Gu Liubao, Huang Liji, Wu Haidi, Lou Qinglin, Bian Rongwen
1 Center for Diabetes Care, Education and Research, Jiangsu Province Institute of Geriatrics, Nanjing, China.
2 Department of Endocrinology and Metabolism, Jiangsu Province Official Hospital, Nanjing, China.
Diab Vasc Dis Res. 2017 May;14(3):221-225. doi: 10.1177/1479164116680318. Epub 2017 Feb 9.
Serum uric acid has shown to be a predictor of renal disease progression in most but not all studies. This study aims to test whether renal function-normalized serum uric acid is superior to serum uric acid as the predictor of incident chronic kidney disease in type 2 diabetes mellitus patients.
In this study, 1339 type 2 diabetes mellitus patients with estimated glomerular filtration rate ⩾60 mL/min/1.73 m and normouricemia were included. Renal function-normalized serum uric acid was calculated using serum uric acid/creatinine. Cox regression analysis was used to estimate the association between serum uric acid, renal function-normalized serum uric acid and incident chronic kidney disease.
In total, 74 (5.53%) patients developed to chronic kidney disease 3 or greater during a median follow-up of 4 years, with older ages, longer diabetes duration and lower estimated glomerular filtration rate at baseline. The decline rate of estimated glomerular filtration rate was positively correlated with serum uric acid/creatinine ( r = 0.219, p < 0.001), but not serum uric acid ( r = 0.005, p = 0.858). Moreover, multivariate analysis revealed that serum uric acid was not an independent risk factor for incident chronic kidney disease ( p = 0.055), whereas serum uric acid to creatinine ratio was significantly associated with incident chronic kidney disease independently of potential confounders including baseline estimated glomerular filtration rate.
serum uric acid to creatinine ratio might be a better predictor of incident chronic kidney disease in type 2 diabetes mellitus patients.
在大多数但并非所有研究中，血清尿酸已被证明是肾脏疾病进展的预测指标。本研究旨在检验在2型糖尿病患者中，肾功能标准化的血清尿酸作为新发慢性肾脏病预测指标是否优于血清尿酸。
本研究纳入了1339例估算肾小球滤过率⩾60 mL/min/1.73 m²且血尿酸正常的2型糖尿病患者。肾功能标准化的血清尿酸通过血清尿酸/肌酐计算得出。采用Cox回归分析来评估血清尿酸、肾功能标准化的血清尿酸与新发慢性肾脏病之间的关联。
在中位随访4年期间，共有74例（5.53%）患者进展为慢性肾脏病3期或更高分期，这些患者年龄较大，糖尿病病程较长，且基线估算肾小球滤过率较低。估算肾小球滤过率的下降速率与血清尿酸/肌酐呈正相关（r = 0.219，p < 0.001），但与血清尿酸无关（r = 0.005，p = 0.858）。此外，多因素分析显示血清尿酸不是新发慢性肾脏病的独立危险因素（p = 0.055），而血清尿酸与肌酐的比值与新发慢性肾脏病显著相关，且独立于包括基线估算肾小球滤过率在内的潜在混杂因素。
血清尿酸与肌酐的比值可能是2型糖尿病患者新发慢性肾脏病的更好预测指标。
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