Higher Fractional Excretion of Uric Acid Independently Associates with Diabetic Kidney Disease in Chinese Patients with Type 2 Diabetes

Introduction and Objective: The causal link between fractional excretion of uric acid (FEUA) and diabetic kidney disease (DKD) and the clinical value of measuring FEUA in interaction with serum uric acid (SUA) as contributors to DKD among patients with type 2 diabetes (T2DM) remain to be evaluated. Methods: In this cross-sectional study, 1,512 Chinese T2DM inpatients were recruited. Logistic models and dose-response relationship between FEUA and DKD were calculated. The prevalences of kidney damage markers in different SUA and FEUA level groupings were compared. Results: FEUA independently associates with DKD (OR=1.216, 95% CI:1.146-1.290, P <0.001), adjusting for confounders. Compared to the lowest quartile of FEUA (Q1), Q2 (OR = 1.626, 95% CI 1.073-2.463; P =0.020), Q3 (OR = 2.130, 95% CI 1.395-3.343; P =0.001), Q4 (OR = 3.746, 95% CI 2.319-6.049; P <0.001) all have increased DKD risk. The prevalences of kidney damage markers in group with hyperuricemia and high FEUA were greatly higher than that with normal SUA and normal FEUA(P <0.001). Conclusion: In T2DM inpatients, FEUA is positively associated with DKD, with a dose-response association. Combining SUA with FEUA may improve risk stratification and guide urate-lowering strategies. Disclosure: L. Zhuo: None. L. Zhou: None. X. Han: None. Funding: This study was funded by the National Natural Science Foundation of China (Grant No.: 82170814) and National Major Science and Technology Project of China (Grant No.2024ZD0530204). This work is also funded by the 2024 National Key Clinical Specialty Discipline Construction Program of China (Department of Endocrinology, Peking University People's Hospital) with support from the central government budget. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.