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Background <p>The serum uric acid-to-albumin ratio (sUAR) has been implicated in various cardiovascular and kidney diseases. However, its association with kidney composite events in patients with type 2 diabetes mellitus (T2DM) remains underexplored. This study aimed to investigate the relationship between sUAR and kidney composite events in T2DM patients.</p> Methods <p>This retrospective cohort study included 3,618 patients with T2DM from Chengdu Integrated TCM &amp; Western Medicine Hospital between January 2018 and December 2025. The sUAR was calculated as serum uric acid divided by serum albumin. Participants were categorized into tertiles (T1: 1.99–7.65; T2: 7.66–10.21; T3: 10.22–31.67) based on sUAR. The primary outcome was a composite kidney endpoint, defined as initiation of maintenance dialysis, chronic kidney disease stage 5, or a eGFR decline ≥ 40% from baseline. Multivariable Cox proportional hazards regression, restricted cubic spline (RCS) analysis, Kaplan-Meier curves, subgroup analyses, and SHapley Additive exPlanations (SHAP) were performed to evaluate the association between sUAR and kidney composite events.</p> Results <p>During a median follow‑up of 28.7 months (IQR: 14.1–52.6), 591 (16.3%) kidney composite events occurred. Compared with the lowest tertile (T1), the highest tertile (T3) of sUAR was associated with a 44% increased risk of kidney composite events after full adjustment (HR = 1.44, 95% CI: 1.12–1.85, <i>P</i> = 0.005). RCS analysis revealed a non-linear relationship between sUAR and kidney composite events. Kaplan-Meier curves demonstrated significant differences in events-free survival across tertiles (log-rank <i>P</i> &lt; 0.001). Subgroup analyses identified age as a significant effect modifier (<i>P</i> &lt; 0.001), with a stronger association observed in younger patients (&lt; 65 years). Among the 22 candidate variables included in the model, sUAR ranked as the sixth most important predictor of kidney composite events, following cystatin C, hemoglobin, albumin, eGFR, and HbA1c.</p> Conclusions <p>Elevated sUAR is independently associated with an increased risk of kidney composite events in patients with T2DM, with a non-linear relationship.</p> Clinical trial number <p>Not applicable.</p> Graphical Abstract <p></p>

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Association of the serum uric acid/albumin ratio with kidney composite events in patients with type 2 diabetes mellitus: a retrospective cohort study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月27日

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  • Jinhua Chen,
  • Guangchun Zou,
  • Xinyi Zhao,
  • Min Chen,
  • Jun Chen,
  • Yijun Wang,
  • Yong Ren,
  • Zaijun Chen,
  • Jingjing Li

摘要

Background

The serum uric acid-to-albumin ratio (sUAR) has been implicated in various cardiovascular and kidney diseases. However, its association with kidney composite events in patients with type 2 diabetes mellitus (T2DM) remains underexplored. This study aimed to investigate the relationship between sUAR and kidney composite events in T2DM patients.

Methods

This retrospective cohort study included 3,618 patients with T2DM from Chengdu Integrated TCM & Western Medicine Hospital between January 2018 and December 2025. The sUAR was calculated as serum uric acid divided by serum albumin. Participants were categorized into tertiles (T1: 1.99–7.65; T2: 7.66–10.21; T3: 10.22–31.67) based on sUAR. The primary outcome was a composite kidney endpoint, defined as initiation of maintenance dialysis, chronic kidney disease stage 5, or a eGFR decline ≥ 40% from baseline. Multivariable Cox proportional hazards regression, restricted cubic spline (RCS) analysis, Kaplan-Meier curves, subgroup analyses, and SHapley Additive exPlanations (SHAP) were performed to evaluate the association between sUAR and kidney composite events.

Results

During a median follow‑up of 28.7 months (IQR: 14.1–52.6), 591 (16.3%) kidney composite events occurred. Compared with the lowest tertile (T1), the highest tertile (T3) of sUAR was associated with a 44% increased risk of kidney composite events after full adjustment (HR = 1.44, 95% CI: 1.12–1.85, P = 0.005). RCS analysis revealed a non-linear relationship between sUAR and kidney composite events. Kaplan-Meier curves demonstrated significant differences in events-free survival across tertiles (log-rank P < 0.001). Subgroup analyses identified age as a significant effect modifier (P < 0.001), with a stronger association observed in younger patients (< 65 years). Among the 22 candidate variables included in the model, sUAR ranked as the sixth most important predictor of kidney composite events, following cystatin C, hemoglobin, albumin, eGFR, and HbA1c.

Conclusions

Elevated sUAR is independently associated with an increased risk of kidney composite events in patients with T2DM, with a non-linear relationship.

Clinical trial number

Not applicable.

Graphical Abstract