Association between serum uric acid level and microalbuminuria to chronic vascular complications in Thai patients with type 2 diabetes☆,☆☆
Introduction
Chronic vascular complications in type 2 diabetes (T2DM) are the deteriorating conditions underlined by inflammation (Ceriello & Motz, 2004). The chronic vascular complications in diabetes mellitus (DM) are classified by vascular size into macro- and microvascular diseases. The chronic vascular complications are a serious problem, since they generally yield devastating outcomes for the T2DM patients, which include coronary arterial disease (CAD), cerebrovascular disease (CVD), peripheral arterial disease (PAD), diabetic nephropathy (DN), diabetic retinopathy (DR), and diabetic peripheral neuropathy (PN) (Alberti & Zimmet, 1998).
Elevated levels of uric acid and microalbuminuria are commonly found in patients with severe cardiovascular diseases, such as stroke, and ischemic heart disease (Fukui et al., 2008, Hayden and Tyagi, 2004, Klausen et al., 2005, Redon, 2006). The elevated levels correlate with the severity of the conditions, namely, the higher the levels, the more severe the conditions (Kanellis and Kang, 2005, Kim et al., 2011, Newman et al., 2005, Tai et al., 1990). Although it is still unclear, the heightened levels are presumably a result of an up-regulation of inflammatory cytokines, such as interleukin-6 (IL-6), C-reactive protein (CRP), and increased oxidative stress (Ceriello and Motz, 2004, Deckert et al., 1992, Giacco and Brownlee, 2010, Koenig and Meisinger, 2008, Newman et al., 2005).
High levels of inflammation are regularly found in patients with T2DM. This observation is accompanied by the findings that there are correlations between increase of the serum uric acid level/microalbuminuria and severity of the insulin resistance and metabolic profiles (Costa et al., 2002, Dehghan et al., 2008, Festa et al., 2000, Hsu et al., 2011, Kodama et al., 2009). It is not known; whether the inflammation associated with T2DM contributes to the elevated levels of serum uric acid and microalbuminuria, and whether or not there is a relationship between uric acid/microalbuminuria, and the inflammatory-driven chronic vascular conditions found in the T2DM patients.
In the hope of identifying a reliable parameter that will allow an early detection of the micro- and macro-vascular complications in T2DM population, we investigated the relationships between levels of serum uric acid/ microalbuminuria, and the chronic vascular conditions in a T2DM population through a cross-sectional observation. The study also took into the consideration the information on other indicative parameters, such as duration of diabetes, hypertension status, smoking status, history of CAD, history of CVD, dyslipidemia status, uric acid, microalbuminuria (MAU), fasting plasma glucose (FPG), and hemoglobin A1C (HbA1C).
Section snippets
Subjects and designed study
This study was a cross-sectional study by design. It included all patients who attended diabetic clinic in the outpatient unit of the Internal Medicine Department at HRH Princess Mahachakri Sirindhorn Medical Center, Faculty of Medicine, Srinakharinwirot University during the years 2007–2008. Inclusion criteria were type 2 diabetes aged of 35 or more. Type 2 diabetes was diagnosed according to the Report of the expert committee on the diagnosis and classification of diabetes mellitus (2003). We
Results
Characteristics of the subjects in the study are shown in the Table 1. Six hundred subjects were included with an average age of 57.8 years old. The majority are females (70.4%). Average body mass index (BMI) and waist circumference were 27.08 kg/m2 (S.D., 5.60), and 90.94 cm. (S.D., 13.13) respectively. Mean levels of uric acid, and microalbuminuria were 6.61 mg/dL (S.D., 2.10) and 75.34 mg/g Cr. (S.D., 97.49), respectively. The most common chronic vascular complications of diabetes in this
Discussion
Our study showed the positive correlations between the increasing levels of uric acid/microalbuminuria and the severity of chronic vascular complications in T2DM patients.
Both elevated uric acid and microalbuminuria levels may be rendered by common underlying pathogenesis of insulin resistance in T2DM (Hsu et al., 2011, Modan et al., 1987). Hyperinsulinemia resulting from insulin resistance in T2DM negatively affects renal excretion, increases rates of renal reabsorption, and the production of
Acknowledgments
This study was funded by a research grant to S.C. from faculty of medicine for medical science, HRH Princess Maha Chakri Sirindhorn Medical Center, Srinakharinwirot University. S.J. is supported by “Chalermphrakiat” Grant, Faculty of Medicine Siriraj Hospital, Mahidol University.
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2019, Journal of Diabetes and its ComplicationsCitation Excerpt :The evidence on the association between SUA and CVD exclusively among diabetes population was poorly synthesized. For example, studies have found a higher SUA level associated with increased morbidity of CVDs such as stroke and coronary heart disease (CHD) among diabetes population.14,15 Additionally, several cohort studies concluded that there was a statistically significant association between SUA and all-cause mortality among type 2 diabetic population.16
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2017, Journal of Plastic, Reconstructive and Aesthetic SurgeryCitation Excerpt :Possible explanations for this could be its high association with the duration of DM and dependence on other risk factors, such as infection or ischemia.11 Nephropathy is a marker of PAD33 and recent studies also demonstrated that diabetic foot ulcers are more frequent in patients with nephropathy.34 However, there was no significant association of nephropathy with major amputation in our present study.
Association between serum uric acid level and renal arteriolar hyalinization in individuals without chronic kidney disease
2017, AtherosclerosisCitation Excerpt :Several studies also demonstrated an association between SUA and microvascular diseases. In patients with type 2 diabetes mellitus, high SUA is associated with worsening of peripheral neuropathy [14], retinopathy [15,16], and nephropathy [17,18], which are typical findings associated with microangiopathy. A recent renal biopsy-based clinicopathological study showed that a high level of SUA was associated with renal arteriolar hyalinization and arteriolar wall thickening in patients with various glomerular and tubulointerstitial diseases [19].
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2015, Journal of Diabetes and its ComplicationsCitation Excerpt :However, clinical trials suggested that intensive control of blood glucose and blood pressure and regulation of blood lipids had limited protective effects on delaying the progression of renal function decline and improving cardiovascular outcomes (Slinin et al., 2012). Uric acid is the end product of purine metabolism in humans, and studies have shown that elevated serum uric acid or hyperuricemia is strongly associated with renal dysfunction in both the general population (Ponte et al., 2013; Ryoo, Choi, Oh, & Kim, 2013; Toda, Ishizaka, Tani, & Yamakado, 2014) and patients with T2DM in various countries (Behradmanesh, Horestani, Baradaran, & Nasri, 2013; Bonakdaran, Hami, & Shakeri, 2011; Cai, Han, & Ji, 2011; Chen, Ding, Fu, Yu, & Ma, 2014; Chuengsamarn, Rattanamongkolgul, & Jirawatnotai, 2014; Kim et al., 2014; Zoppini et al., 2012). For patients with T2DM, studies have shown that higher serum uric acid concentrations were associated with a greater probability of albuminuria, incidence of impaired GFR, or CKD (either decreased kidney function or albuminuria) (Behradmanesh et al., 2013; Bonakdaran et al., 2011; Cai et al., 2011; Chen et al., 2014a; Chuengsamarn et al., 2014; Kim et al., 2014; Sheikhbahaei, Fotouhi, Hafezi-Nejad, Nakhjavani, & Esteghamati, 2014; Zoppini et al., 2012).
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Conflict of interest: The authors declare that they have no conflict of interest.
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Grant support: This study was funded by a research grant to S.C. from Faculty of Medicine for Medical Science, HRH Princess Maha Chakri Sirindhorn Medical Center, Srinakharinwirot University.