Kidney Week

Abstract: FR-PO454

Uric Acid Is an Independent Risk Factor for Decline in Kidney Function, Cardiovascular Event, and Mortality in Patients with Type 1 Diabetes

Session Information

• Diabetic Kidney Disease: Clinical - I
  October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Diabetic Kidney Disease

• 602 Diabetic Kidney Disease: Clinical

Authors

• Pilemann-lyberg, Sascha, Steno Diabetes Center Copenhagen, Gentofte, Denmark

Sascha Pilemann-lyberg,

• Hansen, Tine, Steno Diabetes Center Copenhagen, Gentofte, Denmark

Tine Hansen,

• Tofte, Nete, Steno Diabetes Center Copenhagen, Gentofte, Denmark

Nete Tofte,

• Winther, Signe Abitz, Steno Diabetes Center Copenhagen, Gentofte, Denmark

Signe Abitz Winther,

• Theilade, Simone, Steno Diabetes Center Copenhagen, Gentofte, Denmark

Simone Theilade,

• Ahluwalia, Tarunveer S., Steno Diabetes Center Copenhagen, Gentofte, Denmark

Tarunveer S. Ahluwalia,

• Rossing, Peter, Steno Diabetes Center Copenhagen, Gentofte, Denmark

Peter Rossing,

Background

Previous studies have provided inconclusive results to the role of uric acid (UA) for risk prediction. Here we aimed to improve power and precision of the predictive value of UA for risk of decline in kidney function, cardiovascular event (CVE) and mortality in patients with type 1 diabetes (T1D).

Methods

UA was measured in 670 patients with T1D and various degrees of albuminuria, ranging from normo- (<30 mg/24 h) to macroalbuminuria (≥300 mg/24 h). Patients were traced through national registers to gather data on CVE and mortality. Endpoints: mortality, CVE and eGFR-decline of ≥30%. Median follow-up ranged from 5.1 to 6.2 years. Slope estimates of eGFR and urinary albumin excretion rate (UAER) were calculated for a median of 5.5 years.
We applied Cox regressions and linear regression models. Adjustment included sex, age, body mass index, HDL cholesterol, smoking, HbA_1c, mean arterial pressure, UAER, treatment with RAAS blockers and eGFR. Hazard ratio (HR) were calculated per doubling of UA and presented with 95% confidence interval (CI).
Relative integrated discrimination (rIDI) was calculated to assess predictive contribution of UA to known risk factors.

Results

Of the 670 patients, 372 (55%) were male, mean ± SD age was 55±13 years and eGFR 82±26 ml/min/1.73m². Median (IQR) uric acid was 5.04 (3.87-6.22) mg/dl. Higher UA was associated with higher risk of decline in eGFR of ≥30% (n=89; HR: 3.14 (1.69-5.82), p<0.001), CVE (n=94; HR: 2.43 (1.31-4.52), p=0.005) and mortality (n=58; HR: 2.81 (1.23-6.43), p=0.014) in adjusted analyses. Adding UA to the adjusted model including conventional risk factors improved the rIDI by 12.8% for decline in eGFR of ≥30% (p<0.001), 8.7% for CVE (p=0.008) and 10.8% (p=0.040) for mortality.
Higher UA was also associated with steeper decline in eGFR (p<0.0014) and steeper increase in UACR (p<0.0016) in adjusted analysis.

Conclusion

In T1D, higher UA is associated with higher risk of decline in kidney function, CVE and mortality, independently of other risk factors. Our results suggest that UA have a promising role in risk stratification among T1D.