Serum Uric Acid is a Better Indicator of Kidney Impairment Than Serum Uric Acid-to-Creatinine Ratio and Serum Uric Acid-to-High-Density Lipoprotein Ratio: A Cross-Sectional Study of Type 2 Diabetes Mellitus Patients

Rongfeng Han, Lijun Duan, Yang Zhang, Xia Jiang Department of Endocrinology, Tianjin First Center Hospital, Tianjin, 300192, People’s Republic of ChinaCorrespondence: Rongfeng Han, Department of Endocrinology, Tianjin First Center Hospital, Tianjin, 300192, People’s Republic of China, Email hanmenghappy@126.comBackground: Type 2 diabetes mellitus (T2DM) patients are likely to develop kidney disease. Early diagnosis, finding predictors and controlling risk factors are of great significance for T2DM patients. This study investigated the ability of uric acid (UA), the uric acid to creatinine (CR) ratio (UA/CR) and the uric acid to high-density lipoprotein cholesterol ratio (UHR) to assess the kidney function of T2DM patients and determined the relationship between the three indicators and the estimated glomerular filtration rate (eGFR).Methods: A total of 1326 adult T2DM patients were enrolled in the current study. Patients were stratified into three groups according to their eGFRs. Spearman correlation was used to analyze the correlation between three indicators and the clinical variables. Logistic regression analysis was used to assess the association between the three indicators and diabetic kidney disease (DKD) and kidney impairment (eGFR < 60 mL/min/1.73 m2). Receiver operating characteristic (ROC) analyses and the area under the ROC curve (AUC) were then used to assess the ability of UA, UA/CR, and UHR to discriminate kidney impairment in T2DM.Results: UA and UHR demonstrated a positive association with DKD risk (P < 0.05). The odds ratios (ORs) were 1.005 (95% CI, 1.004– 1.007) and 1.057 (95% CI, 1.039– 1.076), respectively. UA/CR was negatively correlated with DKD risk (OR, 0.922 (95% CI, 0.876, 0.970), P < 0.05). Furthermore, UA and UHR demonstrated a strong positive association with kidney impairment risk, while UA/CR was negatively correlated with kidney impairment risk in T2DM patients (P < 0.05 for all) after adjusting for confounding factors. UA had the highest AUC (0.762) among the three indicators. UHR had a greater AUC (0.713) than UA/CR, which had an AUC value of 0.148 (p < 0.001).Conclusion: UA is the best indicator of renal impairment (eGFR < 60 mL/min/1.73 m2) among the three indicators, and UHR is a better indicator than UA/CR.Keywords: type 2 diabetes mellitus, T2DM, uric acid, UA, uric acid to creatinine ratio, UA/CR, uric acid to high-density lipoprotein cholesterol ratio, UHR, estimated glomerular filtration rate, eGFR