Integrating Renal and Metabolic Parameters into a Derived Risk Score for Hyperuricemia in Uncontrolled Type 2 Diabetes: A Retrospective Cross-Sectional Study in Northwest Romania

<i>Background and Objectives</i>: Hyperuricemia is frequent in patients with uncontrolled type 2 diabetes (T2D) and may reflect intertwined renal and metabolic dysfunction. Simple tools to identify those at highest risk are lacking. <i>Materials and Methods:</i> We retrospectively analyzed 253 adults with uncontrolled T2D (HbA1c ≥ 7%) hospitalized at a tertiary center (2022-2023). Patients were stratified by hyperuricemia status (serum uric acid >7.0 mg/dL in men and >6.0 mg/dL in women). Demographic, clinical, biochemical, and pharmacological data were compared. Independent predictors were explored with multivariable modeling. A two-parameter Renal-Metabolic Risk Score (serum urea and triglyceride-to-LDL cholesterol ratio [TG/LDL]) was derived and evaluated by ROC analysis. <i>Results:</i> Compared with non-hyperuricemic patients (<i>n</i> = 20), those with hyperuricemia (<i>n</i> = 233) had higher serum urea (32.15 ± 21.21 vs. 19.76 ± 10.02 mg/dL; <i>p</i> < 0.001) and numerically higher TG/LDL (2.94 ± 6.73 vs. 1.95 ± 1.28; <i>p</i> = 0.062). Serum uric acid was lower in the hyperuricemia group due to categorical definition thresholds and treatment effects (5.69 ± 1.87 vs. 6.77 ± 2.12 mg/dL; <i>p</i> = 0.038). The derived Renal-Metabolic Risk Score showed an AUC = 0.67 and differed significantly between groups (<i>p</i> ≈ 1.2 × 10^-5). <i>Conclusions:</i> The derived RMRS, based on simple and inexpensive laboratory parameters, offers a preliminary tool for assessing hyperuricemia risk in uncontrolled T2D. From a clinical and assistive practice perspective, this score may help nephrology nurses and multidisciplinary teams identify high-risk patients who require closer monitoring of renal and metabolic complications. It could further guide early dietary counseling, pharmacological optimization, and frailty assessment in chronic kidney disease care. Future studies are needed to validate the score in larger and more diverse populations before its integration into routine practice.