Uric acid is not associated with diabetic nephropathy and other complications in type 1 diabetes

Pilemann-Lyberg, Sascha; Hansen, Tine W.; Persson, Frederik; Theilade, Simone; Ahluwalia, Tarunveer S.; Frystyk, Jan; Rossing, Peter

doi:10.1093/ndt/gfy076

Cited by 19 publications

(25 citation statements)

References 34 publications

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“…Between 2009 and 2011, Caucasian patients with type 1 diabetes were recruited to enter a cross-sectional study at Steno Diabetes Center Copenhagen. The details of the study have been previously described (5,11,12). The cohort was stratified by levels of albuminuria (normoalbuminuria, microalbuminuria, and macroalbuminuria) regardless of the presence of retinopathy.…”

Section: Participantsmentioning

confidence: 99%

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Uric Acid Is an Independent Risk Factor for Decline in Kidney Function, Cardiovascular Events, and Mortality in Patients With Type 1 Diabetes

et al. 2019

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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). RESEARCH DESIGN AND METHODSPlasma 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. RESULTSA doubling in UA level was associated with a higher risk of decline in eGFR of ‡30% (n = 89) (HR 3.18 [IQR 1.71-5.93]; P < 0.001), CVE (n = 94) ; P = 0.011), and mortality (n = 58) (HR 2.58 [IQR 1.12-5.90]; P = 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% (P < 0.001), 6.5% for CVE (P = 0.010), and 11.8% (P = 0.003) for mortality. A doubling in UA level was also associated with a steeper decline in eGFR (P < 0.0026) and a steeper increase in urine albumin-to-creatinine ratio (P < 0.0027) in adjusted analysis. CONCLUSIONSIn 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.

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Section: Participantsmentioning

confidence: 99%

“…Studies have shown that elevated uric acid levels independently predict the incidence and development of chronic kidney disease both in patients without diabetes and in patients with diabetes (2)(3)(4). However, other studies have not been able to confirm these findings (5)(6)(7).…”

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Uric Acid Is an Independent Risk Factor for Decline in Kidney Function, Cardiovascular Events, and Mortality in Patients With Type 1 Diabetes

et al. 2019

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“…It should be noted that the statistical models are different in the two analyses of the same cohort. In the previous study, the data on annual decline in eGFR in the highest UA quartile were compared with the three lower quartiles (2). However, in the present study (1), hazard ratios were calculated per doubling of UA.…”

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confidence: 80%

“…Furthermore, statistical significance may change in different analysis models, and results should be interpreted with caution. It is interesting that in another recently published article on the same cohort (2), no association was found between UA and decline in estimated glomerular filtration rate (eGFR). The research group considered that the difference in these results may be explained by the larger sample size (a rise from 476 patients to 510 patients with eGFR follow-up data) and increase in the follow-up period from 4.1 to 5.3 years (2).…”

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Comment on Pilemann-Lyberg et al. Uric Acid Is an Independent Risk Factor for Decline in Kidney Function, Cardiovascular Events, and Mortality in Patients With Type 1 Diabetes. Diabetes Care 2019;42:1088–1094

Chen

Huang

et al. 2019

Diabetes Care

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“…Son yıllarda ürik asit düzeyi ile diyabet ve komplikasyonları arasındaki ilişkiyi inceleyen çalışmalar yayınlanmış olup bu çalışmaların sonuçlarının birbiri ile tutarsız olduğu ve tartışmaların devam ettiği görülmektedir 5,[9][10][11]13 . T1DM hastalarında SÜA düzeyini ve ürik asidin komplikasyonlarla ilişkisini inceleyen az sayıda çalışma mevcuttur.…”

Section: Tartışma Ve Sonuçunclassified

Evaluation of Serum Uric Acid Level in Type 1 Diabetes Mellitus Patients and Investigation of the Relationship Between Uric Acid Level and Microvascular Complications

Çalapkulu¹,

Sencar²,

Ünsal³

et al. 2021

Uludağ Üniversitesi Tıp Fakültesi Dergisi

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Tip 1 diabetes mellitus (T1DM) pankreasta bulunan beta hücrelerinin hasarı sonucu gelişen ve insülin eksikliği ile karakterize kronik metabolik bir hastalıktır. Nefropati, retinopati ve nöropati diyabetin bilinen mikrovasküler komplikasyonlarıdır. T1DM hastalarında serum ürik asit (SÜA) düzeyini değerlendiren az sayıda çalışma mevcuttur ve SÜA düzeyinin mikrovasküler komplikasyonlar ile ilişkisi tartışmalıdır. Bu çalışmada T1DM hastalarında SÜA düzeyini değerlendirmeyi ve SÜA düzeyinin mikrovasküler komplikasyonlar ile ilişkisini incelemeyi amaçladık. Bu çalışma 18 yaşından büyük T1DM tanısı ile takipli 160 hastanın ve 85 sağlıklı kontrolün dosyalarının retrospektif değerlendirilmesi ile yapıldı. T1DM hastalarında kontrol grubuna göre SÜA düzeyi düşük bulundu (p:0.035) ve SÜA düzeyi ile HbA1c arasında negatif kolerasyon saptandı (r:-0.172, p:0.03). SÜA ile kreatinin düzeyi arasında pozitif kolerasyon saptandı (r:0.269, p:0.001). Nefropati gelişen hastalarda SÜA düzeyi diyabet süresinden bağımsız olarak yüksek saptanırken (r2:0.185, p:0.027) nöropati ve retinopatisi mevcut olan hastalarda SÜA yüksekliği bağımsız bir risk faktörü olarak saptanmadı. Sonuç olarak T1DM hastalarında kontrol grubuna göre daha düşük SÜA düzeyi bulunmasına rağmen diyabetik nefropati gelişen hastalarda SÜA düzeyinin yüksek olduğu saptandı. Yüksek SÜA düzeyinin diyabetik nefropati gelişiminde risk faktörü olup olmadığını belirlemek için daha ileri prospektif çalışmalar gereklidir.

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Uric acid is not associated with diabetic nephropathy and other complications in type 1 diabetes

Abstract: In type 1 diabetes patients, higher UA was associated with lower kidney function and other diabetic complications. The association between higher UA and lower eGFR and lower diastolic BP was independent of traditional risk factors.

Cited by 19 publications

References 34 publications

Uric Acid Is an Independent Risk Factor for Decline in Kidney Function, Cardiovascular Events, and Mortality in Patients With Type 1 Diabetes

Uric Acid Is an Independent Risk Factor for Decline in Kidney Function, Cardiovascular Events, and Mortality in Patients With Type 1 Diabetes

Comment on Pilemann-Lyberg et al. Uric Acid Is an Independent Risk Factor for Decline in Kidney Function, Cardiovascular Events, and Mortality in Patients With Type 1 Diabetes. Diabetes Care 2019;42:1088–1094

Evaluation of Serum Uric Acid Level in Type 1 Diabetes Mellitus Patients and Investigation of the Relationship Between Uric Acid Level and Microvascular Complications

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