Increased serum uric acid in adolescents predicts hypertension, diabetic kidney disease
More than 25% of teens with type 2 diabetes have hyperuricemia, which increases their risks for developing hypertension, cardiovascular disease and kidney disease, according to findings presented in Diabetes Care.
“Elevated serum uric acid is increasingly recognized as an important risk factor for hypertension and [diabetic kidney disease] in adults with type1 diabetes, [type 2 diabetes], and the general population,” Laure El Ghormli, MS, a senior research scientist at the George Washington University Biostatistics Center in Rockville, Maryland, and colleagues wrote. “To our knowledge, there are no longitudinal data on the relationship between [serum uric acid] and hypertension or elevated [urinary albumin excretion] in adolescents with [type 2 diabetes].”
El Ghormli and colleagues explored this potential relationship by examining secondary outcomes data from the Treatment Options for Type 2 Diabetes in Adolescents and Youth trial. The original trial recruited 699 adolescents with type 2 diabetes from 2004 to 2009 and randomly assigned them to receive one of three diabetes treatment regimens. While the effects of treatment were the primary outcome, El Ghormli and colleagues looked at measures of serum uric acid, creatinine in serum and urine, blood pressure and levels of urinary albumin excretion in a subset of the study population (n = 539; mean age, 13.9 years; 63.8% girls) across 7 years of follow-up.
Hyperuricemia, defined as serum uric acid levels of 6.8 mg/dL or higher, was present in 25.6% of the participants at baseline. Nearly one-fifth of participants (18.7%) had hypertension, which was confirmed by BP of 130/80 mm Hg or more at baseline, and 37.4% had the condition after 7 years of follow up. In addition, a urine albumin-to-creatinine ratio of 30 mg/g or more was observed in 6.1% of the population at baseline and in 18% after 7 years.
The researchers found independent associations between rising serum uric acid levels and hypertension development (HR = 1.2; 95% CI, 1-1.4) and increased urinary albumin excretion (HR = 1.2; 95% CI, 1-1.5). Reaching the serum uric acid level for hyperuricemia enhanced the odds for hypertension as well (HR = 1.84; 95% CI, 1.22-2.8). The connection between serum uric acid and urinary albumin excretion was most notable in boys compared with girls (P = .0004) and non-Hispanic white adolescents compared with non-Hispanic black and Hispanic adolescents (P = .02).
“[Serum uric acid] as a unified risk factor for the development of both [diabetic kidney disease] and CVD does not necessarily imply causation, but increasing evidence implicates [serum uric acid] in the pathogenesis of vascular complications in [type 2 diabetes],” the researchers wrote. “Future directions involve examining the relationships between [serum uric acid], retinopathy, neuropathy and other CVD markers,” they wrote. – by Phil Neuffer
Disclosure: The authors report no relevant financial disclosures.