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Aims: Serum uric acid (UA) increases in patients with kidney disease due to the impaired UA clearance. The present study sought to evaluate the association between UA/creatinine ratio (UA/Cr) and renal disease progression in patients with type 2 diabetes mellitus (T2DM) in Chinese communities., Methods: In the present retrospective longitudinal study, 3432 Chinese T2DM patients recruited from 11 community healthcare centers in Nanjing, China were included. Renal disease progression was defined as the occurrence of estimated glomerular filtration rate (eGFR) <15 mL/min/1.73 m 2 or doubling of baseline serum creatinine level. Cox regression analysis was used to estimate the association between UA/Cr and renal disease progression., Results: During a median follow-up of 30 months, 58 (1.70%) patients experienced progression of renal disease, which was more common among those with older ages, longer diabetes duration, and higher baseline eGFR. Multivariate analysis revealed that UA/Cr was an independent risk factor for renal disease progress (hazard ratio 1.364 [95% CI 1.131-1.646], P = 0.001) independently of age, sex, and other potential confounders., Conclusions: UA/Cr might be a novel predictor of chronic kidney disease progression in T2DM patients., (Copyright © 2018. Published by Elsevier Inc.)

Currently, the second-generation intact parathyroid hormone (iPTH) assay is commonly used for measuring PTH levels. The iPTH assay detects both full-length (1-84)PTH and (7-84)PTH fragments, which have antagonistic effects on (1-84)PTH in bones and kidneys. The third-generation PTH assay is specific for (1-84)PTH. This study examined the features of different PTH fragments in stage 5 chronic kidney disease (CKD) and the effects of parathyroidectomy (PTX) on the above markers in severe secondary hyperparathyroidism (SHPT) patients. The cross-sectional study included 262 stage 5 CKD patients and 90 controls. A prospective follow-up study was then conducted in 34 PTX patients. Second- and third-generation assays were used to measure plasma iPTH and (1-84)PTH levels, respectively. Circulating (7-84)PTH levels were calculated by subtracting the (1-84)PTH value from the iPTH value. Different plasma PTH fragments were higher, and (1-84)PTH/iPTH was lower in CKD patients than in controls. Plasma (1-84)PTH and (7-84)PTH concentrations increased as iPTH levels increased, and (7-84)PTH increased more evidently. Plasma iPTH, (1-84)PTH and (7-84)PTH levels were 1530.5 (885.0-2111.5) pg/ml, 683.1 (431.4-1018.0) pg/ml, and 739.3 (452.6-1261.0) pg/ml, respectively, in PTX patients. Plasma iPTH, (1-84)PTH and (7-84)PTH concentrations decreased considerably, and the (1-84)PTH/iPTH ratio increased after PTX (median follow-up interval: 10.9 months). Stage 5 CKD patients had higher plasma levels of different PTH fragments, and lower (1-84)PTH/iPTH ratio. PTX could significantly reverse these abnormalities in severe SHPT patients. The iPTH assay overestimated the function of the parathyroid glands; thus, the third-generation PTH assay is likely better for the management of CKD patients., Competing Interests: The authors declare that they have no conflict of interest., (© Georg Thieme Verlag KG Stuttgart · New York.)