Higher serum urate levels were associated with increased mortality risk among people with diabetes. The population-based cohort analysis, published in Acta Diabetologica, assessed all-cause and cause-specific mortality and evaluated the mediating role of kidney function.

The study analyzed 18,809 UK Biobank participants with diabetes who were free of cardiovascular disease and cancer at baseline. Participants were followed for a median of 13.5 years. Cox proportional hazards models and Fine–Gray models assessed mortality risk, restricted cubic splines evaluated nonlinear associations, and Aalen additive hazards models examined mediation by eGFR.

During follow-up, 2,984 deaths occurred, including 739 cardiovascular deaths and 1,065 cancer deaths. Compared with participants in the lowest serum urate quartile (<4.6 mg/dL), those in the highest quartile (>6.3 mg/dL) had higher risks of all-cause mortality (hazard ratio [HR] 1.329; 95% confidence interval [CI] 1.190–1.485), cardiovascular mortality (HR 1.391; 95% CI 1.115–1.736), cancer mortality (HR 1.258; 95% CI 1.042–1.518), and other-cause mortality (HR 1.245; 95% CI 1.042–1.487).

A J-shaped association was identified, with all-cause mortality increasing above a serum urate level of 5.4 mg/dL. Sex-stratified analyses showed higher inflection points in males than females at 7.2 mg/dL and 5.7 mg/dL, respectively. Mediation analysis indicated that eGFR explained 36.4% of the association between serum urate and all-cause mortality, corresponding to an indirect effect of 10 events per 1,000 person-years (95% CI 4.5–15.2).

These findings show that elevated serum urate, including levels within the normal range, was independently associated with higher mortality risk in diabetes, with kidney function accounting for part of this relationship.