Steno Diabetes Center Copenhagen, Gentofte, Denmark
Steno Diabetes Center Copenhagen, Gentofte, Denmark.
Diabetes Care. 2019 Jun;42(6):1088-1094. doi: 10.2337/dc18-2173. Epub 2019 Mar 18.
Previous studies have provided inconclusive results on the role of uric acid (UA) in risk prediction. Here we aimed to improve the power and precision of the predictive value of UA for the risk of decline in kidney function, cardiovascular events (CVEs), and mortality in patients with type 1 diabetes (T1D).
Plasma UA was measured in 670 patients with T1D and various degrees of albuminuria, ranging from normoalbuminuria to macroalbuminuria. Associations of UA with an estimated glomerular filtration rate (eGFR) decline of ≥30%, CVEs, and mortality were analyzed. The median follow-up time was 5.3 years [interquartile range (IQR) 2.7-6.2 years] for a decline in eGFR of ≥30%, 5.8 years (2.5-6.4 years) for progression in albuminuria status, 5.1 years (4.7-5.6 years) for CVE, and 6.2 years (5.8-6.7 years) for mortality. Both univariable and multivariable associations of UA with relevant outcomes and variables were reported. Hazard ratios (HRs) were calculated per doubling of the UA level.
A doubling in UA level was associated with a higher risk of decline in eGFR of ≥30% ( = 89) (HR 3.18 [IQR 1.71-5.93]; < 0.001), CVE ( = 94) (HR 2.25 [IQR 1.20-4.21]; = 0.011), and mortality ( = 58) (HR 2.58 [IQR 1.12-5.90]; = 0.025) in adjusted analyses. Adding UA to the adjusted model including conventional risk factors improved the relative integrated discrimination index by 12.6% for a decline in eGFR of ≥30% ( < 0.001), 6.5% for CVE ( = 0.010), and 11.8% ( = 0.003) for mortality. A doubling in UA level was also associated with a steeper decline in eGFR ( < 0.0026) and a steeper increase in urine albumin-to-creatinine ratio ( < 0.0027) in adjusted analysis.
In individuals with T1D, a higher UA level is associated with a higher risk of decline in kidney function, CVE, and mortality, independently of other risk factors. Our results suggest that UA has a promising role in risk stratification among individuals with T1D.
先前的研究对于尿酸（UA）在风险预测中的作用提供了不一致的结果。在这里，我们旨在提高 UA 对 1 型糖尿病（T1D）患者肾功能下降、心血管事件（CVE）和死亡率风险的预测价值的效力和精度。
在 670 例具有不同程度白蛋白尿（从正常白蛋白尿到大量白蛋白尿）的 T1D 患者中测量了血浆 UA。分析了 UA 与估计肾小球滤过率（eGFR）下降≥30%、CVE 和死亡率之间的关系。eGFR 下降≥30%的中位随访时间为 5.3 年[四分位距（IQR）2.7-6.2 年]，白蛋白尿状态进展的中位随访时间为 5.8 年（2.5-6.4 年），CVE 的中位随访时间为 5.1 年（4.7-5.6 年），死亡率的中位随访时间为 6.2 年（5.8-6.7 年）。报告了 UA 与相关结局和变量的单变量和多变量关联。每增加一倍 UA 水平，计算风险比（HR）。
UA 水平增加一倍与 eGFR 下降≥30%的风险增加相关（ = 89）（HR 3.18 [IQR 1.71-5.93]；<0.001）、CVE（ = 94）（HR 2.25 [IQR 1.20-4.21]； = 0.011）和死亡率（ = 58）（HR 2.58 [IQR 1.12-5.90]； = 0.025）在调整分析中。在包括传统危险因素的调整模型中加入 UA，可使 eGFR 下降≥30%的相对综合鉴别指数提高 12.6%（<0.001）、CVE 提高 6.5%（ = 0.010）和死亡率提高 11.8%（ = 0.003）。在调整分析中，UA 水平增加一倍也与 eGFR 下降更陡峭（<0.0026）和尿白蛋白/肌酐比值增加更陡峭（<0.0027）相关。
在 T1D 患者中，较高的 UA 水平与肾功能下降、CVE 和死亡率风险增加相关，独立于其他危险因素。我们的结果表明，UA 在 T1D 患者的风险分层中具有有前景的作用。
