High Levels of Serum Uric Acid are Associated with Microvascular Complications in Patients with Long-term Diabetes

Abstract Aims To assess the association between serum uric acid (SUA) level and the prevalence of diabetic retinopathy (DR) and chronic kidney disease (CKD) in patients with long-term diabetes. Methods A cross-sectional analysis was conducted involving diabetic patients from Shanghai General hospital during October 2018 and October 2021. Participants underwent measurements of SUA, renal function test and DR assessments via fundus photography. Multivariable ordinal logistic regression models assessed odd ratios (ORs) and 95% confidence intervals (95% CIs) for the progression of DR and CKD. Receiver operating characteristics (ROC) curves identified SUA thresholds, categorizing participants into low and high SUA groups. Results Among the 1015 patients with diabetes, SUA levels were higher in individuals with more sever CKD (p < 0.001, compared with CKD1) and those with vision-threatening diabetic retinopathy (VTDR) (p = 0.019, compared with no diabetic retinopathy (NDR)). Adjustments for potential confounders revealed that each 1 µmol/L increase in SUA was associated with an OR of 1.002 (95% CI: 1.001–1.004) for DR and 1.008 (95% CI: 1.006–1.011) for CKD. The risk of DR and CKD was elevated when SUA levels surpassed 354.0 µmol/L (95% CI: 318.9–393.2) and 361.0 µmol/L (95% CI: 339.2–386.3), respectively, with ORs of 1.571 (95% CI: 1.136–2.099, P = 0.006) for DR and 1.395 (95% CI: 1.033–1.885, P = 0.030) for CKD. Gender-specific analyses also demonstrated a positive correlation between higher SUA levels and the incidence of DR and CKD in both males and females. Conclusions Elevated SUA levels are independently associated with increased risks of DR and CKD, highlighting the importance of managing SUA levels in the patients with diabetes.