Interaction between Hyperuricemia and Admission Lactate Increases the Risk of Acute Kidney Injury in Patients with ST-Segment Elevation Myocardial Infarction

Abstract

Background and Objective: Acute kidney injury (AKI) is a common complication associated with adverse outcomes among patients with ST-segment elevation myocardial infarction (STEMI). This is conflicting information about the relationship between hyperuricemia and AKI in STEMI. This work aims to investigate the effect of the interaction between hyperuricemia and lactate on the risk of AKI. Methods: We analyzed 2,008 consecutive STEMI patients between January 2014 and January 2019. Hyperuricemia was defined as a serum uric acid (SUA) level >7 mg/dl for males and >6 mg/dl for females. AKI was defined based on the Kidney Disease: Improving Global Outcomes (KDIGO). Logistic regression models were applied to establish the relationship between hyperuricemia and AKI in the overall population and subgroups stratified as per lactate levels at admission (≤ 2.2 mmol/L or > 2.2 mmol/L). Results: In total, we included 1,887 STEMI patients. Multivariate analysis showed that hyperuricemia is associated with the risk of AKI (OR: 1.34; 95% CI: 1.01-1.77; P =0.045). Nonetheless, the predictive effect of hyperuricemia was only observed in patients with lactate level > 2.2mmol/L (OR: 2.05; 95% CI: 1.36-3.10; P < 0.001), but not in those with lactate level ≤ 2.2mmol/L (OR: 0.86, 95% CI: 0.56-1.32, P = 0.493). The interaction between hyperuricemia and lactate levels demonstrated a significant effect on AKI. Conclusions: In summary, hyperuricemia increases the risk of AKI in STEMI patients with lactate levels> 2.2mmol/L, but not those with lactate levels ≤ 2.2 mmol/L.

Relationship between uric acid/ albumin ratio and coronary slow flow

“…Uric acid is produced in the liver and is primarily eliminated by the kidneys. Kidney damage and cardiovascular disease have both been linked to hyperuricemia, according to studies [21]. An independent predictor of the development of microalbuminuria was baseline serum uric acid, according to a prospective cohort study with 1862 participants who did not have the condition [22].…”

Hyperuricemia: Current State and Prospects

“…These combined benefits of exercise contribute to lower UA levels and decreased risk of gout attacks. However, it's worth noting that intense exercise may potentially reduce UA solubility by elevating lactate concentration [63], induce dehydrated HU [64], and increase the risk of rhabdomyolysis through the release of UA from skeletal muscle [65]. Therefore, consulting a healthcare professional before starting an exercise regimen is advised, especially for those with medical conditions.…”

The potential relationship of coronary artery disease and hyperuricemia: A cardiometabolic risk factor

“…Elevated uric acid also contributes to the development of complications in STEMI patients. He et al observed a strong correlation between hyperuricemia and the risk of acute kidney injury in STEMI patients [ 39 ]. Also hyperuricemia was associated with CAD serious complications such as post-infarction ventricular arrhythmias, no-/slow-reflow phenomenon, and heart failure [ [40] , [41] , [42] ].…”