title: Role of elevated serum uric acid levels at the onset of overt nephropathy in the risk for renal function decline in patients with type 2 diabetes.
abstract: OBJECTIVE
  Despite the use of intensive therapies, declining renal function is often observed during the overt nephropathy stage of type 2 diabetes. We aimed at investigating the role of serum uric acid (SUA) levels at the onset of overt nephropathy in the risk of renal function decline in type 2 diabetes patients.
  
  
  METHODS
  The present cohort study included 290 type 2 diabetes patients who were followed from the onset of overt nephropathy. The relationship between SUA and declining renal function was assessed using Cox regression models after adjusting for known risk factors.
  
  
  RESULTS
  Over a median 4.8-year follow-up period, 85 patients (4.9/100 person-years) showed serum creatinine (Cr) doubling with a total cumulative incidence of 71.9% at 20 years of follow up. The highest SUA tertile resulted in significantly a higher incidence (7.7/100 person-years) and cumulative incidence at 20 years (85.7%) than the middle (3.9/100 person-years, 54.2%) and lowest (3.0/100 person-years, 55.5%) tertiles. The univariate Cox hazard model resulted in significant risks for Cr doubling related to female sex, short diabetes duration, smoking and elevated levels of low-density lipoprotein cholesterol (LDL-c), glycated hemoglobin and SUA tertiles. SUA tertiles remained statistically significant in the multivariate model (highest vs lowest hazard ratio 2.68, 95% confidence interval 1.48-5.00, P = 0.0009).
  
  
  CONCLUSIONS
  Elevated SUA levels within the normal range (men >6.3 mg/dL, women >5.1) at the onset of overt nephropathy resulted in an increased risk for declining renal function in type 2 diabetes patients.
authors.affiliation: Division of Diabetes and Metabolism, The Institute for Adult Diseases, Asahi Life Foundation Tokyo, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Tanaka
authors.affiliation: Division of Diabetes and Metabolism, The Institute for Adult Diseases, Asahi Life Foundation Tokyo, Japan.
authors.forename: Shigeko
authors.initials: S
authors.lastname: Hara
authors.affiliation: Division of Diabetes, Clinical Research Center for Endocrinology and Metabolic Diseases, National Hospital Organization, Kyoto Medical Center Kyoto, Japan.
authors.forename: Masakazu
authors.initials: M
authors.lastname: Hattori
authors.affiliation: Department of Nephrology, School of Medicine, Faculty of Medicine, Toho University Tokyo, Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Sakai
authors.affiliation: Division of Diabetes and Metabolism, The Institute for Adult Diseases, Asahi Life Foundation Tokyo, Japan.
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Onishi
authors.affiliation: Division of Diabetes and Metabolism, The Institute for Adult Diseases, Asahi Life Foundation Tokyo, Japan.
authors.forename: Yoko
authors.initials: Y
authors.lastname: Yoshida
authors.affiliation: Division of Diabetes and Metabolism, The Institute for Adult Diseases, Asahi Life Foundation Tokyo, Japan.
authors.forename: Shoji
authors.initials: S
authors.lastname: Kawazu
authors.affiliation: Division of Diabetes and Metabolism, The Institute for Adult Diseases, Asahi Life Foundation Tokyo, Japan.
authors.forename: Akifumi
authors.initials: A
authors.lastname: Kushiyama
keywords: Risk factors; Type 2 diabetic nephropathy; Uric acid