Maintaining Lower Serum Uric Acid Improves Kidney Outcomes in T2DM with CKD: Study

A new study published in the journal of Diabetes Therapy found significantly better renal survival and a 37% lower risk of adverse kidney outcomes in patients having type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD) who are maintaining a time-averaged serum uric acid (TA-SUA) level below 360 μmol/L when compared to higher levels.

The subjects were followed for an average of 60.4 months and it was revealed that renal risk increased sharply above this threshold, with the greatest benefit observed in patients with an eGFR of 30–59 mL/min/1.73 m², supporting tighter uric acid control to help preserve kidney function.

This research analyzed data from 1,072 patients with T2DM and CKD who were treated across eight medical centers between January 2013 and January 2023. Participants were followed for an average of 60.4 months to examine whether time-averaged serum uric acid (TA-SUA) levels influenced long-term kidney outcomes. The primary renal outcomes included doubling of serum creatinine levels, initiation of dialysis, kidney transplantation, or progression to end-stage kidney disease (ESKD).

At the start of the study, hyperuricemia was present in 46.1% of participants, with a higher prevalence among men (50.4%) than women (37.9%). This study evaluated the relationship between long-term uric acid exposure and kidney health using Cox proportional hazards regression models, cubic spline analysis, propensity score matching (PSM), subgroup analyses, and sensitivity analyses to ensure the robustness of the findings.

The results showed that patients who maintained a TA-SUA level below 360 μmol/L experienced significantly better renal survival than those whose long-term uric acid levels remained at or above this threshold. After adjusting for multiple risk factors, individuals with lower TA-SUA had a 37% lower risk of adverse renal outcomes, with an adjusted hazard ratio of 0.63 (95% confidence interval: 0.41–0.98; P=0.038). The probability of kidney disease progression increased sharply once TA-SUA exceeded 360 μmol/L, highlighting this level as a potentially important clinical threshold. 

Subgroup analyses identified patients with moderately reduced kidney function—defined by an estimated glomerular filtration rate (eGFR) between 30 and 59 ml/min/1.73 m²—as those most likely to benefit from maintaining TA-SUA below 360 μmol/L. Overall, long-term maintenance of relatively low serum uric acid levels is independently associated with slower kidney function decline and improved renal outcomes in patients with T2DM and CKD. 

Reference:

Zhang, S., Zhao, X., Xie, J., Zhang, Y., Wang, Y., Chen, X., Li, Q., Liu, D., Jia, R., He, W., Zhu, Y., Hou, H., Li, S., Liu, F., Zhang, Y., Tan, R., Peng, H., Li, J., & Wang, W. (2026). Association between time-averaged serum uric acid and renal outcomes in patients with type 2 diabetes mellitus with chronic kidney disease: A multicenter retrospective cohort study. Diabetes Therapy: Research, Treatment and Education of Diabetes and Related Disorders, 17(8), 1201–1223. https://doi.org/10.1007/s13300-026-01895-z