Sex differences in the association between serum uric acid levels and cardiac hypertrophy in patients with chronic kidney disease

Abstract

Several studies have documented an association between serum uric acid (SUA) concentration and cardiac hypertrophy in hypertensive patients; however, the association remains unclear in chronic kidney disease (CKD) patients. If there is an association between SUA and hypertrophy in these patients, it is unknown whether the association is different between men and women. Our aim in this study is to determine whether SUA is associated with cardiac hypertrophy in CKD patients, focusing on any sex differences. Two hundred sixteen CKD patients (117 men and 99 women) were enrolled in this cross-sectional study. Patients prescribed uric acid-lowering agents and those with congestive heart failure, valvular heart disease, or ischemic heart disease were excluded from this study. Left ventricular mass index (LVMI) and left ventricular hypertrophy (LVH) were assessed using echocardiography. The prevalence of LVH was 58% in men and 47% in women. In multivariate linear regression analysis, SUA levels did not correlate with LVMI in men, whereas SUA was independently associated with LVMI in women (β=0.27, P=0.02). Multivariate logistic regression analysis also revealed that diabetes mellitus (odds ratio (OR), 4.41; P=0.01) was associated with LVH in men, whereas age (OR, 1.13; P<0.01), hypertension (OR, 7.38; P=0.03) and SUA (OR, 1.91; P=0.03) were associated with LVH in women. In female CKD patients, SUA levels were associated with LVMI and LVH, whereas there was no association in male patients. These observations suggest that an association between SUA levels and the development of cardiac hypertrophy is more likely in women than in men.

Is Serum Uric Acid Independently Associated With Left Ventricular Mass Index, Ejection Fraction, and B-Type Natriuretic Peptide Among Female and Male Cardiac Patients?

“…In addition, the strength of the association between SUA and certain cardiac abnormalities might differ between women and men. 3,[20][21][22] We found that among patients with sinus rhythm, SUA was independently associated with diastolic dysfunction only in women. 21) In a previous study, by analyzing the data from male patients, we showed that SUA is associated with cardiac hypertrophy.…”

“…2,3) On the other hand, however, whether uric acid per se plays a causal role in cardiovascular morbidity remains a subject of debate, irrespective of various epidemiological and Mendelian randomization studies. [4][5][6][7][8][9][10][11] Editorial p. 467 To assess whether serum SUA is associated with cardiac hypertrophy and heart failure, 12) we may have to take various possible confounders into account, such as estimated glomerular filtration rate (eGFR), phosphate, 13) and the recently identified phosphaturic hormone fibroblast growth factor 23 (FGF23) that might directly induce hypertrophy of cardiomyocytes.…”

Gender differences in the association between hyperuricemia and diabetic kidney disease in community elderly patients

“…The rate of hyperuricemia increased and the mean eGFR decreased with increased age in both men and women, especially in older women. These gender difference was observed in other studies as well and was suggested to relate to natural aging, the decline in female hormone levels in older women and the reduced excretion of uric acid from the kidney (Chang et al, 2010;Krishnan, Bennett, & Chen, 2014;Liu et al, 2014;Lu et al, 2014;Yoshitomi et al, 2014).…”

Effects of Uric Acid on Hearts of Rats with Chronic Kidney Disease

“…However, researches focusing on the relation between cardiovascular complications and hyperuricemia in CKD patients are rare. Ryota Yoshitomi [20] found a significant correlation between hyperuricemia and ventricular hypertrophy in women, but there was no significant correlation in men. Researches focusing on cardiovascular complications in early-stage CKD are even scarcer.…”