The Effects of Cardiometabolic Factors on the Association Between Serum Uric Acid and Chronic Kidney Disease in Chinese Middle-Aged and Older Population: A Mediation Analysis

Abstract

IntroductionTo explore whether dyslipidemia, hyperglycemia or hypertension has mediating effect on the association between serum uric acid (SUA) and the development of chronic kidney disease (CKD).MethodsWe conducted a mediation analysis to explore the potential mediating effects of systolic blood pressure (SBP), diastolic blood pressure (DBP), blood glucose, triglyceride (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) on the association between SUA and estimated glomerular filtration rate (eGFR). The data were obtained from China Health and Retirement Longitudinal Study (CHARLS), covering 5,762 individuals.ResultsSUA had a negative dose-response total effect on eGFR (β -3.11, 95% CI -3.40 to -2.82, P-value<0.001). The linear regression between SUA and seven potential mediators indicated that blood glucose (β 0.80, 95% CI 0.18 to 1.42, P-value=0.012), TG (β 10.01, 95% CI 8.22 to 11.79, P-value<0.001), TC (β 2.64, 95% CI 1.83 to 3.45, P-value<0.001), HDL-C (β -0.27, 95% CI -0.52 to -0.02, P-value=0.034) and LDL-C (β 1.15, 95% CI 0.49 to 1.80, P-value=0.001) all had significant dose-response association with SUA, but SBP and DBP showed no significant association with SUA. In terms of the association between potential mediators and eGFR, only TG (β 0.003, 95% CI -0.001 to 0.01, P-value=0.117) and HDL-C (β 0.01, 95% CI -0.02 to 0.04, P-value=0.444) did not have significant linear association with eGFR. The linear regression showed that SUA was directly associated with eGFR (P-value<0.001).ConclusionsThis study supported that the association between SUA and the risk of CKD was not mediated by hypertension, hyperglycemia or dyslipidemia.

Early-stage non-alcoholic fatty liver disease in relation to atherosclerosis and inflammation

“…However, its use within the cardiovascular sphere has been progressively expanding in recent years. 36 , 37 The results show that the mediating effect of FIB-4 mediated by NLR on coronary heart disease was significant, and the direct effect was not significant, which means that within the early-stage NAFLD population, liver fibrosis might primarily spur atherosclerosis progression through the conduit of inflammation. In contrast, Chen et al’s 20 mediation analysis indicated both mediating and direct effects concerning the association between NAFLD fibrosis markers and the coronary Gensini score.…”

Disparity of serum uric acid threshold for CKD among hypertensive and non-hypertensive individuals

“…Our analysis did not account for RAS inhibitor and CCB usage, yet it revealed a substantial risk of CKD with concurrent high sUA and hypertension. Despite this correlation, mediation analysis suggested hypertension may not serve as a mediating factor in sUA-induced CKD [ 30 ].…”