Time-averaged Serum Uric Acid Level Associated with the Outcomes of Type 2 Diabetes Mellitus with Chronic Kidney Disease: A 10-Year Multicenter Retrospective Cohort Study

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Abstract Title *

Time-averaged Serum Uric Acid Level Associated with the Outcomes of Type 2 Diabetes Mellitus with Chronic Kidney Disease: A 10-Year Multicenter Retrospective Cohort Study

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Co-author 1

Shaogui Zhang zsg2005048@163.com Guangdong Provincial People's Hospital Department of Nephrology Guangzhou China *

Co-author 2

Jianteng Xie 13826495245@139.com Guangdong Provincial People's Hospital Department of Nephrology Guangzhou China -

Co-author 3

Yifan Zhang zhangyf0727@126.com Wenzhou Central Hospital Department of Nephrology Wenzhou China -

Co-author 4

Yanhui Wang wyh104006@163.com The First Affiliated Hospital of Wenzhou Medical University Department of Nephrology Wenzhou China -

Co-author 5

Xiaojie Chen cxjsmallclean@163.com Shenzhen Second People's Hospital Department of Nephrology Shenzhen China -

Co-author 6

Qiuling Li qiulingli@126.com Guangdong Provincial People's Hospital Department of Nephrology Guangzhou China -

Co-author 7

Danfeng Liu 202220156990@mail.scut.edu.cn South China University of Technology School of Medicine Guangzhou China -

Co-author 8

Runli Jia 1633309377@qq.com South China University of Technology School of Medicine Guangzhou China -

Co-author 9

Xuan Zhao 1328238937@qq.com Guangdong Provincial People's Hospital Department of Nephrology Guangzhou China -

Co-author 10

Fanna Liu tliufana@jnu.edu.cn The First Affiliated Hospital of Jinan University Department of Nephrology Guangzhou China -

Co-author 11

Yiming Zhang zhangym@126.com The Sixth Affiliated Hospital of Sun Yat-sen University Department of Nephrology Guangzhou China -

Co-author 12

Rongshao Tan tanrongshao@126.com Guangzhou Red Cross Hospital Department of Nephrology Guangzhou China -

Co-author 13

Hongquan Peng hpeng93170@gmail.com Kiang Wu Hospital Department of Nephrology Macau Macau, China -

Co-author 14

Jie Li ljieecho@163.com Guangdong Provincial People's Hospital Global Health Research Center Guangzhou China -

Co-author 15

Wenjian Wang wangwenjian@gdph.org.cn Guangdong Provincial People's Hospital Department of Nephrology Guangzhou China -

Introduction

To explore the association of time-averaged serum uric acid (TA-SUA) on the long-term outcomes of type 2 diabetes mellitus (T2DM) with chronic kidney disease (CKD).

Methods

Current retrospective study was conducted in a cohort of type 2 DM with CKD from eight centers, with follow-up period spanning from January 2013 to October 2023. The primary outcomes included serum creatinine doubling, initiation of dialysis, kidney transplantation, progression to end-stage kidney disease, and all-cause mortality.

Results

Kaplan-Meier survival curves for the Composite Endpoint, stratified by serum uric acid levels Total of 1,072 patients were enrolled from 1651 patients diagnosed of T2DM with CKD in cohort. The median of follow-up time was 60.4±5.6 months. The overall prevalence of hyperuricemia (HUA) in current cohort was 46.1%, of which in men (50.4%) was significantly higher than that in women (37.9%). After adjusting for confounding factors, both baseline and time-averaged SUA were identified as the independent risk factor for composite endpoints. Patients with baseline SUA and TA-SUA ≥ 420 μmol/L exhibited 1.9-fold (HR 1.92, 95% CI:1.40-2.62, P < 0.001）and 2.6-fold (HR 2.60, 95% CI:1.82-3.70, P < 0.001）higher risk to composite endpoint compared to those with baseline SUA or TA-SUA < 360 μmol/L respectively. Patients with TA-SUA< 360 μmol/L exhibited much improved composite endpoint after adjusted for age, sex, hemoglobin, glycosylated hemoglobin and usage of lipid-lowering, glucose-lowering, blood- pressure lowering, and urate-lowering drugs.

Conclusion

Type 2 DM with CKD benefits from long-term controlled TA-SUA less than 360 μmol/L by significantly improved renal function decline and all-cause mortality.

Kewords