Associations between metabolic indices and the prevalence of simple renal cysts among hospitalized patients with hypertension in Xinjiang, China: a large-scale cross-sectional study

Background Metabolic dysfunction may be associated with simple renal cysts (SRCs) in patients with hypertension, but the relationships between routinely available metabolic indices and SRC prevalence remain unclear. We therefore aimed to examine the associations between six routinely available metabolic indices and SRC prevalence among hospitalized patients with hypertension. Methods This cross-sectional study included 35,000 adults hospitalized with hypertension between January 1, 2014, and October 31, 2025, who had complete data required to calculate the metabolic indices and available renal ultrasonography or abdominal CT findings. Patients aged <18 years, pregnant patients, and those with major hepatic, renal, endocrine, urinary tract, malignant, or non-simple cystic kidney conditions were excluded. Additional exclusions included prior mineralocorticoid receptor antagonist use and extreme values. Associations of six metabolic indices with prevalent SRCs were examined using multivariable logistic regression, supplemented by RCS, ROC, subgroup, sensitivity, and E-value analyses. Results Among 35,000 participants, 7,250 (20.7%) had SRCs. SRC prevalence increased progressively across quartiles of all six metabolic indices (all P for trend <0.001). In fully adjusted models, each 1-SD increase in the six indices was associated with higher odds of SRCs, with ORs ranging from 1.19 (95% CI: 1.16–1.22) for TG/HDL-C to 1.65 (95% CI: 1.59–1.71) for METS-VF. Compared with Q1, participants in Q4 had adjusted ORs ranging from 1.48 (95% CI: 1.35–1.61) to 3.76 (95% CI: 3.47–4.09). Similar associations were observed for large and multiple SRCs. RCS analyses showed generally increasing exposure-response relationships, and METS-VF had the highest observed discriminative performance for prevalent SRCs (AUC = 0.654). Conclusion Higher levels of all six metabolic indices were independently associated with a greater prevalence of SRCs in patients with hypertension, with consistent associations observed for large and multiple cysts. Among the indices evaluated, METS-VF showed the strongest association and the highest observed discriminative performance, suggesting that visceral adiposity-related metabolic dysfunction may be particularly relevant to SRC burden. Prospective studies are needed to confirm the temporal relationship and clinical utility of these findings.