BMC Endocr Disord. 2026 Jul 27;26(1):331. doi: 10.1186/s12902-026-02436-2.
ABSTRACT
BACKGROUND: The serum uric acid-to-albumin ratio (sUAR) has been implicated in various cardiovascular and kidney diseases. However, its association with kidney composite events in patients with type 2 diabetes mellitus (T2DM) remains underexplored. This study aimed to investigate the relationship between sUAR and kidney composite events in T2DM patients.
METHODS: This retrospective cohort study included 3,618 patients with T2DM from Chengdu Integrated TCM & Western Medicine Hospital between January 2018 and December 2025. The sUAR was calculated as serum uric acid divided by serum albumin. Participants were categorized into tertiles (T1: 1.99-7.65; T2: 7.66-10.21; T3: 10.22-31.67) based on sUAR. The primary outcome was a composite kidney endpoint, defined as initiation of maintenance dialysis, chronic kidney disease stage 5, or a eGFR decline ≥ 40% from baseline. Multivariable Cox proportional hazards regression, restricted cubic spline (RCS) analysis, Kaplan-Meier curves, subgroup analyses, and SHapley Additive exPlanations (SHAP) were performed to evaluate the association between sUAR and kidney composite events.
RESULTS: During a median follow‑up of 28.7 months (IQR: 14.1-52.6), 591 (16.3%) kidney composite events occurred. Compared with the lowest tertile (T1), the highest tertile (T3) of sUAR was associated with a 44% increased risk of kidney composite events after full adjustment (HR = 1.44, 95% CI: 1.12-1.85, P = 0.005). RCS analysis revealed a non-linear relationship between sUAR and kidney composite events. Kaplan-Meier curves demonstrated significant differences in events-free survival across tertiles (log-rank P < 0.001). Subgroup analyses identified age as a significant effect modifier (P < 0.001), with a stronger association observed in younger patients (< 65 years). Among the 22 candidate variables included in the model, sUAR ranked as the sixth most important predictor of kidney composite events, following cystatin C, hemoglobin, albumin, eGFR, and HbA1c.
CONCLUSIONS: Elevated sUAR is independently associated with an increased risk of kidney composite events in patients with T2DM, with a non-linear relationship.
CLINICAL TRIAL NUMBER: Not applicable.
PMID:42919291 | DOI:10.1186/s12902-026-02436-2