type 2 diabetes mellitus (T2DM), to explore the related risk factors of DKD and construct a nomogram model for the risk of DKD, so as to provide a simpler observation index for clinical prediction of DKD and a basis for early intervention and delaying the progress of DKD. Methods This cross-sectional study enrolled 500 patients with T2DM who visited the Endocrinology Department of Hebei Provincial People’s Hospital from January 2023 to May 2024. Clinical data, including demographic characteristics (gender, age), disease duration, smoking/alcohol history, and laboratory serum indicators (including the fibrinogen-to-prealbumin ratio, FPR), were collected. Participants were categorized into a DKD group and a NDKD group based on the presence or absence of DKD. Intergroup differences in clinical characteristics were analyzed using t-tests or Mann-Whitney U tests. A nomogram model for predicting DKD risk was developed using SPSS 25.0 and R software, with emphasis on evaluating the predictive value of FPR. A significance threshold of P  < 0.05 was applied for all statistical analyses. Results This study found that DKD patients had significantly lower ALB and eGFR but higher hypertension prevalence, SBP, TG, Scr, BUN, FIB, and FPR compared to NDKD patients (P < 0.05). Multivariate analysis identified DM duration, SBP, TG, BUN, and FPR as risk factors for the occurrence of DKD. FPR > 16.49 significantly increased DKD risk (P < 0.001). A predictive model incorporating these factors achieved an AUC of 0.738 (95%CI:0.694–0.782) and a C-index of 0.738 after Bootstrap validation, with optimal net benefit (0.122) at a 0.6 threshold. Conclusions FPR, duration of DM, SBP, TG, and BUN are risk factors for the development of DKD in patients with T2DM. Additionally, the combination of FPR, duration of DM, SBP, TG, and BUN can accurately predict the risk of DKD development, offering significant clinical value in the diagnosis of DKD.