High Baseline Serum Uric Acid Linked to Increased Cardiovascular and Renal Risks in Type 2 Diabetes: Study

The prospective cohort study, published in the Journal of Diabetes and its Complications, found that elevated baseline sUA levels were associated with a higher risk of cardiovascular events, renal complications, and peripheral neuropathy in patients with type 2 diabetes.

"Baseline sUA levels were linked to major adverse cardiovascular events (HR: 2.4), renal failure, and microalbuminuria, with women showing a stronger cardiovascular risk association (HR: 2.6) compared to men (HR: 1.2). Additionally, changes in sUA levels were specifically connected to an increased risk of renal failure (HR: 2.4)," the researchers reported.

Serum uric acid, a substance typically associated with gout and kidney disease, has been emerging as an important biomarker for complications in diabetes. Claudia R.L. Cardoso, Department of Internal Medicine, University Hospital Clementino Fraga Filho, School of Medicine; Universidade Federal do Rio de Janeiro, Brazil, and colleagues aimed to examine the relationships between baseline and changes in serum uric acid (sUA) levels and the risks of cardiovascular and microvascular outcomes, as well as mortality, in a type 2 diabetes cohort.

For this purpose, the researchers measured baseline serum uric acid (sUA) in 685 individuals, with 463 having a second sUA measurement during follow-up. The sUA was analyzed as a continuous variable and categorized into sex-specific tertile subgroups, along with low/high levels (>4.5 mg/dl for women; >5.5 mg/dl for men). Cox analyses were used to examine the risks associated with baseline sUA and its changes for all outcomes.

The study led to the following findings:

• The median follow-up was 10.7 years, with 173 major cardiovascular events (MACEs), 268 all-cause deaths, 127 cases of microalbuminuria, 104 instances of renal failure, 160 cases of retinopathy, and 178 occurrences of peripheral neuropathy.
• Baseline serum uric acid was a predictor for all outcomes except for all-cause mortality and retinopathy.
• In tertile and high/low sUA analyses, hazard ratios (HRs) ranged from 1.6 (for microalbuminuria development) to 2.4 (for MACEs and cardiovascular mortality).
• An interaction with sex was observed for MACEs, with an increased risk in women (HR: 2.6), but not in men (HR: 1.2).
• Changes in sUA were linked to an increased risk of renal failure (HR: 2.4).

"In a prospective cohort, elevated baseline serum uric acid levels were associated with an increased risk of cardiovascular, renal, and peripheral neuropathy. However, changes in sUA were only linked to the risk of renal failure," the researchers concluded.

Reference:

Cardoso, C. R., Da Silva Pereira, L., Leite, N. C., & Salles, G. F. (2024). Prognostic importance of baseline and changes in serum uric acid for macro/microvascular and mortality outcomes in individuals with type 2 diabetes: The Rio de Janeiro type 2 diabetes cohort. Journal of Diabetes and its Complications, 39(1), 108921. https://doi.org/10.1016/j.jdiacomp.2024.108921