Hyperuricemia and chronic kidney disease: to treat or not to treat

Piani, Federica; Sasai, Fumihiko; Bjornstad, Petter; Borghi, Claudio; Yoshimura, Akinobu; Sánchez-Lozada, Laura G.; Roncal-Jiménez, Carlos A.; García, Gabriela; Hernando, Ana Andres; Cara-Fuentes, Gabriel; Rodríguez‐Iturbe, Bernardo; Lanaspa, Miguel A.; Johnson, Richard J.

doi:10.1590/2175-8239-jbn-2020-u002

Cited by 23 publications

(14 citation statements)

References 75 publications

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“…Hyperuricaemia was significantly associated with CKD progression on univariate analysis in our study but this significance was lost on multivariate analysis; studies have reported that high serum uric acid levels commonly occur as a result of the impaired glomerular filtration rate (GFR) that occurs in CKD. Hyperuricaemia can also precede the development of CKD, predict incident CKD and is associated with high risk for advanced CKD/ CKD progression [ 59 , 60 ]. Hypocalcaemia was reported in 17.7% patients who had CKD progression with 3.8-fold association with CKD progression; low serum calcium levels are commonly caused by increased serum phosphorus and decreased renal production of 1,25(OH)2 vitamin D due to hyperparathyroidism.…”

Section: Discussionmentioning

confidence: 99%

Progression of chronic kidney disease among black patients attending a tertiary hospital in Johannesburg, South Africa

Meremo

Paget²,

Duarte³

et al. 2023

PLoS ONE

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Background Chronic kidney disease (CKD) is a major public health issue worldwide and is an important contributor to the overall non-communicable disease burden. Chronic kidney disease is usually asymptomatic, and insidiously and silently progresses to advanced stages in resource limited settings. Methodology A prospective longitudinal study was carried out on black patients with CKD attending the kidney outpatient clinic at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) in South Africa, between September 2019 to March 2022. Demographic and clinical data were extracted from the ongoing continuous clinic records, as well as measurements of vital signs and interviews at baseline and at follow up. Patients provided urine and blood samples for laboratory investigations as standard of care at study entry (0) and at 24 months, and were followed up prospectively for two (2) years. Data were descriptively and inferentially entered into REDcap and analysed using STATA version 17, and multivariable logistic regression analysis was used to identify predictors of CKD progression. Results A total of 312 patients were enrolled into the study, 297 (95.2%) patients completed the study, 10 (3.2%) patients were lost to follow and 5 (1.6%) patients died during the study period. The prevalence of CKD progression was 49.5%, while that of CKD remission was 33% and CKD regression was 17.5%. For patients with CKD progression the median age at baseline was 58 (46–67) years, the median eGFR was 37 (32–51) mL/min/1.73 m2, median urine protein creatinine ratio (uPCR) was 0.038 (0.016–0.82) g/mmol and the median haemoglobin (Hb) was 13.1 (11.7–14.4) g/dl; 95.2% had hypertension, 40.1% patients had diabetes mellitus and 39.5% had both hypertension and diabetes mellitus. Almost half (48.3%) of patients with CKD progression had severely increased proteinuria and 45.6% had anaemia. Variables associated with higher odds for CKD progression after multivariable logistic regression analysis were severely increased proteinuria (OR 32.3, 95% CI 2.8–368.6, P = 0.005), moderately increased proteinuria (OR 23.3, 95% CI 2.6–230.1, P = 0.007), hypocalcaemia (OR 3.8, 95% CI 1.0–14.8, P = 0.047), hyponatraemia (OR 4.5, 95% CI 0.8–23.6, P = 0.042), anaemia (OR 2.1, 95% CI 1.0–4.3, P = 0.048), diabetes mellitus (OR 1.8, 95% CI 0.9–3.6, P = 0.047), elevated HbA1c (OR 1.8, 95% CI 1.2–2.8, P = 0.007) and current smoking (OR 2.8, 95% CI 0.9–8.6, P = 0.049). Conclusion Our study identified a higher prevalence of CKD progression in a prospective longitudinal study of black patients with CKD compared with literature reports. CKD Progression was associated with proteinuria, diabetes mellitus, elevated HbA1c, anaemia, hypocalcaemia, hyponatraemia and current smoking in a cohort of black patients with CKD who had controlled hypertension and diabetes mellitus at baseline.

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Section: Discussionmentioning

confidence: 99%

Progression of chronic kidney disease among black patients attending a tertiary hospital in Johannesburg, South Africa

Meremo

Paget²,

Duarte³

et al. 2023

PLoS ONE

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show abstract

“…Hyperuricaemia was significantly associated with CKD progression on univariate analysis in our study but this significance was lost on multivariate analysis; studies have reported that high serum uric acid levels commonly occur as a result of the impaired glomerular filtration rate (GFR) that occurs in CKD. Hyperuricaemia can also precede the development of CKD, predict incident CKD and is associated with high risk for advanced CKD/ CKD progression (54, 55). Hypocalcaemia was reported in 17.7 % patients who had CKD progression with 3.8-fold association with CKD progression; low serum calcium levels are commonly caused by increased serum phosphorus and decreased renal production of 1,25(OH)2 vitamin D due to hyperparathyroidism.…”

Section: Discussionmentioning

confidence: 99%

Progression of chronic kidney disease among black patients attending a tertiary hospital in Johannesburg, South Africa

Meremo

Paget

Duarte

et al. 2022

Preprint

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Background: Chronic kidney disease (CKD) is a major public health issue worldwide and is an important contributor to the overall non-communicable disease burden. Chronic kidney disease is usually asymptomatic, and insidiously and silently progresses to advanced stages in resource limited settings. Methodology: A prospective longitudinal study was carried out on black patients with CKD attending the kidney outpatient clinic at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) in South Africa, between September 2019 to March 2022. Demographic and clinical data were extracted from the ongoing continuous clinic records, as well as measurements of vital signs and interviews at baseline and at follow up. Patients provided urine and blood samples for laboratory investigations as standard of care at study entry (0) and at 24 months, and were followed up prospectively for two (2) years. Data were descriptively and inferentially entered into REDcap and analysed using STATA version 17, and multivariable logistic regression analysis was used to identify predictors of CKD progression. Results: A total of 312 patients were enrolled into the study, 297 (95.2%) patients completed the study, 10 (3.2%) patients were lost to follow and 5 (1.6%) patients died during the study period. The prevalence of CKD progression was 49.5%, while that of CKD remission was 33% and CKD regression was 17.5%. For patients with CKD progression the median age at baseline was 58 (46 - 67) years, the median eGFR was 37 (32 -51) mL/min/1.73 m2, median urine protein creatinine ratio (uPCR) was 0.038 (0.016 -0.82) g/mmol and the median haemoglobin (Hb) was 13.1 (11.7 – 14.4) g/dl; 95.2% had hypertension, 40.1% patients had diabetes mellitus and 39.5% had both hypertension and diabetes mellitus. Almost half (48.3%) of patients with CKD progression had severely increased proteinuria and 45.6% had anaemia. Variables associated with higher odds for CKD progression after multivariable logistic regression analysis were severely increased proteinuria (OR 32.3, 95 % CI 2.8 - 368.6, P = 0.005), moderately increased proteinuria (OR 23.3, 95% CI 2.6 - 230.1, P= 0.007), hypocalcaemia (OR 3.8, 95 % CI 1.0 - 14.8, P = 0.047), hyponatraemia (OR 4.5, 95% CI 0.8 - 23.6, P= 0.042), anaemia (OR 2.1, 95% CI 1.0 - 4.3, P= 0.048), diabetes mellitus (OR 1.8, 95 % CI 0.9 - 3.6, P = 0.047), elevated HbA1c (OR 1.8, 95 % CI 1.2 - 2.8, P = 0.007) and current smoking (OR 2.8, 95 % CI 0.9 - 8.6, P = 0.049). Conclusion: Our study identified a higher prevalence of progression of CKD in a prospective longitudinal study of black patients with CKD. Progression of CKD was associated with proteinuria, diabetes mellitus, elevated HbA1c, anaemia, hypocalcaemia, hyponatraemia and current smoking. This is a call for nephrologists and clinicians to be vigilant in identifying CKD patients at risk of CKD progression at early stages as this would allow risk stratification to improve kidney disease outcomes.

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“…Studies have shown that hyperuricaemia is an independent risk factor for the onset and progression of CKD 53 . The target level of SUA in patients with gout is <6 mg/dl (or in patients with tophaceous gout, <5 mg/dl) 54 . UA is formed from nucleic acids either endogenously from cell breakdown or exogenously from the metabolism of food.…”

Section: Discussionmentioning

confidence: 99%

“… 53 The target level of SUA in patients with gout is <6 mg/dl (or in patients with tophaceous gout, <5 mg/dl). 54 UA is formed from nucleic acids either endogenously from cell breakdown or exogenously from the metabolism of food. Phosphoribosyl pyrophosphate synthetase (PRPS) and xanthine oxidase play essential roles in the generation of UA.…”

Section: Discussionmentioning

confidence: 99%

A Retrospective Study of the Perioperative Period Management of Joint Arthroplasty in Patients with Chronic Kidney Disease

Jin

Yang

et al. 2022

Orthopaedic Surgery

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Objective With the rising prevalence of chronic kidney disease (CKD) and the increasing demand for joint arthroplasty, the management of CKD patients in the perioperative period of joint arthroplasty has become an issue worthy of attention for orthopedic surgeons. This study aimed to explore comprehensive perioperative period management strategies for CKD patients. Methods From March 2017 to August 2022, 62 patients who underwent joint arthroplasty in our hospital were included in a retrospective study, including 31 CKD patients (mean age 69.8 ± 13.4 years old) and 31 non‐CKD patients (mean age 69.4 ± 14.2 years old). The outcome indicators were analyzed, including serum urea, serum creatinine, blood uric acid, hematocrit, and hemoglobin. Results All patients included in the retrospective study had an average preoperative preparation time of 4.3 ± 2.6 days and an average hospitalization time of 11.0 ± 7.3 days. There were no significant differences in the changes in the serum urea values between the preoperative and postoperative measurements in the CKD patients or in the serum creatinine values and blood uric acid values (P > 0.05). The hemoglobin value in postoperative measurements was lower than in preoperative measurements in the CKD patients (P < 0.05). The hematocrit value in postoperative measurements was lower than in preoperative measurements in the CKD patients (P < 0.001). Conclusion Patients with CKD have distinct characteristics compared to non‐CKD patients, and they generally have a higher risk for postoperative complications and adverse events. Recognition of risk factors, suitable timing of surgery, the undertaking of protective strategies, and proper management of complications are vital for managing CKD patients in the perioperative period of joint arthroplasty.

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Hyperuricemia and chronic kidney disease: to treat or not to treat

Cited by 23 publications

References 75 publications

Progression of chronic kidney disease among black patients attending a tertiary hospital in Johannesburg, South Africa

Progression of chronic kidney disease among black patients attending a tertiary hospital in Johannesburg, South Africa

Progression of chronic kidney disease among black patients attending a tertiary hospital in Johannesburg, South Africa

A Retrospective Study of the Perioperative Period Management of Joint Arthroplasty in Patients with Chronic Kidney Disease

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