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<p>Hyperuricemia is prevalent in patients with chronic kidney disease (CKD) and diabetes mellitus (DM), but its prognostic significance in this population remains unclear. This study investigated the association between serum uric acid (SUA) levels and all-cause, cardiovascular, and cancer mortality in patients with DM and CKD. Using the National Health and Nutrition Examination Survey (NHANES) 1999–2010 data, adults with DM and CKD (estimated glomerular filtration rate (eGFR) &lt; 60 mL/min/1.73&#xa0;m²) were stratified by SUA: &lt;5, 5–7, 7–9, and &gt; 9&#xa0;mg/dL. Weighted Cox proportional hazards models assessed all-cause, cardiovascular disease (CVD), and cancer mortality after adjusting for body mass index (BMI), sex, age, race/ethnicity, high-density lipoprotein-cholesterol (HDL-C), systolic blood pressure, glycated hemoglobin (HbA1c), eGFR, and albumin. Stratified analyses were performed by glycemic control (HbA1c &lt; 7% vs. ≥7%), kidney function (eGFR &lt; 30 vs. ≥30 mL/min/1.73&#xa0;m²), and CVD status. CVD status was incorporated as a covariate in multivariable models, and stratified analyses were additionally performed by CVD history. Among 672 participants (mean age 71.0 years, 41.8% male), after full multivariable adjustment including eGFR and albumin, SUA levels were not significantly associated with all-cause mortality in the overall cohort. SUA &gt; 9&#xa0;mg/dL was significantly associated with increased cancer mortality (Hazard ratio (HR) 8.77, 95% confidence interval (CI) 1.97–39.01, <i>p</i> = 0.005) and the composite CVD-or-cancer endpoint (HR 3.92, 95% CI 1.26–12.24, <i>p</i> = 0.019) compared with the 5–7&#xa0;mg/dL reference group. Associations with all-cause and CVD mortality were attenuated after adjustment for eGFR and albumin and did not reach statistical significance in the overall cohort. Notably, among patients without established CVD at baseline, SUA &gt; 9&#xa0;mg/dL was significantly associated with CVD mortality (HR 7.63, 95% CI 1.16–50.40, <i>p</i> = 0.035). Associations were strongest in patients with HbA1c &lt; 7% and eGFR ≥ 30 mL/min/1.73&#xa0;m². Elevated SUA is independently associated with increased cancer mortality and the composite CVD-or-cancer endpoint in patients with DM and CKD. Among those without established CVD, SUA &gt; 9&#xa0;mg/dL confers a significantly elevated risk of CVD mortality, suggesting that SUA may serve as a potential risk marker. These findings are hypothesis-generating and support serum uric acid as a potential prognostic biomarker in this high-risk population; prospective studies with repeated SUA measurements and randomized trials are warranted to establish causality before clinical recommendations can be made.</p>

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Serum uric acid levels and mortality in diabetic patients with chronic kidney disease

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月7日

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  • Chia-Po Fu,
  • Wei-Ju Liu,
  • Chia-Lin Lee,
  • Shih-Yi Lin,
  • Hsin-Kai Huang,
  • Jun-Sing Wang

摘要

Hyperuricemia is prevalent in patients with chronic kidney disease (CKD) and diabetes mellitus (DM), but its prognostic significance in this population remains unclear. This study investigated the association between serum uric acid (SUA) levels and all-cause, cardiovascular, and cancer mortality in patients with DM and CKD. Using the National Health and Nutrition Examination Survey (NHANES) 1999–2010 data, adults with DM and CKD (estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m²) were stratified by SUA: <5, 5–7, 7–9, and > 9 mg/dL. Weighted Cox proportional hazards models assessed all-cause, cardiovascular disease (CVD), and cancer mortality after adjusting for body mass index (BMI), sex, age, race/ethnicity, high-density lipoprotein-cholesterol (HDL-C), systolic blood pressure, glycated hemoglobin (HbA1c), eGFR, and albumin. Stratified analyses were performed by glycemic control (HbA1c < 7% vs. ≥7%), kidney function (eGFR < 30 vs. ≥30 mL/min/1.73 m²), and CVD status. CVD status was incorporated as a covariate in multivariable models, and stratified analyses were additionally performed by CVD history. Among 672 participants (mean age 71.0 years, 41.8% male), after full multivariable adjustment including eGFR and albumin, SUA levels were not significantly associated with all-cause mortality in the overall cohort. SUA > 9 mg/dL was significantly associated with increased cancer mortality (Hazard ratio (HR) 8.77, 95% confidence interval (CI) 1.97–39.01, p = 0.005) and the composite CVD-or-cancer endpoint (HR 3.92, 95% CI 1.26–12.24, p = 0.019) compared with the 5–7 mg/dL reference group. Associations with all-cause and CVD mortality were attenuated after adjustment for eGFR and albumin and did not reach statistical significance in the overall cohort. Notably, among patients without established CVD at baseline, SUA > 9 mg/dL was significantly associated with CVD mortality (HR 7.63, 95% CI 1.16–50.40, p = 0.035). Associations were strongest in patients with HbA1c < 7% and eGFR ≥ 30 mL/min/1.73 m². Elevated SUA is independently associated with increased cancer mortality and the composite CVD-or-cancer endpoint in patients with DM and CKD. Among those without established CVD, SUA > 9 mg/dL confers a significantly elevated risk of CVD mortality, suggesting that SUA may serve as a potential risk marker. These findings are hypothesis-generating and support serum uric acid as a potential prognostic biomarker in this high-risk population; prospective studies with repeated SUA measurements and randomized trials are warranted to establish causality before clinical recommendations can be made.