The serum uric acid to creatinine ratio as a diagnostic biomarker for normoalbuminuric diabetic kidney disease

To evaluate the potential of the serum uric acid to serum creatinine ratio (SUA/SCr) as a diagnostic biomarker for normoalbuminuric diabetic kidney disease (NADKD). We retrospectively analyzed demographic and biochemical data from 3,101 type 2 diabetes patients. Patients were stratified into non-diabetic kidney disease (non-DKD), albuminuric diabetic kidney disease (ADKD), and NADKD groups according to their estimated glomerular filtration rate (eGFR), urinary albumin creatinine ratio (UACR), and urinary albumin excretion rate (UAER). We employed multivariate logistic regression analyses using a stepwise forward-LR method to develop a nomogram. Both area under the curve (AUC) from receiver operating characteristic (ROC), and calibration curves were employed to assess the predictive accuracy of the nomogram. A decision curve analysis (DCA) was conducted to assess the clinical utility of the nomogram. SUA/SCr, along with glycosylated hemoglobin A1c (HbA1C) and fasting plasma glucose (FPG), showed significant associations with NADKD, both pre- and post-propensity score matching (PSM). Seven variables were incorporated into the risk nomogram. The calibration plots indicated strong agreement between predicted and observed outcomes in both training and validation cohorts. The NADKD risk model demonstrated robust performance, as evidenced by the AUC from ROC analysis and DCA. SUA/SCr is a significant and independent predictor of NADKD risk. The developed nomograms offer valuable tools for clinical decision-making, potentially enhancing diagnostic accuracy for NADKD in type 2 diabetes patients.