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Purpose <p>Serum uric acid to creatinine ratio (SUA/sCr) has emerged as potential biomarker for non-albuminuric diabetic kidney disease (NA-DKD), a recently recognized high-prevalence DKD phenotype. However, the relationship between SUA/sCr and cardiovascular and renal injury profile in this population is not well established. This study aimed to evaluate SUA/sCr across the spectrum of DKD, particularly focusing on NA-DKD, and to test its association with subclinical vascular damage, urinary biomarkers and ultrasound features of kidney damage.</p> Methods <p>Presence of carotid plaques, pulse wave velocity (PWV), renal resistive index (RRI), and urinary biomarkers of tubular injury were assessed in 207 individuals with type 2 diabetes. Participants were split based on estimated-glomerular-filtration-rate (eGFR) and urinary-albumin-to-creatinine-ratio (UACR) into four groups: controls (UACR &lt; 30&#xa0;mg/g, eGFR ≥ 60&#xa0;ml/min/1.73m<sup>2</sup>), A-DKD (Albuminuric-DKD; UACR ≥ 30&#xa0;mg/g, eGFR ≥ 60&#xa0;ml/min/1.73m<sup>2</sup>), NA-DKD (Non-albuminuric-DKD; UACR &lt; 30&#xa0;mg/g, eGFR &lt; 60&#xa0;ml/min/1.73m<sup>2</sup>), A&amp;L-DKD (Albuminuric-and-Low-eGFR-DKD; UACR ≥ 30&#xa0;mg/g, eGFR &lt; 60&#xa0;ml/min/1.73m<sup>2</sup>).</p> Results <p>Participants with NA-DKD showed a lower SUA/sCr than those with A-DKD and controls (4.71 ± 1.52 vs 6.06 ± 1.70 vs 6.67 ± 1.87, both <i>P</i> &lt; 0.0001). A lower SUA/sCr was independently correlated with NA-DKD (β = -1.63, <i>P</i> &lt; 0.0001) and A&amp;L-DKD (β = -2.01, <i>P</i> &lt; 0.0001). SUA/sCr was inversely and independently associated with urinary β2-microglobulin (β = -0.21, <i>P</i> = 0.0082). Moreover, lower SUA/sCr was associated with PWV &gt; 10&#xa0;m/s (OR 0.77, 95%CI 0.63–0.95, <i>P</i> = 0.014), the presence of carotid plaques (OR 0.78, 95%CI 0.63–0.96, <i>P</i> = 0.020), and higher RRI (β = -0.18, <i>P</i> = 0.0082).</p> Conclusion <p>In T2D, lower SUA/sCr correlated with NA-DKD, but not with A-DKD. Lower SUA/sCr was associated with subclinical vascular and tubular damage. Future studies are needed to test SUA/sCr as candidate biomarker to improve DKD risk stratification.</p>

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Serum uric acid to creatinine ratio as marker of early vascular damage and renal tubular injury in non-albuminuric diabetic kidney disease

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月10日

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  • Maurizio Di Marco,
  • Sabrina Scilletta,
  • Nicoletta Miano,
  • Nicola Marrano,
  • Annalisa Natalicchio,
  • Francesco Giorgino,
  • Giosiana Bosco,
  • Francesco Di Giacomo Barbagallo,
  • Roberto Scicali,
  • Andrea Tumminia,
  • Agostino Milluzzo,
  • Lucia Frittitta,
  • Salvatore Piro,
  • Antonino Di Pino

摘要

Purpose

Serum uric acid to creatinine ratio (SUA/sCr) has emerged as potential biomarker for non-albuminuric diabetic kidney disease (NA-DKD), a recently recognized high-prevalence DKD phenotype. However, the relationship between SUA/sCr and cardiovascular and renal injury profile in this population is not well established. This study aimed to evaluate SUA/sCr across the spectrum of DKD, particularly focusing on NA-DKD, and to test its association with subclinical vascular damage, urinary biomarkers and ultrasound features of kidney damage.

Methods

Presence of carotid plaques, pulse wave velocity (PWV), renal resistive index (RRI), and urinary biomarkers of tubular injury were assessed in 207 individuals with type 2 diabetes. Participants were split based on estimated-glomerular-filtration-rate (eGFR) and urinary-albumin-to-creatinine-ratio (UACR) into four groups: controls (UACR < 30 mg/g, eGFR ≥ 60 ml/min/1.73m2), A-DKD (Albuminuric-DKD; UACR ≥ 30 mg/g, eGFR ≥ 60 ml/min/1.73m2), NA-DKD (Non-albuminuric-DKD; UACR < 30 mg/g, eGFR < 60 ml/min/1.73m2), A&L-DKD (Albuminuric-and-Low-eGFR-DKD; UACR ≥ 30 mg/g, eGFR < 60 ml/min/1.73m2).

Results

Participants with NA-DKD showed a lower SUA/sCr than those with A-DKD and controls (4.71 ± 1.52 vs 6.06 ± 1.70 vs 6.67 ± 1.87, both P < 0.0001). A lower SUA/sCr was independently correlated with NA-DKD (β = -1.63, P < 0.0001) and A&L-DKD (β = -2.01, P < 0.0001). SUA/sCr was inversely and independently associated with urinary β2-microglobulin (β = -0.21, P = 0.0082). Moreover, lower SUA/sCr was associated with PWV > 10 m/s (OR 0.77, 95%CI 0.63–0.95, P = 0.014), the presence of carotid plaques (OR 0.78, 95%CI 0.63–0.96, P = 0.020), and higher RRI (β = -0.18, P = 0.0082).

Conclusion

In T2D, lower SUA/sCr correlated with NA-DKD, but not with A-DKD. Lower SUA/sCr was associated with subclinical vascular and tubular damage. Future studies are needed to test SUA/sCr as candidate biomarker to improve DKD risk stratification.