Serum Uric Acid and Risk of CKD in Type 2 Diabetes

Abstract

Background and objective Serum uric acid may predict the onset and progression of kidney disease, but it is unclear whether uric acid is an independent risk factor for diabetic nephropathy. Our aim was to study the relationship between uric acid levels and the development of CKD components in patients with type 2 diabetes.Design, setting, participants, & measurements Longitudinal study of a cohort of patients with type 2 diabetes from the database of the Italian Association of Clinical Diabetologists network. From a total of 62,830 patients attending the diabetes centers between January 1, 2004, and June 30, 2008, we considered those with baseline eGFR values $60 ml/min per 1.73 m 2 and normal albumin excretion (n=20,142). Urinary albumin excretion, GFR, and serum uric acid were available in 13,964 patients. We assessed the association of serum uric acid quintiles with onset of CKD components by multinomial logistic regression model adjusting for potential confounders. We calculated the relative risk ratios (RRRs) for eGFR ,60 ml/min per 1.73 m 2 , albuminuria, and their combination at 4 years.Results At 4-year follow-up, 1109 (7.9%) patients developed GFR ,60 ml/min per 1.73 m 2 with normoalbuminuria, 1968 (14.1%) had albuminuria with eGFR $60 ml/min per 1.73 m 2 , and 286 (2.0%) had albuminuria with eGFR ,60 ml/min per 1.73 m 2 . The incidence of eGFR ,60 ml/min per 1.73 m 2 increased in parallel with uric acid quintiles: Compared with the lowest quintile, RRRs were 1.46 (95% confidence interval [CI], 1.14 to 1.88; P=0.003), 1.44 (95% CI, 1.11 to 1.87; P=0.006), 1.95 (95% CI, 1.48 to 2.58; P,0.001), and 2.61 (95% CI, 1.98 to 3.42; P,0.001) for second, third, fourth, and fifth quintiles, respectively. Serum uric acid was significantly associated with albuminuria only in presence of eGFR ,60 ml/min per 1.73 m 2 .Conclusions Mild hyperuricemia is strongly associated with the risk of CKD in patients with type 2 diabetes.

Apparent Treatment Resistant Hypertension, Blood Pressure Control and the Progression of Chronic Kidney Disease in Patients with Type 2 Diabetes

“…As already reported [17][18][19], in Italy, diabetes care is mostly provided by a public network of about 700 diabetes clinics in which a team of specialists provides diagnostic confirmation, prevention and treatment for diabetes and its complications through close patients follow-up and regular checkups [17][18][19]. In the present study we selected a large cohort of patients with T2D followed up at 90 diabetes centers in Italy among those participating in the Italian Association of Clinical Diabetologists (Associazione Medici Diabetologi, AMD) initiative.…”

“…Participating centers adopted the same software systems for everyday management of outpatients, whereas a specially developed software package allowed us to extract the information we intended to analyze from all the clinical databases (AMD Data File). Moreover, data from all participating centers were collected and centrally analyzed anonymously [17][18][19]. All patients gave their informed consent and internal approval was obtained by the AMD annals Scientific Committee.…”

Serum uric acid and its association with hypertension, early nephropathy and chronic kidney disease in type 2 diabetic patients

“…Our results were consistent with previous findings, which registered that hyperuricemia seemed to be an independent risk factor for the development of incident CKD rather associated with overt nephropathy 37 and even in normalbuminuria patients with T2DM. 38 Collectively in the current study we, achieved that T2DM patients with UA ≤ 6.2 mg/dl were, younger, recently diabetic, better glycemic control, normotensive, lesser BMI, comparatively ideal TG/HDL-C, lower prevalence of early and overt nephropathy and preserved GFR. The current data give an important, highlighting to maintain SUA ≤ 6.2 mg/dl.…”

Serum Uric acid is correlated with HbA1c levels in type 2 diabetes mellitus

“…Occurrence rate of metabolic syndrome in type 2 diabetes mellitus (DM) is increased as serum uric levels elevated [5]. Moreover, hyperuricemia was found to be associated with development of chronic kidney disease in subjects with type 2 DM [6]. In present retrospective analysis, we aimed to compare serum uric acid levels of well controlled type 2 diabetic subjects to those of poorly controlled type 2 DM patients.…”

“…As expected, fasting plasma glucose of wellcontrolled type 2 diabetic patients (131±26 mg/dl) was significantly lower than poorly controlled subjects (225±19 mg/dl), (p<0.001). Similarly, HbA1c of well-controlled type 2 diabetic patients (6,8% [5,[1][2][3][4][5][6][7]4]) was significantly lower than poorly controlled diabetics (9,3% [7,[6][7][8][9][10][11][12][13][14][15][16]5]), (p<0.001). Systolic (p=0.74) and diastolic (p=0.34) blood pressures were similar in well-controlled and poorly controlled diabetics.…”