The Relationship Of The Hyperuricemia And Kidney Function Impairment In Type2Diabetic Patients Without Albuminuria

Part One The prevalence and related factors of hyperuricemia in type2diabetic patients without albuminuriaObjective:To investigate the prevalence and related factors of hyperuricemia (HUA) in type2diabetic patients without albuminuria.Methods:This cross-sectional study enrolled991type2diabetic patients without albuminuria. Normal buminuria was defined as albumin creatinine ratio (ACR)<30mg/g and24hour microalbuminuria (24hMA)<30mg. The patients were divided into quartiles according to their SUA level:Q1、Q2、Q3and Q4. We analysed the prevalence of HUA (defined as serum uric acid level≥420umol/L in male patients and^360umol/L in femal patients) and the related factors.Results:The prevalence of HUA in the type2diabetic patients without albuminuria was 12.7%.With the increased SUA levels, eGFR and high-density lipoprotein cholesterol levels were gradually reduced significantly (P<0.01). SUA levels were closely related with male、hypertension duration、fasting C peptide、eGFR、waist、body mass index、 hemoglobin、triglycerides、high-density lipoprotein cholesterol、Male、high blood pressure、fasting C peptide、waist circumference、body mass index、hemoglobin、blood triglyceride were positively correlated with serum uric acid levels, while eGFR、 high-density lipoprotein cholesterol were negatively correlated with serum uric acid levels. Uric acid and waist circumference had a strongest correlation.Conclusions:The serum uric acid level of type2diabetic patients without albuminuria was related to hypertension duration, estimated glomerular filtration rate, waist, fasting C peptide and triglycerides. We should pay attention not only to the blood pressure、lipid levels and obesity, but also to the high level of uric acid, which is a risk factor of type2diabetes and has an important clinical significance. Part Two The relation between early-stage chronic kidney disease and hyperuricemia in type2diabetic patients without albuminuriaObjective:The relation between early-stage chronic kidney disease and hyperuricemia in type2diabetic patients without albuminuria was unknown. This study was designed to investigate the role and status of HUA in early-stage chronic kidney disease (CKD) which was defined as an eGFR between60～89ml/min/1.73m2of type2diabetic patients without albuminuria and to determine the association between the HUA and mildly decreased eGFR. Methods:The cross-sectional study enrolled947type2diabetic patients with normoal-buminuria. The patients were stratified into two groups according to the CKD-EPI eGFR level:the CKD1group with eGFR level≥90mL/min/1.73m2and the CKD2group with eGFR level of60-89mL/min/1.73m2. Furthermore, the patients were categorized as HUA group and normal group according to SUA.HUA group was defined as SUA≥360umol/L and normal group was defined as SUA<360umol/L. Both stepwise forward multiple linear regression and binary logistic regression analyses were performed to assess the relation of HUA and early-stage CKD.Results:The prevalence of HUA in CKD2group was33.4%, higher than that of CKD1group with a prevalence of18.1%. HUA was associated with an approximate1.009-fold greater risk of early-stage CKD in bivariate logistic regression analysis, after adjusting traditional chronic kidney disease risk factors (P=0.000, OR=1.009). The correlation between eGFR and HUA levels had statistical significance (p=-0.042; P=0.000).Conclusions:There is a high prevalence of HUA in early-stage CKD patients of type2diabetes who have normoalbuminuria and a close relation between HUA and early-stage CKD, suggesting that we should pay much more attention to the patients who have only mildly decreased eGFR and normoalbuminuria but have already had a relatively high level of uric acid in clinic work and consider the preventive therapy in early stage.