Analysis of influencing factors of hyperuricemia in non-dialysis diabetic kidney disease patients
DUAN Jun1 ZHANG Ruijing2 REN Wanting1 LI Yingjuan1 LIU Xinyan2
1.The Second Clinical Medical College, Shanxi Medical University, Shanxi Province, Taiyuan 030001, China;
2.Department of Nephrology, the Second Hospital of Shanxi Medical University, Shanxi Province, Taiyuan 030001, China
Abstract：Objective To investigate the influencing factors of hyperuricemia (HUA) in patients with type 2 diabetic kidney disease in non-dialysis state (ND-DKD). Methods Clinical data of 326 patients with ND-DKD admitted to the Department of Nephrology, the Second Hospital of Shanxi Medical University from January 1, 2018 to December 31, 2021 were collected and divided into HUA group and non-HUA group according to the diagnostic criteria of HUA. Based on the estimated glomerular filtration rate (eGFR), patients were divided into stages 1 to 2 of CKD and 3 to 5 of CKD. The clinical data of the two groups were compared, and the influencing factors of ND-DKD patients with HUA were analyzed by logistic regression. Results The incidence of HUA in 326 patients with ND-DKD was 50.3%, and the incidence of HUA in patients with CKD stage 1 to 2 and CKD stage 3 to 5 was 34.0% and 58.2%, respectively. The level of platelet, glutamyltransferase (GGT), albumin, globulin, total protein, urea nitrogen, serum creatinine, cystatin C (CysC), α1 microglobulin, β2 microglobulin, blood potassium, blood phosphorus, QTc interval, the history of hypertension, the incidence of anemia, 3 to 5 of CKD, and hypertriglyceridemia in HUA group were higher than those in non-HUA group, and the differences were statistically significant (P＜0.05). The glycosylated hemoglobin, bicarbonate, eGFR, and urine pH in HUA group were lower than those in non-HUA group, and the differences were statistically significant (P＜0.05). Logistic regression analysis showed that GGT (OR=1.013, 95%CI: 1.003-1.024), total protein (OR=1.071, 95%CI: 1.040-1.104), CysC (OR=2.760, 95%CI: 1.750-4.353), blood phosphorus (OR=3.717, 95%CI: 1.296-10.658), hypertriglyceridemia (OR=2.424, 95%CI: 1.440-4.081) were the factors influencing the occurrence of HUA in ND-DKD patients (P＜0.05). Conclusion The incidence of HUA in ND-DKD patients increases with the decline of renal function, and GGT, total protein, CysC, blood phosphorus, and hypertriglyceridemia are the influencing factors for the occurrence of HUA in ND-DKD patients. Dietary guidance and health education for patients with ND-DKD should be strengthened. Low-fat and low-phosphorus high-quality protein diet can reduce the incidence of HUA in patients with ND-DKD, which has a positive significance in delaying disease progression.
[1] Demir S，Nawroth PP，Herzig S，et al. Emerging targets in type 2 diabetes and diabetic complications [J]. Adv Sci （Weinh），2021（18）：e2100275.
[2] Hu F，Zhang T. Study on risk factors of diabetic nephropathy in obese patients with type 2 diabetes mellitus [J]. Int J Gen Med，2020，13：351-360.
[3] Bartakova V，Kuricova K，Pacal L，et al. Hyperuricemia contributes to the faster progression of diabetic kidney disease in type 2 diabetes mellitus [J]. J Diabetes Complications，2016， 30（7）：1300-1307.
[4] Liu R，Han C，Wu D，et al. Prevalence of hyperuricemia and gout in mainland china from 2000 to 2014：a systematic review and meta-analysis [J]. Biomed Res Int，2015，2015：762820.
[5] Ciarla S，Struglia M，Giorgini P，et al. Serum uric acid levels and metabolic syndrome [J]. Arch Physiol Biochem，2014， 120，3：119-122.
[6] Lima WG，Martins-santos ME，Chaves VE. Uric acid as a modulator of glucose and lipid metabolism [J]. Biochimie，2015，116：17-23.
[7] 中华医学会肾脏病学分会专家组.糖尿病肾脏疾病临床诊疗中国指南[J].中华肾脏病杂志，2021，37（3）：255-304.
[8] 中国医师协会肾脏内科医师分会.中国肾脏疾病高尿酸血症诊治的实践指南（2017版）[J].中华医学杂志，2017， 97（25）：1927-1936.
[9] Cirillo P，Sato W，Reungjui S，et al. Uric acid，the metabolic syndrome，and renal disease [J]. J Am Soc Nephrol，2006，17（12 Suppl 3）：S165-168.
[10] Maiuolo J，Oppedisano F，Gratteri S，et al. Regulation of uric acid metabolism and excretion [J]. Int J Cardiol，2016，213：8-14.
[11] Kawamoto R，Katoh T，Ninomiya D，et al. Synergistic association of changes in serum uric acid and triglycerides with changes in insulin resistance after walking exercise in community-dwelling older women [J]. Endocr Res，2016，41（2）：116-123.
[12] Feng X，Huang J，Peng Y，et al. Association between decreased thyroid stimulating hormone and hyperuricemia in type 2 diabetic patients with early-stage diabetic kidney disease [J]. BMC Endocr Disord，2021，21（1）：1.
[13] 中华医学会糖尿病学分会微血管并发症学组.中国糖尿病肾脏病防治指南（2021年版）[J].中华糖尿病杂志，2021，13（8）：762-784.
[14] Guo YJ，Huang H，Chen Y，et al. Association between circulating cystatin C and hyperuricemia：a cross-sectional study [J]. Clin Rheumatol，2022，41（7）：2143-2151.
[15] Shlipak MG，Katz R，Sarnak MJ，et al. Cystatin C and prognosis for cardiovascular and kidney outcomes in elderly persons without chronic kidney disease [J]. Ann Intern Med，2006，145（4）：237-246.
[16] Stevens LA，Schmid CH，Greene T，et al. Factors other than glomerular filtration rate affect serum cystatin C levels [J]. Kidney Int，2009，75（6）：652-660.
[17] Koenig G，Seneff S. Gamma-Glutamyltransferase：A Predictive Biomarker of Cellular Antioxidant Inadequacy and Disease Risk [J]. Dis Markers，2015，2015：818570.
[18] Hernández-rubio A，Sanvisens A，Bolao F，et al. Association of hyperuricemia and gamma glutamyl transferase as a marker of metabolic risk in alcohol use disorder [J]. Sci Rep，2020，10（1）： 20060.
[19] Caravaca f，Villa J，García E，et al. Relationship between serum phosphorus and the progression of advanced chronic kidney disease [J]. Nefrologia，2011，31（6）：707-715.
[20] Guo M，Niu JY，Li SR，et al. Gender differences in the association between hyperuricemia and diabetic kidney disease in community elderly patients [J]. J Diabetes Complications，2015，29（8）：1042-1049.
[21] Yang L，He Z，Gu X，et al. Dose-response relationship between BMI and hyperuricemia [J]. Int J Gen Med，2021，（14）：8065-8071.
京公网安备 11010502046598号