Department of Non-Communicable Disease Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China.
Front Endocrinol (Lausanne). 2024 Jul 29;15:1415459. doi: 10.3389/fendo.2024.1415459. eCollection 2024.
This study aimed to explore the synergistic interaction effect between hyperuricemia and hypertension towards chronic kidney disease in patients with type 2 diabetes.
This research originates from a cross-sectional study performed in Zhejiang Province, Eastern China, between March and November 2018. The correlation between serum uric acid levels and the risk of chronic kidney disease was assessed using a restricted cubic spline model. An unconditional multivariable logistic regression model, along with an interaction table, was utilized to explore the potential interaction effect of hyperuricemia and hypertension towards chronic kidney disease.
1,756 patients with type 2 diabetes were included in this study, the prevalence of chronic kidney disease (CKD) was 27.62% in this population. A U-shaped non-linear pattern emerged correlating serum uric acid (SUA) levels and CKD risk, indicating that both low and high SUA levels were linked to an increased CKD risk. This risk achieved its lowest point (nadir) at SUA approximately equals to 285μmol/L (p for trend <0.05). Once adjustments for age, gender, education level, abnormal fasting plasma glucose (FPG), abnormal hemoglobin A1c (HbA1c), abnormal total cholesterol (TC), abnormal high-density lipoprotein cholesterol (HDL-C), alcohol consumption and duration of diabetes were factored in, it was found that patients with both hyperuricemia and hypertension demonstrated a 5.42-fold (95% CI: 3.72-7.90) increased CKD risk compared to the reference group. The additive interaction between hyperuricemia and hypertension was statistically significant, as manifested by the following values: a relative excess risk due to interaction (RERI) of 2.57 (95% CI: 0.71-4.71), an attributable proportion due to interaction (AP) of 0.47 (95% CI: 0.14-0.64), and a synergy index (SI) of 2.39 (95% CI: 1.24-4.58). In contrast, there was no significant interaction effect in multiplicative scale.
Hyperuricemia and hypertension may contribute additively to CKD, beyond their isolated impacts. Evaluating the risk of CKD in type 2 diabetes patients necessitates considering this potential interaction.
本研究旨在探讨 2 型糖尿病患者中血尿酸（UA）与高血压协同作用对慢性肾脏病（CKD）的影响。
本研究来源于 2018 年 3 月至 11 月在中国东部浙江省进行的横断面研究。采用受限立方样条模型评估血清 UA 水平与 CKD 风险之间的相关性。采用非条件多变量 logistic 回归模型和交互表探讨高尿酸血症和高血压对 CKD 的潜在交互作用。
共纳入 1756 例 2 型糖尿病患者，该人群 CKD 的患病率为 27.62%。血清 UA（SUA）水平与 CKD 风险呈 U 型非线性相关，提示低和高 SUA 水平均与 CKD 风险增加相关。在 SUA 约等于 285μmol/L 时（趋势检验 P<0.05），风险达到最低点。在校正年龄、性别、教育程度、空腹血糖异常、糖化血红蛋白异常、总胆固醇异常、高密度脂蛋白胆固醇异常、饮酒和糖尿病病程等因素后，发现同时患有高尿酸血症和高血压的患者发生 CKD 的风险较对照组增加 5.42 倍（95%CI：3.72-7.90）。高尿酸血症和高血压之间的相加交互作用具有统计学意义，表现为交互超额危险度（RERI）为 2.57（95%CI：0.71-4.71）、归因交互比例（AP）为 0.47（95%CI：0.14-0.64）和协同指数（SI）为 2.39（95%CI：1.24-4.58）。在乘法尺度上，没有显著的交互作用效应。
高尿酸血症和高血压可能会协同作用导致 2 型糖尿病患者的 CKD 发生，其作用超出了各自的独立影响。在评估 2 型糖尿病患者的 CKD 风险时，需要考虑这种潜在的交互作用。
