Elevated Serum Uric Acid Linked With Death in Diabetes Population

Investigators examined uric acid levels in patients with diabetes from a national sample and 13 cohort studies and their risk for death.

High serum uric acid levels are associated with increased risks of all-cause and cardiovascular death in patients with diabetes, according to data from both real-world and study settings.

Among 7101 adults with diabetes from the 1999-2018 US National Health and Nutritional Examination Survey (NHANES), 1900 died, including 674 from cardiovascular causes. In a fully adjusted model, patients with the highest quintile of serum uric acid (more than 6.9 mg/mL) had a significant 28% and 41% increased risk for all-cause and cardiovascular mortality, respectively, compared with patients with the lowest quintile of serum uric acid (less than 4.4 mg/mL), Shuang Rong, PhD, of Wuhan University of Science and Technology in China, and colleagues reported in Diabetes Care. For every 1 mg/mL increment in serum uric acid in this nationally representative sample, the risk for all-cause and cardiovascular death significantly increased 7% and 10%, respectively. The investigators adjusted the model for demographics, diet and lifestyle factors, cardiovascular risk factors, diabetes duration, medications, comorbid diseases, and kidney function.

Dr Rong’s team separately performed a meta-analysis of 13 observational cohort studies involving 51,368 patients with diabetes. Among these, 5242 patients died, including 1682 from cardiovascular disease. For every 1 mg/dL increment in serum uric acid, the risk for all-cause and cardiovascular death significantly increased 8% and 5%, respectively, they reported.

“The observed relationship between [serum uric acid] level and increased mortality is biologically plausible and may involve endothelial dysfunction, cardiometabolic syndromes, and inflammation,” the investigators wrote.

“Clinical trials are needed to determine the potential effects of lowering levels of circulating uric acid medications on cardiovascular health.”

The study could not distinguish between type 1 and 2 diabetes, which is a limitation.

This article originally appeared on Renal and Urology News


Li B, Chen L, Hu X, et al. Association of serum uric acid with all-cause and cardiovascular mortality in diabetes. Diabetes Care. ;46(2):425-433. doi:10.2337/dc22-1339