Relationship between Serum Uric Acid Concentration and Acute Kidney Injury after Coronary Artery Bypass Surgery

Lee, Eun‐Ho; Choi, Ji-Young; Joung, Kyoung Woon; Kim, Ji Yeon; Baek, Seung Hee; Ji, Sung-Mi; Chin, Ji Hyun; Choi, In‐Cheol

doi:10.3346/jkms.2015.30.10.1509

Cited by 18 publications

(13 citation statements)

References 34 publications

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“…The relationship between serum uric acid and mortality risk in different populations, such as CKD patients [28], hemodialysis patients [29], peritoneal dialysis patients [30, 31], and the general population [32], has been confirmed. High SUA has also been reported to be an independent predictor for AKI [33, 34]. In this study, we found that AKI patients with elevated serum uric acid concentrations had a higher in-hospital mortality risk.…”

Section: Discussionsupporting

confidence: 65%

Risk Factor Analysis for AKI Including Laboratory Indicators: a Nationwide Multicenter Study of Hospitalized Patients

Nie

Feng

et al. 2017

Kidney Blood Press Res

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Background/Aims: Risk factor studies for acute kidney injury (AKI) in China are lacking, especially those regarding non-traditional risk factors, such as laboratory indicators. Methods: All adult patients admitted to 38 tertiary and 22 secondary hospitals in China in any one month between July and December 2014 were surveyed. AKI patients were screened according to the Kidney Disease: Improving Global Outcomes’ definition of AKI. Logistic regression was used to analyze the risk factors for AKI, and Cox regression was used to analyze the risk of in-hospital mortality for AKI patients; additionally, a propensity score analysis was used to reconfirm the risk factors among laboratory indicators for mortality. Results: The morbidity of AKI was 0.97%. Independent risk factors for AKI were advancing age, male gender, hypertension, and chronic kidney disease. All-cause mortality was 16.5%. The predictors of mortality in AKI patients were advancing age, tumor, higher uric acid level and increases in Acute Physiologic Assessment and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores. The hazard ratio (HR) for mortality with uric acid levels > 9.1 mg/dl compared with ≤ 5.2 mg/dl was 1.78 (95% CI: 1.23 to 2.58) for the AKI patients as a group, and was 1.73 (95% CI: 1.24 to 2.42) for a propensity score-matched set. Conclusion: In addition to traditional risk factors, uric acid level is an independent predictor of all-cause mortality after AKI.

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Section: Discussionsupporting

confidence: 65%

Risk Factor Analysis for AKI Including Laboratory Indicators: a Nationwide Multicenter Study of Hospitalized Patients

Nie

Feng

et al. 2017

Kidney Blood Press Res

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“…34 Our results also conflict with a number of published studies on the association between uric acid level and the development of AKI or risk for death. 39 Higher uric acid levels have been reported to predict the risk for AKI in hospitalized patients [40][41][42] and after cardiac surgery, [16][17][18] with some reports of a J-shaped association showing higher risk at both very low and high uric acid levels. 43 In the Atherosclerosis Risk in Communities Study, higher uric acid levels predicted risk for a hospital stay with AKI during a mean follow-up of 12 years, although results from Mendelian randomization analyses did not support a causal association.…”

Section: Discussionmentioning

confidence: 99%

“…44 Prior retrospective studies in cardiac surgery have found increased risk for postoperative AKI in patients with higher preoperative uric acid levels. 16,17,43 However, these prior studies in cardiac surgery adjust for kidney function as a dichotomous variable (estimated GFR < 60 mL/min/ 1.73 m 2 ), whereas adjustment as a continuous variable may address confounding by kidney function more appropriately. A recent prospective study in 247 patients undergoing cardiac surgery demonstrated that patients with preoperative uric acid levels ≥ 373 μmol/L (≥ 6.3 mg/dL) were at greater than 5-fold increased risk for the development of postoperative AKI even after adjustment for preoperative Scr level.…”

Section: Discussionmentioning

confidence: 99%

“… 12 , 13 Prior studies have demonstrated higher uric acid levels as a risk factor for the development of contrast-induced AKI 14 , 15 and AKI after cardiac surgery. 16 , 17 , 18 , 19 Few studies have investigated the potential role of uric acid in inciting or perpetuating AKI in critically ill patients. In the setting of AKI from tumor lysis syndrome, hyperuricemia is thought to cause kidney injury by intratubular obstruction and intrarenal inflammation by the precipitated crystals.…”

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confidence: 99%

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Uric Acid and Acute Kidney Injury in the Critically Ill

et al. 2019

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Rationale & Objective Uric acid is excreted by the kidney and accumulates in acute kidney injury (AKI). Whether higher plasma uric acid level predisposes to AKI or its complications is not known. Study Design Prospective observational cohort study. Setting & Participants 2 independent cohorts of critically ill patients: (1) 208 patients without AKI admitted to the intensive care unit (ICU) at Brigham & Women’s Hospital between October 2008 and December 2016; and (2) 250 participants with AKI requiring renal replacement therapy (RRT) who had not yet initiated RRT enrolled in the Acute Renal Failure Trial Network (ATN) Study. Exposure Plasma uric acid level upon ICU admission and before RRT initiation in the ICU and ATN Study cohorts, respectively. Outcomes Incident AKI and 60-day mortality in the ICU and ATN Study cohorts, respectively. Analytical Approach Logistic regression models were used to test the association of plasma uric acid level with incident AKI and 60-day mortality. Results In the ICU cohort, median plasma uric acid level was 4.7 (interquartile range [IQR], 3.6-6.4) mg/dL, and 40 patients (19.2%) developed AKI. Higher plasma uric acid levels associated with incident AKI, but this association was confounded by serum creatinine level and was not significant after multivariable adjustment (adjusted OR per doubling of uric acid, 1.50; 95% CI, 0.80-2.81). In the ATN Study cohort, median plasma uric acid level was 11.1 (IQR, 8.6–14.2) mg/dL, and 125 participants (50.0%) died within 60 days. There was no statistically significant association between plasma uric acid levels and 60-day mortality in either unadjusted models or after multivariable adjustment for demographic, severity-of-illness, and kidney-specific covariates (adjusted OR per doubling of uric acid, 1.15; 95% CI, 0.71-1.86). Limitations Heterogeneity of ICU patients. Conclusions Plasma uric acid levels upon ICU admission or before RRT initiation are not independently associated with adverse clinical outcomes in critically ill patients.

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“…Both urate and calcium phosphate crystals could induce oxidative stress and the expression of chemokine, and lead to the renal tubular epithelium and acute alterations in auto-regulation of renal blood flow which contribute to the decrease of renal perfusion and the subsequent injury of renal tubule [8,9,10,11]. Elevated serum level of uric acid has been reported as a novel marker for predicting AKI and mortality in several clinical settings, such as admission, percutaneous coronary intervention, and surgery, especially cardiovascular survey [12,13,14,15,16,17,18,19].…”

Section: Introductionmentioning

confidence: 99%

The Predictive Value of Hyperuricemia on Renal Outcome after Contrast-Enhanced Computerized Tomography

Tsai

Lee

et al. 2019

JCM

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The aim of this study was to determine whether elevated serum level of uric acid (sUA) could predict renal outcome after contrast-enhanced computerized tomography (CCT). We used a historical cohort of 58,106 non-dialysis adult patients who received non-ionic iso-osmolar CCT from 1 June 2008 to 31 March 2015 to evaluate the association of sUA and renal outcome. The exclusion criteria were patients with pre-existing acute kidney injury (AKI), multiple exposure, non-standard volume of contrast, and missing data for analysis. A total of 1440 patients were enrolled. Post-contrast-AKI (PC-AKI), defined by the increase in serum creatinine ≥ 0.3 mg/dL within 48 h or ≥50% within seven days after CCT, occurred in 180 (12.5%) patients and the need of hemodialysis within 30 days developed in 90 (6.3%) patients, both incidences were increased in patients with higher sUA. sUA ≥ 8.0 mg/dL was associated with an increased risk of PC-AKI (odds ratio (OR) of 2.62; 95% confidence interval (CI), 1.27~5.38, p = 0.009) and the need of hemodialysis (OR, 5.40; 95% CI, 1.39~21.04, p = 0.015). Comparing with sUA < 8.0 mg/dL, patients with sUA ≥ 8.0 mg/dL had higher incidence of PC-AKI (16.7% vs. 11.1%, p = 0.012) and higher incidence of hemodialysis (12.1% vs. 4.3%, p < 0.001). We concluded that sUA ≥ 8.0 mg/dL is associated with worse renal outcome after CCT. We suggest that hyperuricemia may have potential as an independent risk factor for PC-AKI in patients receiving contrast-enhanced image study.

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Relationship between Serum Uric Acid Concentration and Acute Kidney Injury after Coronary Artery Bypass Surgery

Cited by 18 publications

References 34 publications

Risk Factor Analysis for AKI Including Laboratory Indicators: a Nationwide Multicenter Study of Hospitalized Patients

Risk Factor Analysis for AKI Including Laboratory Indicators: a Nationwide Multicenter Study of Hospitalized Patients

Uric Acid and Acute Kidney Injury in the Critically Ill

The Predictive Value of Hyperuricemia on Renal Outcome after Contrast-Enhanced Computerized Tomography

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