Association between Serum Uric Acid Level and ESRD or Death in a Korean Population

Abstract

Background: Serum uric acid (SUA) is recognized as a risk factor for chronic kidney disease (CKD) and mortality. However, there is controversy as to whether a high or low level of SUA is related to the risk of CKD progression or death, and whether it differs between males and females. Methods: We included 143,762 adults who underwent voluntary health screening between 1995 and 2009 in Korea. For each sex, we divided participants into sex-specific quintiles according to SUA levels and compared end-stage renal disease (ESRD) incidence and mortality between the groups with low and high SUA levels and those with middle SUA levels. Sex-specific Cox proportional hazard analyses were performed for ESRD and all-cause mortality. Results: Among the 143,762 participants, 0.2% (n = 272) developed ESRD. The hazard ratio (HR) of ESRD was higher in the highest (adjusted HR, 2.13; 95% confidence interval [CI], 1.18-3.84) and lowest (adjusted HR, 1.90; 95% CI, 1.02-3.51) SUA quintiles than in the middle SUA quintile in males and the highest SUA quintile in females (adjusted HR, 2.31; 95% CI, 1.10-4.84). Four-point three percent (n = 6,215) of participants died during a mean follow-up period of 157 months. The hazard ratio (HR) of all-cause mortality was higher in the highest SUA quintile than in the middle SUA quintile in males (adjusted HR, 1.15; 95% CI, 1.03-1.28) and females (adjusted HR, 1.17; 95% CI, 1.01-1.35). Conclusion: Elevated levels of SUA are associated with increased risk for ESRD and all-cause mortality in both sexes. Low levels of SUA might be related to ESRD and death only in males, showing U-shaped associations. Our findings suggest sex-specific associations between SUA levels and ESRD development and mortality.

Serum Uric Acid Revealed a U-Shaped Relationship With All-Cause Mortality and Cardiovascular Mortality in High Atherosclerosis Risk Patients: The ASSURE Study

“…The relationship between SUA and mortality has been explored in previous studies. Similarly, several studies including a longitudinal Taiwanese cohort study ( 23 ), US adult cohort study ( 24 ), Korean study ( 25 , 26 ) and Chinese chronic kidney disease study ( 17 ) reported U-shaped associations between SUA and all-cause mortality as well as cardiovascular mortality. Nevertheless, the different patient populations recruited might affect the occurrence of ending events to affect different SUA cutoff values and ranges of variation.…”

Serum Uric Acid and Mortality in Patients with Chronic Kidney Disease: A Systematic Review and Meta-Analysis

“…Egger’s test indicated no significant evidence of publication bias ( p = 0.421). Another 8 studies [33-40] covered HR of the minimum or maximum group as compared with the middle group. Patients exhibiting minimum or maximum level of SUA were both associated with an increased risk of all-cause mortality compared with those exhibiting middle level (HR, 1.36; 95% CI, 1.20–1.54, p < 0.00001; HR, 1.39; 95% CI, 1.05–1.83, p = 0.02).…”

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

“…Hyperuricemia is a strong independent risk factor for incident CKD [14][15][16][22][23][24][25][26][27][28] . The relationship of serum uric acid with incident CKD is not linear, but risk shows a rapid increase as serum uric acid concentrations reach 7 mg/dL or more 29,30 .…”