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

Zhang, Jialing; Lu, Xiangxue; Han, Li; Wang, Shixiang

doi:10.1159/000513944

Cited by 8 publications

(4 citation statements)

References 56 publications

(72 reference statements)

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“…The antioxidant effect of uric acid is protective on the nervous system, intestinal tract, and kidney ( 36 – 38 ). Some researchers have demonstrated that low uric acid levels are associated with an increased risk of mortality in patients ( 39 , 40 ). Therefore, decreased sex hormones levels and increased uric acid levels in the elderly may be a protective mechanism that needs further exploration in subsequent studies.…”

Section: Discussionmentioning

confidence: 99%

The dose-response relationship between sex hormones and hyperuricemia in different gender: NHANES 2013-2016

Qian²,

Ma³

et al. 2022

Front. Endocrinol.

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ObjectivesTo access the dose-response relationship between sex hormones and hyperuricemia (HUA), and to find the cut-off value in different gender.Methods9,685 participants were derived from the database of National Health and Nutrition Examination Survey (NHANES). Restricted cubic spline (RCS) analysis were applied to explore the relationship between sex hormones and HUA after adjusting for confounding factors by propensity score match (PSM). Logistic regression was used to estimate the odds ratio (OR) and 95% CI.ResultsThe prevalence of HUA was 15.13% in female participants and 22.30% in male participants. Logistic regression analysis showed that estradiol (E2) was independently associated with HUA for a P value of 0.003 and 0.01in female and male participants, respectively. Testosterone (T) was only independently associated with HUA in male participants (P<0.001) but not in female participants (P = 0.59). RCS analysis showed a dose-response relationship between sex hormones and HUA. The risk of HUA increased as E2 lower than 29.6pg/mL in female participants and T lower than 389.1ng/dL in male participants. E2 higher than 23.6pg/ml was an independent risk factor for HUA in male participants.ConclusionA dose-response relationship was found between sex hormones and HUA. The cut-off value of E2 in male and female participants was 29.6pg/mL and 23.6pg/mL, respectively, and the cut-off value of T in male participants was 389.1ng/dL. These results provide a reference for preventing HUA and hormone supplement therapy.

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Section: Discussionmentioning

confidence: 99%

The dose-response relationship between sex hormones and hyperuricemia in different gender: NHANES 2013-2016

Qian²,

Ma³

et al. 2022

Front. Endocrinol.

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“…Uric acid levels are often elevated in patients with CKD due to decreased renal function. Meta-analyses of CKD patients have shown a U-shaped trend between SUA and all-cause mortality ( 17 ), and higher SUA levels are significantly associated with increased risk of cardiovascular mortality ( 18 ). Another meta-analysis of HD patients has shown that high SUA levels are a protective factor for cardiovascular mortality ( 19 ).…”

Section: Introductionmentioning

confidence: 99%

Serum Uric Acid and Cardiovascular or All-Cause Mortality in Peritoneal Dialysis Patients: A Systematic Review and Meta-Analysis

Liu

Huang

Kang

et al. 2021

Front. Cardiovasc. Med.

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Background: Studies have shown inconsistent associations between serum uric acid (SUA) levels and mortality in peritoneal dialysis (PD) patients. We conducted this meta-analysis to determine whether SUA levels were associated with cardiovascular or all-cause mortality in PD patients.Methods: PubMed, Embase, Web of Science, the Cochrane Library, CNKI, VIP, Wanfang Database, and trial registry databases were systematically searched up to April 11, 2021. Cohort studies of SUA levels and cardiovascular or all-cause mortality in PD patients were obtained. Random effect models were used to calculate the pooled adjusted hazard ratio (HR) and corresponding 95% confidence interval (CI). Sensitivity analyses were conducted to assess the robustness of the pooled results. Subgroup analyses and meta-regression analyses were performed to explore the sources of heterogeneity. Funnel plots, Begg's tests, and Egger's tests were conducted to evaluate potential publication bias. The GRADE approach was used to rate the certainty of evidence. This study was registered with PROSPERO, CRD42021268739.Results: Seven studies covering 18,113 PD patients were included. Compared with the middle SUA levels, high SUA levels increased the risk of all-cause mortality (HR = 1.74, 95%CI: 1.26–2.40, I2 = 34.8%, τ2 = 0.03), low SUA levels were not statistically significant with the risk of all-cause or cardiovascular mortality (HR = 1.04, 95%CI: 0.84–1.29, I2 = 43.8%, τ2 = 0.03; HR = 0.89, 95%CI: 0.65–1.23, I2 = 36.3%, τ2 = 0.04; respectively). Compared with the low SUA levels, high SUA levels were not statistically associated with an increased risk of all-cause or cardiovascular mortality (HR = 1.19, 95%CI: 0.59–2.40, I2 = 88.2%, τ2 = 0.44; HR = 1.22, 95%CI: 0.39–3.85, I2 = 89.3%, τ2 = 0.92; respectively).Conclusion: Compared with middle SUA levels, high SUA levels are associated with an increased risk of all-cause mortality in PD patients. SUA levels may not be associated with cardiovascular mortality. More high-level studies, especially randomized controlled trials, are needed to determine the association between SUA levels and cardiovascular or all-cause mortality in PD patients.Systematic Review Registration:https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021268739, identifier: CRD42021268739.

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“…Moreover, several studies have identified SUA as a risk factor for the development of kidney disease in specific populations such as diabetic, non-diabetic, hypertensive, and non-hypertensive populations. 11,[30][31][32][33][34] Given that hyperuricemia can interact with other risk factors, such as metabolic syndrome, diabetes, and hypertension, to accelerate the progression of declining renal function, 33,[35][36][37] prompt identification of high-risk patients is crucial to reduce the burden of CKD. Furthermore, our study revealed a non-linear relationship between SUA levels and the risk of CKD.…”

Section: Discussionmentioning

confidence: 99%

Serum Uric Acid Levels and Their Association with Renal Function Decline and Kidney Disease Progression in Middle-Aged and Elderly Populations: A Retrospective Cohort Study

Luo,

Wu,

Meng

et al. 2023

JMDH

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Objective To evaluate the associations between serum uric acid (SUA) levels and estimated glomerular filtration rate (eGFR) and chronic kidney disease (CKD), with a focus on gender differences, and variations among women pre-and post-menopausal stages. Design A retrospective cohort study. Setting A large community-based survey was conducted every two years from 2010 to 2018 in Hangzhou, Zhejiang Province, Southeastern China. Participants 10,218 participants (40 years or above) without CKD at baseline who underwent three physical examinations were enrolled. CKD was defined as an eGFR of less than 60 mL/min/1.73m 2 . Methods Participants with SUA levels were divided into four groups (Q1-Q4) based on baseline SUA quartiles. The Q1 was the reference. By stratifying participants by gender, the relationships between SUA levels and eGFR were investigated using the generalized additive mixture model. The associations of SUA and the risk of incident CKD were examined using multivariate logistic regression models in the generalized estimating equation. Results After adjusting for confounding variables, a nonlinear association between SUA and eGFR was observed in females, while an approximately linear relationship was observed in males, suggesting that elevated SUA levels are associated with renal function decline. Furthermore, the highest quartile of SUA was associated with a 2.16-fold (95% CI: 1.31–3.58) increased risk of CKD in males and a 2.76-fold (95% CI: 1.59–4.78) increased risk in females, compared with the lowest quartile. And the spline curves demonstrated a U-shaped pattern, suggesting a potential threshold effect of SUA on the risk of CKD. Additionally, Subgroup analyses revealed significant associations between elevated SUA levels with CKD in postmenopausal women, but not in premenopausal women. Conclusion Elevated SUA levels are associated with an increased risk of CKD development and renal function decline in middle-aged and elderly individuals, particularly in postmenopausal women.

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

Cited by 8 publications

References 56 publications

The dose-response relationship between sex hormones and hyperuricemia in different gender: NHANES 2013-2016

The dose-response relationship between sex hormones and hyperuricemia in different gender: NHANES 2013-2016

Serum Uric Acid and Cardiovascular or All-Cause Mortality in Peritoneal Dialysis Patients: A Systematic Review and Meta-Analysis

Serum Uric Acid Levels and Their Association with Renal Function Decline and Kidney Disease Progression in Middle-Aged and Elderly Populations: A Retrospective Cohort Study

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