Is Uric Acid elevation a random finding or a causative agent of diabetic nephropathy?

Koçak, Mehmet Zahid; Aktas, Gülali; Duman, Tuba Taslamacıoğlu; Tel, Burçin Meryem Atak; Şavlı, Haluk

doi:10.1590/1806-9282.65.9.1156

Cited by 38 publications

(30 citation statements)

References 24 publications

(20 reference statements)

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“…5 Hyperuricemia has drawn much attention in recent decades, as patients with hyperuricemia often present with metabolic diseases, cardiovascular diseases and cardiometabolic related complications. 6,7 Regarding diabetes, various longitudinal studies have demonstrated that higher baseline levels of serum uric acid increased the risk of developing type 2 diabetes, and a meta-analysis of 11 cohort studies including 42,834 participants indicated a 17% increase in the risk of type 2 diabetes for each 1 mg/dl increase in SUA. [8][9][10] Thus, how uric acid contributes to the pathophysiology of type 2 diabetes deserves research.…”

Section: Introductionmentioning

confidence: 99%

The Association of Serum Uric Acid with Beta-Cell Function and Insulin Resistance in Nondiabetic Individuals: A Cross-Sectional Study

Huang

Wang

et al. 2021

DMSO

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Purpose Higher serum levels of uric acid (SUA) are associated with an increased risk of developing type 2 diabetes. Meanwhile, insulin resistance and beta-cell dysfunction are critical factors that mediate the progression from normal glucose tolerance to impaired fasting glucose (IFG) and type 2 diabetes. We aimed to investigate the association between SUA levels and insulin resistance and beta-cell dysfunction in individuals without diabetes, thus explicating the role of uric acid in the early stage of the natural history of type 2 diabetes. Patients and Methods We used cross-sectional data from the China Health and Nutrition Survey to examine the association. Insulin resistance and beta-cell dysfunction were estimated using the homeostasis model assessment of insulin resistance (HOMA-IR) index and homeostasis model assessment of beta-cell function (HOMA-beta) index, respectively. The associations were analyzed by using partial correlation analysis and multivariate logistic regressionl analysis. Results SUA levels were positively associated with fasting glucose, fasting insulin, HOMA-IR in the total population. After adjustment for age, drinking, smoking, living area, daily dietary nutrient intake, body mass index (BMI), estimated glomerular filtration rate (eGFR), hypertension, and dyslipidemia, compared with participants in the lowest quartile of SUA, the adjusted odds ratios for the fourth quartiles were 1.56(1.09-2.24) for IFG, 1.51(1.27-1.78) for insulin resistance, and 1.06(0.88-1.27) for beta-cell dysfunction. In the subgroup analysis, no interactions were found between serum uric acid and age, drinking status, smoking status, BMI, hypertension, or dyslipidemia (all p for interaction>0.05). Conclusion In nondiabetic individuals, SUA levels are independently associated with IFG and insulin resistance, while no significant association exists between SUA and beta-cell dysfunction.

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Section: Introductionmentioning

confidence: 99%

The Association of Serum Uric Acid with Beta-Cell Function and Insulin Resistance in Nondiabetic Individuals: A Cross-Sectional Study

Huang

Wang

et al. 2021

DMSO

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“… 22 Meanwhile, HDL of the subjects with diabetic nephropathy have lower levels of HDL compared to the diabetic patients without diabetic nephropathy. 23 These findings were considered to be associated with increased inflammatory burden. Besides, our study confirmed that HDL was strongly associated with poor prognosis in anti-MDA5 + patients.…”

Section: Discussionmentioning

confidence: 99%

Clinical Characteristics of Lipid Metabolism in Untreated Patients with Anti-MDA5 Antibody-Positive

Huang¹,

Ren²,

Luo³

et al. 2021

IJGM

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Objective Clinical characterization of lipid metabolism in untreated patients with anti-melanoma differentiation-associated gene 5 antibodies-positive (anti-MDA5 + ). Methods Body-mass index (BMI), autoantibodies, lipid levels, and serum ferritin levels in 57 anti-MDA5 + patients were determined in the Department of Rheumatology and Immunology of the Second Affiliated Hospital of Chongqing Medical University. Results Plasma high-density lipoprotein (HDL) and apolipoprotein A1 (ApoA1) levels were significantly lower in deceased group than in the survival group (P < 0.05). Plasma levels of HDL and ApoA1 were significantly lower in patients who were simultaneously anti-MDA5 + and anti-Ro-52 + than in patients who were anti-MDA5 + alone (P < 0.05). Plasma levels of total cholesterol, low-density lipoprotein, HDL, and ApoA1 were significantly decreased in patients with high levels of serum ferritin compared with patients with low levels (P < 0.05). There were no significant differences in blood lipid levels between patients grouped according to BMI. Conclusion 1) HDL and ApoA1 levels are important indicators of poor prognosis in anti-MDA5 + patients; 2) Dysregulated lipid metabolism in anti-MDA5 + patients is closely associated with anti-Ro-52 antibody and ferritin levels but independent of BMI; 3) HDL involvement in inflammation and immune regulation merits close attention by rheumatologists.

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“…DN was diagnosed by at least two renal pathologists and/or nephrologists on the basis of the Renal Pathology Society classification and was defined using the standard of An et al in 2015 ( 11 , 12 ). The inclusion criteria were patients ( 1 ) with a diagnosis of T2DM, ( 2 ) aged ≥18 years old, ( 3 ) with a diagnosis of renal biopsy-proven DN and ( 4 ) with an e-GFR >15 mL/min/1.73 m 2 . The exclusion criteria were participants with non-T2DM, a history of kidney transplantation or incomplete data, those who began the dialysis treatment before the renal biopsy and those with a follow-up time of less than 1 year ( Fig.…”

Section: Methodsmentioning

confidence: 99%

“…In China Kidney Disease Network 2015 annual data report, diabetes related kidney disease is now the leading cause of CKD, accounting for 26.96%. 2 Serum uric acid (SUA) level has been widely recognized as a risk factor for DN development because oxidants are produced that can play a key role in renal injury during UA synthesis 3 . A host of previous studies had reported an association between SUA levels and DN development.…”

Section: Introductionmentioning

confidence: 99%

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Association between serum uric acid and renal outcome in patients with biopsy-confirmed diabetic nephropathy

Zou

Zhao

Zhang

et al. 2021

Endocrine Connections

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Objective: 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). Methods: A total of 393 Chinese patients with T2DM and biopsy-proven DN and followed at least one year were enrolled in this study. Patients were stratified by the quartiles of baseline level of SUA: Q1 group286.02± 46.66 μmol/L (n=98); Q2 group: 358.23±14.03μmol/L (n=99); Q3 group: 405.50±14.59μmol/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. Results: During the median 3-year follow-up period, there were 173 ESRD outcome events (44.02%) during follow-up. No significant difference among SUA level the risk of progression of DN (P=0.747) was shown in the Kaplan-Meier survival analysis. In multivariable-adjusted model, HRs 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). Conclusions: 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 improve 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.

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Is Uric Acid elevation a random finding or a causative agent of diabetic nephropathy?

Cited by 38 publications

References 24 publications

The Association of Serum Uric Acid with Beta-Cell Function and Insulin Resistance in Nondiabetic Individuals: A Cross-Sectional Study

The Association of Serum Uric Acid with Beta-Cell Function and Insulin Resistance in Nondiabetic Individuals: A Cross-Sectional Study

Clinical Characteristics of Lipid Metabolism in Untreated Patients with Anti-MDA5 Antibody-Positive

Association between serum uric acid and renal outcome in patients with biopsy-confirmed diabetic nephropathy

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