Urate-lowering therapy and risk of cardiorenal mortality in patients with type 2 diabetes and asymptomatic hyperuricemia.

Aims: Epidemiological evidence has linked elevated serum uric acid levels with increased mortality risk in patients with type 2 diabetes mellitus (T2DM). This study aimed to evaluate whether urate-lowering therapy (ULT) is associated with a lower risk of cardiorenal and all-cause mortality in patients with T2DM and asymptomatic hyperuricemia (HUA).

Methods: This retrospective, multicenter cohort study utilized electronic health records in Taiwan. Adult patients with T2DM and asymptomatic HUA who either initiated ULT or remained untreated in Taiwan between 2016 and 2021 were included. Propensity score matching and prescription time-distribution matching were applied to minimize confounding and immortal time bias.

Results: After matching, 2,534 patients were included. During a mean follow-up of 3.4 years, ULT use was associated with significantly lower risks of cardiorenal mortality (HR, 0.66; 95 % CI, 0.52-0.83) and all-cause mortality (HR, 0.71; 95 % CI, 0.62-0.80). Sensitivity analyses yielded consistent findings across multiple models.

Conclusions: In patients with T2DM and asymptomatic HUA, ULT use was associated with a significant reduction in cardiorenal and all-cause mortality. These findings highlight a potential role for ULT in the broader context of cardiometabolic risk management, beyond its traditional use for gout prevention.