Abstract
To assess the prospective association between baseline serum uric acid level and subsequent risk of development or progression in albuminuria. Longitudinal data were obtained from 2518 patients with type 2 diabetes in the development cohort and registered in a Japanese diabetes registry. To assess the independent correlations between baseline serum uric acid quartiles and either the development or progression of diabetic nephropathy for 2years, the Cox proportional hazards model was used and adjusted for potential confounders. The mean patient age, body mass index, and glycated hemoglobin (HbA1c) level were 66.1years, 24.6kg/m(2), and 7.5% (57.6mmol/mol), respectively. The baseline serum uric acid levels, with mean values of 3.6, 4.9, 5.8, and 7.3mg/dL from the first to fourth quartiles, were significantly associated with the urinary albumin/creatinine ratio at baseline (p<0.001). Baseline uric acid levels were not significantly associated with the development of nephropathy, but they were with the progression of nephropathy. The multivariable-adjusted hazards ratios for the progression from microalbuminuria to macroalbuminuria were 2.17 [95% confidence interval (CI) 1.15-4.08; p=0.016], 3.04 (95% CI 1.67-5.53; p<0.001), and 3.56 (95% CI 1.83-6.93; p<0.0011) for the first, third, and fourth quartiles of serum uric acid levels, respectively, as compared to that for the second quartile. We did not observe significant association between uric acid levels and change in estimated glomerular filtration rate. Low and high serum uric levels, independent of possible confounders, were associated with a subsequent risk of progression, not development, in albuminuria in type 2 diabetes patients. Therefore, serum uric acid levels may be useful for predicting the future risk of progression of microalbuminuria.
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