The Coexistence of Hyperuricemia and Low Urine Uric Acid Excretion Further Increases the Risk of Chronic Kidney Disease in Type 2 Diabetes

Abstract

Aims: To investigate whether hyperuricemia and decreased urine uric acid excretion (UUAE) are associated with increased risk of chronic kidney disease (CKD), and whether the coexistence of hyperuricemia and low UUAE further increases the CKD risk in type 2 diabetes mellitus (T2DM). Methods: Based on serum uric acid (SUA) and UUAE levels, 2 846 T2DM inpatients were divided into patients with SUA and UUAE (group 1), normal SUA and low UUAE (group 2), hyperuricemia and normal UUAE (group 3), and hyperuricemia and low UUAE (group 4). Hyperuricemia was defined as SUA levels ≥ 420 μmol/L in men and ≥ 360 μmol/L in women. Low UUAE was defined as UUAE levels < the first UUAE quintiles (< 2161 μmol/24h in men and 1977 μmol/24h in women). Results: There was significantly increased trend of the prevalence of CKD (4.3%, 12.6%, 18.3% and 47.8%, p< 0.001), albuminuria (20.2%, 26.4%, 36.9% and 54.9%, p< 0.001), and macroalbuminuria (3.3%, 10.1%, 10.7% and 31.9%, p< 0.001) from group 1 to 4. After controlling for multiple confounding factors, the prevalence of CKD (p<0.001) and the urinary albumin levels (p=0.013) had obviously increased trend, while eGFR levels had markedly decreased trend from group 1 to 4 (p<0.001). Conclusion: Hyperuricemia and low UUAE levels were closely associated the presence of CKD, and the concomitant presence of hyperuricemia and decreased UUAE levels further increased the CKD risk in T2DM. The combined application of SUA and UUAE levels may help identify the type 2 diabetics at higher CKD risk. Funding Statement: This work was supported by grants from the National Natural Science Foundation of China (81170759, 81770813, 81770810) and the Science and Technology Commission of Shanghai Municipality (15411960600). Declaration of Interests: There are no conflicts of interest. Ethics Approval Statement: The study was carried out in accordance with the “Declaration of Helsinki” and approved by the human research ethic committee of Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, and all patients had given written informed consent before participated in the study.