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However, the relationship between SUA\/sCr and cardiovascular and renal injury profile in this population is not well established. This study aimed to evaluate SUA\/sCr across the spectrum of DKD, particularly focusing on NA-DKD, and to test its association with subclinical vascular damage, urinary biomarkers and ultrasound features of kidney damage.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Presence of carotid plaques, pulse wave velocity (PWV), renal resistive index (RRI), and urinary biomarkers of tubular injury were assessed in 207 individuals with type 2 diabetes. Participants were split based on estimated-glomerular-filtration-rate (eGFR) and urinary-albumin-to-creatinine-ratio (UACR) into four groups: controls (UACR\u2009&lt;\u200930\u00a0mg\/g, eGFR\u2009\u2265\u200960\u00a0ml\/min\/1.73m\n                      <jats:sup>2<\/jats:sup>\n                      ), A-DKD (Albuminuric-DKD; UACR\u2009\u2265\u200930\u00a0mg\/g, eGFR\u2009\u2265\u200960\u00a0ml\/min\/1.73m\n                      <jats:sup>2<\/jats:sup>\n                      ), NA-DKD (Non-albuminuric-DKD; UACR\u2009&lt;\u200930\u00a0mg\/g, eGFR\u2009&lt;\u200960\u00a0ml\/min\/1.73m\n                      <jats:sup>2<\/jats:sup>\n                      ), A&amp;L-DKD (Albuminuric-and-Low-eGFR-DKD; UACR\u2009\u2265\u200930\u00a0mg\/g, eGFR\u2009&lt;\u200960\u00a0ml\/min\/1.73m\n                      <jats:sup>2<\/jats:sup>\n                      ).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Participants with NA-DKD showed a lower SUA\/sCr than those with A-DKD and controls (4.71\u2009\u00b1\u20091.52 vs 6.06\u2009\u00b1\u20091.70 vs 6.67\u2009\u00b1\u20091.87, both\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.0001). A lower SUA\/sCr was independently correlated with NA-DKD (\u03b2\u2009=\u2009-1.63,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.0001) and A&amp;L-DKD (\u03b2\u2009=\u2009-2.01,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.0001). SUA\/sCr was inversely and independently associated with urinary \u03b22-microglobulin (\u03b2\u2009=\u2009-0.21,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.0082). Moreover, lower SUA\/sCr was associated with PWV\u2009&gt;\u200910\u00a0m\/s (OR 0.77, 95%CI 0.63\u20130.95,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.014), the presence of carotid plaques (OR 0.78, 95%CI 0.63\u20130.96,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.020), and higher RRI (\u03b2\u2009=\u2009-0.18,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.0082).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In T2D, lower SUA\/sCr correlated with NA-DKD, but not with A-DKD. Lower SUA\/sCr was associated with subclinical vascular and tubular damage. Future studies are needed to test SUA\/sCr as candidate biomarker to improve DKD risk stratification.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s40618-026-02972-7","type":"journal-article","created":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T07:13:34Z","timestamp":1783667614000},"page":"2975-2984","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Serum uric acid to creatinine ratio as marker of early vascular damage and renal tubular injury in non-albuminuric diabetic kidney disease"],"prefix":"10.1007","volume":"49","author":[{"given":"Maurizio","family":"Di Marco","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabrina","family":"Scilletta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicoletta","family":"Miano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola","family":"Marrano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annalisa","family":"Natalicchio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Giorgino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giosiana","family":"Bosco","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Di Giacomo Barbagallo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Scicali","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Tumminia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Agostino","family":"Milluzzo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucia","family":"Frittitta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1781-0902","authenticated-orcid":false,"given":"Salvatore","family":"Piro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonino","family":"Di Pino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,10]]},"reference":[{"key":"2972_CR1","doi-asserted-by":"publisher","first-page":"2032","DOI":"10.2215\/CJN.11491116","volume":"12","author":"RZ Alicic","year":"2017","unstructured":"Alicic RZ, Rooney MT, Tuttle KR (2017) Diabetic kidney disease: challenges, progress, and possibilities. 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