Association of the serum uric acid/albumin ratio with kidney composite events in patients with type 2 diabetes mellitus: a retrospective cohort study
5 affiliations
- 1Department of General Practice, Chengdu Integrated TCM & Western Medicine Hospital
- 2Department of Endocrinology and Metabolism, Chengdu Integrated TCM & Western Medicine Hospital
- 3Department of Nephrology, Chengdu Integrated TCM& Western Medicine Hospital
- 4Shitang Community Health Service Center
- 5Longhu Community Health Service Center
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. Graphical Abstract
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BibTeX
@article{chen2026association,
title = {{Association of the serum uric acid/albumin ratio with kidney composite events in patients with type 2 diabetes mellitus: a retrospective cohort study}},
author = {Jinhua Chen and Guangchun Zou and Xinyi Zhao and Min Chen and Jun Chen and Yijun Wang and Yong Ren and Zaijun Chen and Jingjing Li},
journal = {BMC Endocrine Disorders},
year = {2026},
month = jul,
doi = {10.1186/s12902-026-02436-2},
url = {https://doi.org/10.1186/s12902-026-02436-2},
note = {CC BY},
}
RIS
TY - JOUR
TI - Association of the serum uric acid/albumin ratio with kidney composite events in patients with type 2 diabetes mellitus: a retrospective cohort study
AU - Jinhua Chen
AU - Guangchun Zou
AU - Xinyi Zhao
AU - Min Chen
AU - Jun Chen
AU - Yijun Wang
AU - Yong Ren
AU - Zaijun Chen
AU - Jingjing Li
PY - 2026
DA - 2026/07/01
JO - BMC Endocrine Disorders
DO - 10.1186/s12902-026-02436-2
UR - https://doi.org/10.1186/s12902-026-02436-2
AB - 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. Graphical Abstract
SN - 1472-6823
ER -