Serum uric acid to creatinine ratio as marker of early vascular damage and renal tubular injury in non-albuminuric diabetic kidney disease.
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.
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).
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).
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.
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).
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).
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.
Authors
Di Marco Di Marco, Scilletta Scilletta, Miano Miano, Marrano Marrano, Natalicchio Natalicchio, Giorgino Giorgino, Bosco Bosco, Di Giacomo Barbagallo Di Giacomo Barbagallo, Scicali Scicali, Tumminia Tumminia, Milluzzo Milluzzo, Frittitta Frittitta, Piro Piro, Di Pino Di Pino
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