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Introduction <p>The aim of this work is to explore the association of time-averaged serum uric acid (TA-SUA) with renal outcomes of type 2 diabetes mellitus (T2DM) with chronic kidney disease (CKD).</p> Methods <p>A cohort of T2DM with CKD from eight centers was followed from January 2013 to January 2023. A Cox proportional hazards regression model was designed to evaluate the association of TA-SUA with renal outcomes (defined as serum creatinine doubling, or initiation of dialysis, or kidney transplantation, or progression to end-stage kidney disease). Cox proportional hazards regression with cubic spline functions and smooth curve fitting were used to explore the nonlinear relationship. Detailed evaluations for TA-SUA were also performed using propensity score matching (PSM), subgroup analyses, and sensitivity analyses.</p> Results <p>A total of 1072 patients were enrolled with a mean follow-up duration of 60.4 ± 5.6&#xa0;months. The baseline&#xa0;prevalence&#xa0;of hyperuricemia was 46.1% (50.4% in male vs. 37.9% in female). Patients with TA-SUA &lt; 360&#xa0;μmol/l demonstrated significantly better renal survival compared to those with TA-SUA ≥ 360&#xa0;μmol/l (adjusted hazard ratio 0.63, 95% confidence interval, 0.41–0.98; <i>P</i> = 0.038). Restriction cubic spline analysis showed a rapid risk increase when TA-SUA exceeded 360&#xa0;μmol/l, which was confirmed by PSM <i>(P</i> &lt; 0.001). Subgroup analyses and sensitivity analyses showed that patients with eGFR between 30 and 59&#xa0;ml/min/1.73&#xa0;m<sup>2</sup> were the most likely to benefit from maintaining TA-SUA &lt; 360&#xa0;μmol/l.</p> Conclusion <p>Long-term maintenance of relatively low TA-SUA levels is independently associated with slowed renal function decline and favorable renal outcomes among patients with type 2 DM with CKD.</p>

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Association Between Time-Averaged Serum Uric Acid and Renal Outcomes in Patients with Type 2 Diabetes Mellitus with Chronic Kidney Disease: A Multicenter Retrospective Cohort Study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月9日

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  • Shaogui Zhang,
  • Xuan Zhao,
  • Jianteng Xie,
  • Yifan Zhang,
  • Yanhui Wang,
  • Xiaojie Chen,
  • Qiuling Li,
  • Danfeng Liu,
  • Runli Jia,
  • Weiting He,
  • Yaxi Zhu,
  • Hanchen Hou,
  • Sheng Li,
  • Fanna Liu,
  • Yiming Zhang,
  • Rongshao Tan,
  • Hongquan Peng,
  • Jie Li,
  • Wenjian Wang

摘要

Introduction

The aim of this work is to explore the association of time-averaged serum uric acid (TA-SUA) with renal outcomes of type 2 diabetes mellitus (T2DM) with chronic kidney disease (CKD).

Methods

A cohort of T2DM with CKD from eight centers was followed from January 2013 to January 2023. A Cox proportional hazards regression model was designed to evaluate the association of TA-SUA with renal outcomes (defined as serum creatinine doubling, or initiation of dialysis, or kidney transplantation, or progression to end-stage kidney disease). Cox proportional hazards regression with cubic spline functions and smooth curve fitting were used to explore the nonlinear relationship. Detailed evaluations for TA-SUA were also performed using propensity score matching (PSM), subgroup analyses, and sensitivity analyses.

Results

A total of 1072 patients were enrolled with a mean follow-up duration of 60.4 ± 5.6 months. The baseline prevalence of hyperuricemia was 46.1% (50.4% in male vs. 37.9% in female). Patients with TA-SUA < 360 μmol/l demonstrated significantly better renal survival compared to those with TA-SUA ≥ 360 μmol/l (adjusted hazard ratio 0.63, 95% confidence interval, 0.41–0.98; P = 0.038). Restriction cubic spline analysis showed a rapid risk increase when TA-SUA exceeded 360 μmol/l, which was confirmed by PSM (P < 0.001). Subgroup analyses and sensitivity analyses showed that patients with eGFR between 30 and 59 ml/min/1.73 m2 were the most likely to benefit from maintaining TA-SUA < 360 μmol/l.

Conclusion

Long-term maintenance of relatively low TA-SUA levels is independently associated with slowed renal function decline and favorable renal outcomes among patients with type 2 DM with CKD.