Decreased urine uric acid excretion is an independent risk factor for chronic kidney disease but not for carotid atherosclerosis in hospital-based patients with type 2 diabetes: a cross-sectional study - PubMed (original) (raw)

Decreased urine uric acid excretion is an independent risk factor for chronic kidney disease but not for carotid atherosclerosis in hospital-based patients with type 2 diabetes: a cross-sectional study

Lian-Xi Li et al. Cardiovasc Diabetol. 2015.

Abstract

Background: The associations between urine uric acid excretion (UUAE) and chronic kidney disease (CKD)/atherosclerosis have not been investigated. Our aims were to investigate the relationships between UUAE and CKD and carotid atherosclerotic lesions in hospitalized Chinese patients with type 2 diabetes.

Methods: This was a cross-sectional study that was conducted with 2627 Chinese inpatients with type 2 diabetes. UUAE was determined enzymatically using a single 24-h urine collection. The subjects were stratified into quartiles according to their UUAE levels. Carotid atherosclerotic lesions, including carotid intima-media thickness (CIMT), plaque and stenosis, were assessed by Doppler ultrasound. Both CKD and carotid atherosclerotic lesions were compared between the UUAE quartile groups.

Results: After adjustment for confounding factors, there was a significant decrease in the prevalence of CKD in the patients with type 2 diabetes across the UUAE quartiles (16.9%, 8.5%, 5.9%, and 4.9%; p < 0.001). Multiple logistic regression analyses revealed that the UUAE quartiles were significantly and inversely associated with the presence of CKD (p < 0.001). Compared with the diabetics in the highest UUAE quartile, those in the lowest quartile exhibited a nearly 4.2-fold increase in the risk of CKD (95% CI: 2.272-7.568; p < 0.001). The CIMT value (0.91 ± 0.22 mm for the diabetics with CKD and 0.82 ± 0.20 mm for the diabetics without CKD, p = 0.001) and the prevalence of carotid plaques (62.1% for the diabetics with CKD and 41.8% for the diabetics without CKD, p = 0.025) were significantly higher in the diabetics with CKD than in those without CKD. However, there was no obvious difference in carotid atherosclerotic lesions across the UUAE quartiles after controlling for the confounding factors.

Conclusions: Decreased UUAE was closely associated with the presence of CKD but not with carotid atherosclerotic lesions in hospitalized Chinese patients with type 2 diabetes. Our results suggest that UUAE is an independent risk factor for CKD in type 2 diabetes. In selected populations, such as patient with type 2 diabetes, the role of uric acid in atherosclerosis might be the result of other concomitant atherosclerotic risk factors, such as CKD.

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Figures

Figure 1

Figure 1

Comparison of CKD among the UUAE quartiles. (A) Comparison of the prevalence of CKD among the UUAE quartile groups after adjusting for age, sex, and DD. The P values for the trends were <0.001. (B) Comparison of the UUAE levels between the diabetics with and without CKD after adjusting for age, sex, and DD. The P value was <0.001. (C) Comparison of UUAE levels among the different eGFR levels after adjusting for age, sex, and DD. The P values for the trends were <0.001. (D) Comparison of UUAE levels among the different UAE levels after adjusting for age, sex, and DD. The P values for the trends were <0.001.

Figure 2

Figure 2

Comparison of carotid atherosclerotic lesions among the UUAE quartiles. (A) Comparison of the CIMT values among the UUAE quartile groups after adjusting for age, sex, and DD. (B) Comparison of the prevalence of carotid atherosclerotic plaques among the UUAE quartile groups after adjusting for age, sex, and DD. (C) Comparison of the prevalence of carotid atherosclerotic stenosis among the UUAE quartile groups after adjusting for age, sex, and DD.

Figure 3

Figure 3

Comparison of carotid atherosclerotic lesions between the diabetics with and without CKD. (A) Comparison of the CIMT values between the diabetics with and without CKD after adjusting for age, sex, and DD. (B) Comparison of the prevalence of carotid atherosclerotic plaques between the diabetics with and without CKD after adjusting for age, sex, and DD. (C) Comparison of the prevalence of carotid atherosclerotic stenosis between the diabetics with and without CKD after adjusting for age, sex, and DD.

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