European Journal of Cardiovascular Medicine

Type-2 Diabetes Mellitus (T2DM) is a chronic condition that has reached epidemic proportions worldwide, affecting millions of individuals and representing a significant public health burden. T2DM is primarily characterized by insulin resistance and beta-cell dysfunction, which leads to sustained hyperglycemia.

Over time, this uncontrolled blood sugar can lead to a range of microvascular and macrovascular complications. Diabetic nephropathy, a complication resulting from damage to the kidneys, is one of the most common and severe outcomes of long-standing diabetes. [1]

Proteinuria is the presence of an unusually high amount of protein in the urine. It is often a sign of kidney disease, as healthy kidneys typically prevent significant amounts of protein from passing through.

In the context of diabetes, however, SUA levels may also play a role in the development of insulin resistance and kidney damage. Recent studies have shown that elevated SUA levels are associated with an increased risk of nephropathy and other complications in diabetic patients, making it a potential biomarker for monitoring kidney health. [2]

Creatinine is another widely used biomarker for assessing kidney function. It is a breakdown product of muscle metabolism and is excreted by the kidneys. Elevated serum creatinine levels are indicative of reduced kidney function, and the glomerular filtration rate (GFR) is often estimated using creatinine measurements. [3]

The ratio of serum uric acid to creatinine (SUA/Cr ratio) has been proposed as a novel marker for assessing the risk of kidney damage and other metabolic disturbances, including in diabetic patients. Elevated SUA/Cr ratios have been linked to the early stages of diabetic nephropathy, including proteinuria, and may help identify individuals at risk before significant kidney dysfunction develops. [4]

Objective Of the Study

To estimate the correlation between serum uric acid to creatinine ratio and proteinuria in Diabetes Mellitus patients

It’s a cross-sectional study conducted on 60 Diabetic patients visiting to K R Hospital, Mysuru from April 2023 to October 2024.

Secondary sources of information including published articles, journals, books and related website.

Sample size

Sample size: 60

The sample size was calculated using formula

S = Z²PQ / D²

S = sample size

Z = Std. value @ 0.05 level = 1.96

P = Proportion of prevalance = 5.5 % becomes .055

Q = 1 – P = 1 - .055 = .945

D² = Margin of error or confidence interval = 5% = .05

Inclusion Criteria

1. Participants aged 18 years or older, diagnosed with Type-2 Diabetes Mellitus.
2. Participants willing to provide valid informed consent for the study.

Exclusion Criteria

1. Use of drugs known to cause hyperuricemia
2. Presence of liver disease / CKD / Muscle disorder / Gout
3. Patients with active urinary tract infections (UTIs)
4. History of malignancy

METHODS

After taking institutional ethical clearance for the study purpose of the study will be explained to patient and attenders. Written informed consent will be taken from the subjects. Relevant history and clinical examination will be done. Urine for proteinuria, blood samples for uric acid, creatinine shall be sent.

Statistical Analysis

Data obtained from the study will be entered in excel sheets and it will be double checked. Data analysed using SPSS software version 22.0 and it will be presented as descriptive statistics in the form of frequency table, figures and graphs. Association between variables will be done using chi square test and unpaired test for qualitative and quantitative variables. Result will be expressed as mean +/- SD. Correlation of parameters is done by Pearson’s correlation formula. P value of < .05 is considered statistically significant.

The data shows a sample of subjects with Type-2 Diabetes, revealing the key parameters related to metabolic control and kidney function. The average age of participants is 60.13 years, with elevated blood glucose levels (HbA1C 10.11%, FBS 213.23 mg/dl, PPBS 260.38 mg/dl), suggesting poor glycemic control. Serum uric acid and creatinine levels are within normal ranges, but the serum uric acid-to-creatinine ratio (3.42) is notably higher, which may indicate an early metabolic disturbance. Proteinuria and kidney health monitoring are crucial in these patients.

The distribution of sex among the study participants is almost balanced, with 48.3% of the subjects being male and 51.7% female. This indicates a fairly equal representation of both sexes in the sample, which is important for reducing sex-based bias in the study's findings.

The analysis revealed a positive correlation (r = 0.42) between the serum uric acid to creatinine ratio and proteinuria in patients with type 2 diabetes mellitus, with a statistically significant p-value of 0.05. This suggests that as the serum uric acid to creatinine ratio increases, the level of proteinuria also tends to rise, indicating a potential link between this biochemical ratio and renal involvement in diabetic individuals.

In a cross-sectional study containing 60 patients with Type 2 DM. The objective was to study the correlation between serum uric acid to creatinine ratio and proteinuria. The study population had an average age of 60.13 years, the mean serum uric acid level was 3.69mg/dl, serum uric acid to creatinine ratio of 3.4

An analytical observational study conducted by Kulkarni S, Yadav A. in 2021, at Father Muller Medical College and Hospital, Mangalore, Karnataka, among 131 participants (60-DM,71-normal controls) concluded that there is association of serum uric acid-creatinine ratio with microalbuminuria and glycemic status (HbA1C) as an early indicator of diabetic nephropathy. [5,6]

An observational study conducted by Shashidar K. et al. in 2016, at Sri Devraj Urs Medical College Kolar, Karnataka among 180 subjects concluded the significant association between elevated uric acid levels and higher UACR, which is a marker of kidney damage and also uric acid as a potential risk factor for renal complications in diabetes. [7,8]

This study highlights the importance of early detection and monitoring of kidney disfunction in individuals with Type-2 DM particularly by using SUA/Cr ratio and proteinuria as a potential marker and demonstrates clear relationship between SUA/Cr ratio and proteinuria.  This underscores the need for early and proactive interventions to manage diabetes and prevent diabetic nephropathy. Regular monitoring of this could significantly improve the ability to identify at-risk patients and prevent the progression to end stage renal disease.

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