Habitual Alcohol Intake Modifies Relationship of Uric Acid to Incident Chronic Kidney Disease

Abstract

Background: Previous studies showed that higher serum uric acid levels increased the risk of chronic kidney disease (CKD), but moderate alcohol consumption decreased it. The comparative importance of serum uric acid levels and habitual alcohol consumption as risk factors for CKD remain undefined. We therefore evaluated the relationship of baseline serum uric acid level in combination with daily alcohol consumption to the incidence of CKD. Methods: A prospective cohort study of 9,116 middle-aged nondiabetic ­Japanese men without CKD nor proteinuria who were not taking antihypertensive medications nor urate-lowering medications at entry. CKD was defined as estimated glomerular filtration rate <60 mL/min/1.73 m². We investigated the relationship of baseline serum uric acid level in combination with daily alcohol consumption to the incidence of CKD during an 11-year observation period. Daily alcohol consumption was classified into 4 groups: nondrinkers, light drinkers (0.1–23.0 g ethanol/day), moderate drinkers (23.1–46.0 g ethanol/day), and heavy drinkers (≥46.1 g ethanol/day). Cox proportional hazards models were used in multivariate analysis. Results: During the 79,361 person-years follow-up period, a total of 1,230 subjects developed CKD. In multivariate models, higher serum uric acid levels increased risk of CKD; and moderate daily alcohol consumption decreased the risk. Multiple-adjusted hazard ratios of CKD were 1.38 (95% CI 1.11–1.70), 1.58 (95% CI 1.28–1.95), 2.27 (95% CI 1.86–2.77), and 3.12 (95% CI 2.56–3.81) for quintile 2, quintile 3, quintile 4, and quintile 5 of serum uric acid levels, respectively, compared with quintile 1, and that for moderate drinkers was 0.55 (95% CI 0.46–0.66) compared with nondrinkers. In the joint analysis of alcohol consumption and serum uric acid, moderate drinkers with the lowest tertile of serum uric acid levels had the lowest risk of CKD, but nondrinkers with the highest tertile of serum uric acid levels had the highest risk of CKD. Conclusions: Serum uric acid level and daily alcohol consumption were independently associated with the risk of CKD. Nondrinkers with the highest serum uric acid level had the highest risk of CKD.

Alcohol consumption and serum uric acid are synergistically associated with renal dysfunction among community‐dwelling persons

“…Further, alcohol consumption leads to hyperuricemia as a result of the high purine content of certain types of alcoholic beverages, 13 increased urate production from purine nucleotide degradation during ethanol catabolism, and lactic acid inhibition of renal urate excretion 13 . However, to the best of our knowledge, few studies have examined the interactive effects of alcohol consumption and SUA levels on renal dysfunction in Japanese populations 14 …”

Long-term drinking behavior change patterns and its association with hyperuricemia in chinese adults: evidence from China Health and Nutrition Survey

“…The China Kadoorie Biobank reported that 8% of males are drinkers and individuals engaging in heavy drinking episodes were likely to have multiple risk factors such as regular smoking, low physical activity, and hypertension [ 7 ]. Various diseases including diabetes, chronic kidney disease (CKD), and ischemic stroke are associated with heavy alcohol intake in the Chinese population [ 8 , 9 ]. Although drinking behaviors vary over time in China, there is emerging evidence that defines the potential correlation of the changing drinking behaviors with the development of HUA.…”

A Dose-Dependent Association between Alcohol Consumption and Incidence of Proteinuria and Low Glomerular Filtration Rate: A Systematic Review and Meta-Analysis of Cohort Studies

“…Of the 34 publications selected, the present meta-analysis finally included 12 publications [ 19 , 20 , 21 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 ] from 11 cohort studies ( N = 14,634,940), including the Physicians’ Health Study (PHS) study which defined the outcome as eGFR of <55 mL/min [ 32 ]. We excluded 23 publications because two publications were cross-sectional studies [ 41 , 42 ], two did not assess alcohol consumption (g/day) as a predictor of proteinuria and/or low GFR [ 43 , 44 ], three categorized alcohol consumption into only two levels (none vs. ≥1 drink/day [ 45 ], no use vs. use of alcohol [ 46 ], and alcohol consumption of <20 vs. ≥20 g/day [ 47 ]), four did not stratify current drinkers by alcohol consumption level (g/day) [ 48 , 49 , 50 , 51 ], one had the highest alcohol consumption category with the lower boundary of <12 g/day, [ 52 ] one had a sex-specific definition of alcohol consumption level [ 53 ], one did not define the outcome of CKD [ 54 ], seven did not have the outcome of incidence of proteinuria or low GFR [ 55 , 56 , 57 , 58 , 59 , 60 , 61 ], one had missing information on the number of participants of alcohol consumption categories [ 62 ], and one reported similar results in previous publications [ 63 ].…”