Hubungan Rasio Asam Urat-Kreatinin Serum dengan Kejadian Nefropati Diabetik pada Diabetes Melitus Tipe 2

Abstract

Background : Diabetic nephropathy (DN) is a major complication of type 2 diabetes mellitus (T2DM). Albumin-to-creatinine ratio (ACR) and estimated glomerular filtration rate (eGFR) remain standard markers, but their sensitivity is limited in early stages. The uric acid-to-creatinine ratio (UA/Cr) has been proposed as an additional biomarker for detecting renal impairment. Objective : To investigate the association between the UA/Cr ratio and DN in patients with T2DM. Methods : A cross-sectional study was conducted on 66 T2DM patients at Adam Malik General Hospital, Medan. Demographic and laboratory data, including uric acid, creatinine, ACR, and eGFR, were collected. The UA/Cr rasio was calculated, and mean difference tests and correlation analyses were performed. Results : The median eGFR was 74 mL/min/1.73m², significantly lower in DN than non-DN patients (50.5 vs. 85; p<0.001). Median ACR was higher in DN (62.8 vs. 6.47 mg/g; p<0.001). The mean UA/Cr ratio was 6.03 ± 1.57, lower in DN (5.44 vs. 6.29) though not significant (p=0.121). Significant differences were observed in serum uric acid (9.57 ± 3.42 vs. 6.41 ± 2.86 mg/dL; p<0.001) and eGFR (50.5 vs. 85; p<0.001). The UA/Cr ratio correlated positively with eGFR (r=0.733; p<0.001 for eGFR <60; r=0.299; p=0.049 for eGFR ≥60). No significant association was found with ACR in normo- or microalbuminuria, while a strong negative correlation appeared in macroalbuminuria (r=–0.709; p<0.001). Subgroup analysis showed significantly lower UA/Cr in DN with normoalbuminuria compared to non-DN (4.83 vs. 6.38; p=0.005). Conclusion : The UA/Cr ratio is closely related to eGFR and may serve as a practical biomarker for early detection of DN, even in normoalbuminuric patients.