Hyperuricemia and Diabetes Mellitus when Occurred Together Have Higher Risks Than Alone on All-cause Mortality and End-stage Renal Disease in Patients with Chronic Kidney Disease

Introduction: Hyperuricemia and diabetes mellitus (DM) are associated with increased mortality risk in patients with chronic kidney disease (CKD). Here we aimed to evaluate the independent and joint risks of these two conditions on mortality and end stage kidney disease (ESKD) in CKD-patients.

Methods: This retrospective cohort study enrolled 4380 outpatients (with CKD stage 3-5) with mortality and ESKD linkage during a 7-year period (from 2007 to 2013). All-causes mortality and ESKD risks were analyzed by multivariable-adjusted Cox proportional hazards models (adjusted for age, sex, smoke, previous coronary arterial disease, blood pressure, and medications for hyperlipidemia, hyperuricemia and renin-angiotensin system inhibitors).

Results: Overall, 40.5% of participants had DM and 66.4% had hyperuricemia. In total, 356 deaths and 932 ESKD events occurred during the 7 years follow-up. With the multivariate analysis, increased risks for all-cause mortality were: hyperuricemia alone, HR = 1.48 (1-2.19); DM alone, and HR = 1.52 (1.02-2.46); DM and hyperuricemia together, HR = 2.12 (1.41-3.19). Similar risks for ESKD were: hyperuricemia alone, HR = 1.34 (1.03-1.73); DM alone, HR = 1.59 (1.15-2.2); DM and hyperuricemia together, HR = 2.46 (1.87-3.22).

Conclusions: DM and hyperuricemia are strongly associated with higher all-cause mortality and ESKD risk in patients with CKD stage 3-5. Hyperuricemia is similar to DM in terms of risk for all-cause mortality and ESKD. DM and hyperuricemia when occurred together further increase both risks of all-cause mortality and ESKD.