Serum uric acid levels are associated with a high risk of rapid chronic kidney disease progression among patients with type 2 diabetes: a prospective cohort study [Diabetes Distress and Care Registry at Tenri (DDCRT 12)

Abstract

We assessed the prospective association between baseline serum uric acid (SUA) concentrations and consequent risk of chronic kidney disease (CKD) progression in type 2 diabetes patients. Longitudinal data from a Japanese diabetes registry including 3454 type 2 diabetes patients were obtained. To assess the independent correlations between SUA and rapid CKD progression [i.e., 30% reduction in estimated glomerular filtration rate (eGFR) over 2years], participants were divided into five groups based on SUA levels:<5.0,≥5.0-6.0,≥6.0-7.0,≥7.0-8.0, and≥8.0mg/dl. Cox proportional hazards model adjusted for potential confounders was used for analysis. After 2years, rapid CKD progression was recognized in 169 patients (4.89%) who showed longer duration of type 2 diabetes (15.5 vs. 13.5years, p=0.005); higher systolic blood pressure (142.0 vs. 138.3mmHg, p=0.016), SUA (6.15 vs. 5.32mg/dl, p<0.001), and urinary albumin-creatinine ratio (1127.4 vs. 184.7mg/gCr, p<0.001); and lower diastolic blood pressure (69.7 vs. 72.8mmHg, p=0.003). Multivariate ratios for rapid CKD progression were 1.19 (p=0.371), 1.02 (p=0.937), 1.18 (p=0.625), and 3.04 (p=0.004), respectively, for the first, third, fourth, and fifth serum UA range groups; a second group was used as a reference. Higher SUA levels, independent of possible confounders, were associated with rapid eGFR decline and CKD progression in type 2 diabetes patients. SUA may be a useful biomarker for predicting future risk of rapid diabetic CKD progression.