Abstract
BackgroundThe associations between urine uric acid excretion (UUAE) and chronic kidney disease (CKD)/atherosclerosis have not been investigated. Our aims were to investigate the relationships between UUAE and CKD and carotid atherosclerotic lesions in hospitalized Chinese patients with type 2 diabetes.MethodsThis was a cross-sectional study that was conducted with 2627 Chinese inpatients with type 2 diabetes. UUAE was determined enzymatically using a single 24-h urine collection. The subjects were stratified into quartiles according to their UUAE levels. Carotid atherosclerotic lesions, including carotid intima-media thickness (CIMT), plaque and stenosis, were assessed by Doppler ultrasound. Both CKD and carotid atherosclerotic lesions were compared between the UUAE quartile groups.ResultsAfter adjustment for confounding factors, there was a significant decrease in the prevalence of CKD in the patients with type 2 diabetes across the UUAE quartiles (16.9%, 8.5%, 5.9%, and 4.9%; p < 0.001). Multiple logistic regression analyses revealed that the UUAE quartiles were significantly and inversely associated with the presence of CKD (p < 0.001). Compared with the diabetics in the highest UUAE quartile, those in the lowest quartile exhibited a nearly 4.2-fold increase in the risk of CKD (95% CI: 2.272-7.568; p < 0.001). The CIMT value (0.91 ± 0.22 mm for the diabetics with CKD and 0.82 ± 0.20 mm for the diabetics without CKD, p = 0.001) and the prevalence of carotid plaques (62.1% for the diabetics with CKD and 41.8% for the diabetics without CKD, p = 0.025) were significantly higher in the diabetics with CKD than in those without CKD. However, there was no obvious difference in carotid atherosclerotic lesions across the UUAE quartiles after controlling for the confounding factors.ConclusionsDecreased UUAE was closely associated with the presence of CKD but not with carotid atherosclerotic lesions in hospitalized Chinese patients with type 2 diabetes. Our results suggest that UUAE is an independent risk factor for CKD in type 2 diabetes. In selected populations, such as patient with type 2 diabetes, the role of uric acid in atherosclerosis might be the result of other concomitant atherosclerotic risk factors, such as CKD.
Highlights
In recent decades, accumulated clinical and epidemiological studies have confirmed the positive correlation between serum uric acid (SUA) and chronic kidney disease (CKD)
After controlling for age, sex, and durations of diabetes (DD), there was a significantly decreasing trend in the prevalence of CKD in patients across the urine uric acid excretion (UUAE) quartiles (16.9%, 8.5%, 5.9%, and 4.9%, respectively, p < 0.001 for the trend; Figure 1A)
The UUAE levels gradually decreased with the decreases in estimated glomerular filtration rate (eGFR) (p < 0.001; Figure 1C), and the UUAE levels were significantly decreased in the diabetics with urinary albumin excretion (UAE) ≥ 300 mg/24 h compared to those with UAEs
Summary
In recent decades, accumulated clinical and epidemiological studies have confirmed the positive correlation between serum uric acid (SUA) and chronic kidney disease (CKD). A previous study indicated that SUA is an independent risk factor for carotid atherosclerosis in type 2 diabetes [2]. Another study by Iribarren et al reported that the correlation between SUV levels and carotid intimal-medial thickness (CIMT) did not remain significant after controlling for other risk factors for atherosclerosis [3]. In our previous study, we found no significant association between SUA levels and atherosclerotic lesions in type 2 diabetes [4]. The associations between urine uric acid excretion (UUAE) and chronic kidney disease (CKD)/ atherosclerosis have not been investigated. Our aims were to investigate the relationships between UUAE and CKD and carotid atherosclerotic lesions in hospitalized Chinese patients with type 2 diabetes
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