Zou Yutong, Zhao Lijun, Zhang Junlin, Wang Yiting, Wu Yucheng, Ren Honghong, Wang Tingli, Zhang Rui, Wang Jiali, Zhao Yuancheng, Qin Chunmei, Xu Huan, Li Lin, Chai Zhonglin, Cooper Mark E, Tong Nanwei, Liu Fang
Division of Nephrology, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
Laboratory of Diabetic Kidney Disease, Centre of Diabetes and Metabolism Research, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
Endocr Connect. 2021 Oct 13;10(10):1299-1306. doi: 10.1530/EC-21-0307.
To investigate the relationship between serum uric acid (SUA) level and renal outcome in patients with type 2 diabetes mellitus (T2DM) and diabetic nephropathy (DN).
A total of 393 Chinese patients with T2DM and biopsy-proven DN and followed at least 1 year were enrolled in this study. Patients were stratified by the quartiles of baseline level of SUA: Q1 group: 286.02 ± 46.66 μmol/L (n = 98); Q2 group: 358.23 ± 14.03 μmol/L (n = 99); Q3 group: 405.50 ± 14.59 μmol/L (n = 98) and Q4 group: 499.14 ± 56.97μmol/L (n = 98). Renal outcome was defined by progression to end-stage renal disease (ESRD). Kaplan-Meier survival analysis and Cox proportional hazards model were used to analyze the association between SUA quartiles and the renal outcomes.
During the median 3-year follow-up period, there were 173 ESRD outcome events (44.02%). No significant difference between SUA level and the risk of progression of DN (P = 0.747) was shown in the Kaplan-Meier survival analysis. In multivariable-adjusted model, hazard ratios for developing ESRD were 1.364 (0.621-2.992; P = 0.439), 1.518 (0.768-3.002; P = 0.230) and 1.411 (0.706-2.821; P = 0.330) for the Q2, Q3 and Q4, respectively, in comparison with the Q1 (P = 0.652).
No significant association between SUA level and renal outcome of ESRD in Chinese patients with T2DM and DN was found in our study. Besides, the role of uric acid-lowering therapy in delaying DN progression and improving ESRD outcome had not yet been proven. Further study was needed to clarify the renal benefit of the uric acid-lowering therapy in the treatment of DN.
探讨2型糖尿病（T2DM）合并糖尿病肾病（DN）患者血清尿酸（SUA）水平与肾脏结局之间的关系。
本研究纳入了393例经活检证实为DN且随访至少1年的中国T2DM患者。根据SUA基线水平的四分位数对患者进行分层：Q1组：286.02±46.66μmol/L（n = 98）；Q2组：358.23±14.03μmol/L（n = 99）；Q3组：405.50±14.59μmol/L（n = 98）；Q4组：499.14±56.97μmol/L（n = 98）。肾脏结局定义为进展至终末期肾病（ESRD）。采用Kaplan-Meier生存分析和Cox比例风险模型分析SUA四分位数与肾脏结局之间的关联。
在中位3年的随访期内，发生了173例ESRD结局事件（44.02%）。Kaplan-Meier生存分析显示，SUA水平与DN进展风险之间无显著差异（P = 0.747）。在多变量调整模型中，与Q1组相比，Q2、Q3和Q4组发生ESRD的风险比分别为1.364（0.621-2.992；P = 0.439）、1.518（0.768-3.002；P = 0.230）和1.411（0.706-2.821；P = 0.330）（P = 0.652）。
在本研究中，未发现中国T2DM合并DN患者的SUA水平与ESRD肾脏结局之间存在显著关联。此外，降尿酸治疗在延缓DN进展和改善ESRD结局方面的作用尚未得到证实。需要进一步研究以阐明降尿酸治疗在DN治疗中的肾脏益处。
