Could serum uric acid levels predict progression to diabetic kidney disease?

This study assessed the association between serum uric acid levels and progression to chronic kidney disease in type 2 diabetes.

Type 2 diabetes is associated with the development of many complications, including diabetic nephropathy (kidney disease or damage), which often leads to chronic kidney disease.

Uric acid is a byproduct of many metabolic pathways, and is typically filtered in the kidneys and removed from the body through the urine. Higher levels of uric acid in the blood (referred to as serum uric acid) often indicates kidney damage, and several studies has suggested that serum uric acid may be used as a marker of progressive diabetic kidney damage.

The aim of this study was to determine whether serum uric acid levels could predict the development of chronic kidney disease among patients with type 2 diabetes mellitus and preserved kidney function at the beginning of the study.

The study evaluated 512 type 2 diabetic patients with normal uric acid levels (less than or equal to 8 mg/dL). Patients were classified into four groups based on their serum uric acid levels. Group 1 was composed of 137 patients with uric acid levels of less than or equal to 3.8 mg/dL. Group 2 was composed of 120 patients with uric acid levels of 3.9 to 4.5 mg/dL. Group 3 was composed of 136 patients with uric acid levels of 4.6 to 5.5 mg/dL, and group 4 was composed of 119 patients with uric acid levels of greater than 5.5 mg/dL but less than 8 mg/dL. Patients were followed for an average of 3 years and evaluated for progressing diabetic nephropathy.

Of the 512 patients, 12.1% (62 patients) progressed to significant chronic kidney disease during the course of the study. A significantly higher incidence of progression to chronic kidney disease was noted among patients with increased serum uric acid levels. Patients in group 4 were almost three times more likely to progress to chronic kidney disease compared to patients in group 1.

Glomerular filtration rate (a known indicator of kidney function) and albuminuria (the presence of the blood protein albumin in the urine, an indicator of kidney damage) were also associated with the development of chronic kidney disease. Patients with albuminuria, for example, were twice as likely to experience progressive kidney disease. An increased diabetic nephropathy risk among patients with higher serum uric acid levels was noted regardless of glomerular filtration rate and albuminuria.

This study concluded that high range serum uric acid levels act as an independent predictor of chronic kidney disease development in patients with type 2 diabetes and preserved kidney function.

Consult with your physician regarding the prevention of diabetic nephropathy and the monitoring of kidney function with diabetes.