The diagnostic value of immune-inflammatory markers for diabetic kidney disease in type 2 diabetic patients: a meta-analysis.

INTRODUCTION

Diabetic kidney disease (DKD) constitutes a chronic renal condition arising from type 2 diabetes mellitus after excluding other causes. Immune-inflammatory responses are pivotal in the pathogenesis of DKD, and related biomarkers may be diagnostic targets.

METHODS

The current meta-analysis appraises the diagnostic value of common immune-inflammatory indicators-red blood cell distribution width (RDW), monocyte-to-lymphocyte ratio (MLR), systemic immune-inflammation index (SII), platelet-to-lymphocyte ratio (PLR), mean platelet volume (MPV), and systemic inflammation response index (SIRI)-for early and established DKD.

RESULTS

We systematically retrieved the Cochrane Library, Embase, PubMed, Web of Science, CNKI, CBM, VIP, and Wanfang databases up to October 11, 2025. The QUADAS-2 tool was applied to evaluate study quality. Meta-analyses were implemented employing Stata 16.0, RevMan 5.3, and MetaDisc 1.4.

CONCLUSION

Thirty-two eligible investigations were incorporated: 11 on early DKD(649 subjects) and 21 on DKD(9,120 subjects). The meta-analysis yielded pooled diagnostic performance metrics. For early DKD, PLR showed a sensitivity of 0.74 (95% CI: 0.65-0.81), specificity of 0.69(0.54-0.81), and AUC of 0.78(0.74-0.81). For established DKD, SII demonstrated a sensitivity of 0.68(0.59-0.75), specificity of 0.64 (0.54-0.72), and an AUC of 0.71(0.67-0.74). PLR, MLR, MPV, and RDW exhibited low to moderate diagnostic accuracy for both stages (AUC range: 0.68-0.74). Common immune-inflammatory markers have diagnostic value for early and established DKD. Among them, PLR offers moderate diagnostic accuracy for early DKD, while SII performs relatively better for diagnosing DKD. These findings should be verified through future high-quality studies due to limitations of eligible research.

SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/, Identifier CRD420251174942.