Uric Acid and Acute Kidney Injury in the Critically Ill

Srivastava, Anand; Pálsson, Ragnar; Leaf, David E.; Higuera, Angelica; Chen, Margaret E.; Palacios, Polly; Baron, Rebecca M.; Sabbisetti, Venkata; Hoofnagle, Andrew N.; Vaingankar, Sucheta M.; Palevsky, Paul M.; Waikar, Sushrut S.

doi:10.1016/j.xkme.2019.01.003

Cited by 9 publications

(9 citation statements)

References 50 publications

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“…These findings might suggest that targeting SUA levels to normal ranges should be a principal goal to extend patient survival. However, whether this would confer an absolute survival benefit in all patient subgroups remains to be proven from appropriately designed clinical trials [36,37].…”

Section: Discussionmentioning

confidence: 99%

Serum uric acid and mortality thresholds among men and women in the Irish health system: A cohort study

Browne

Jaouimaa²,

Walsh

et al. 2021

European Journal of Internal Medicine

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Background: Elevation of serum uric acid (SUA) is associated with increased mortality; however, controversy exists regarding the nature of the relationship and differences between men and women. We explored relationships of SUA levels with all-cause mortality in a large cohort of patients within the Irish health system. Methods: A retrospective cohort study of 26,525 participants was conducted using data from the National Kidney Disease Surveillance System. SUA was modelled in increments of 59.48 µmol/L (1 mg/dL), Cox's proportional hazards model estimated hazard ratios (HRs) and 95% Confidence Intervals (CI), median lifetimes were also computed separately for men and women. Mortality patterns were further explored using penalised splines. Results: There were 1,288 (4.9%) deaths over a median follow-up of 5.1 years. In men, the risk of mortality was greatest for the lowest (<238 µmol/L) and highest (>535 µmol/L) categories and HR 2.52 (1.87-3.29) respectively]; the corresponding median lifetimes for men were reduced by 9.5 and 11.7 years respectively compared to the referent. In women, mortality risks were elevated for SUA >416 mol/L [HR 1.69 (1.13-2.47) and beyond; the corresponding median lifetime for women were reduced by 5.9 years compared to the referent. Spline analysis revealed a U-shaped association between SUA and mortality in men, while for women, the pattern of association was J-shaped. Conclusion: Mortality patterns attributed to SUA differ between men and women. Optimal survival was associated with SUA concentrations of 304-454 µmol/L for men and < 409 µmol/L for women.

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Section: Discussionmentioning

confidence: 99%

Serum uric acid and mortality thresholds among men and women in the Irish health system: A cohort study

Browne

Jaouimaa²,

Walsh

et al. 2021

European Journal of Internal Medicine

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“…A study by Bagshaw SM et al concluded that septic AKI is independently associated with higher odds of death and longer duration of hospitalization [12] . A study by Anand Srivastava et al Concluded that plasma uric acid levels upon ICU admission or before RRT initiation are not independently associated with adverse clinical outcomes in critically ill patients [13] .…”

Section: Discussionmentioning

confidence: 99%

Significance of hyperuricemia on the early diagnosis of disease severity in sepsis

Pulloori¹,

Dhananjay²

2021

Int. J. Adv. Res. Med.

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Serum uric acid levels are an ideal marker in sepsis cases to assess oxidative stress and to predict disease prognosis. Elevated serum uric acid levels are associated with chronic disease conditions such as chronic kidney disease (CKD), cardiovascular disease (CVD). The present study was designed to assess the correlation between Hyperuricemia and mortality and morbidity in cases with clinically diagnosed sepsis. A total of 94 cases with a working diagnosis of sepsis above 18 years of age were recruited. The duration of hospital stay, mechanical ventilation, acute respiratory syndrome and acute kidney injury was noted. Patient discharge or death was considered an outcome of the sepsis. The most prevalent comorbidity was type 2 diabetes (44.68%), followed by type 1 diabetes (8.5%), type 2 diabetes with systemic hypertension (4.25%), chronic kidney disease (3.19%), cerebrovascular accident (3.19%), severe pulmonary disease (2.12%) and malignancy (2.12%). 59% cases had uric acid levels <7mg/dl and 41% had uric acid levels >7mg/dl. The comparison of uric acid levels with comorbidities (p=0.022), duration of hospital stay (p=0.003) and associated complications (p=0.003) was statistically significant. Hyperuricemia on patient arrival to the MICU with sepsis was associated with poor clinical outcome. High mortality rate was associated in cases with elevated uric acid levels.

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“…Several studies have linked increased plasma uric acid and poor prognosis and reported an increased risk for AKI among patients with elevated uric acid (136,138). However, in another study using multivariate analysis, such association was no longer significant (139). Uric acid can cause AKI due to a variety of mechanisms ranging from direct tubular toxicity and crystal induced nephropathy to indirect injury secondary to the release of vasoactive mediators and oxidative stress (136).…”

Section: Rasburicasementioning

confidence: 99%

Role of Damage-Associated Molecular Patterns in Septic Acute Kidney Injury, From Injury to Recovery

et al. 2021

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Damage-associated molecular patterns (DAMPs) are a group of immunostimulatory molecules, which take part in inflammatory response after tissue injury. Kidney-specific DAMPs include Tamm-Horsfall glycoprotein, crystals, and uromodulin, released by tubular damage for example. Non-kidney-specific DAMPs include intracellular particles such as nucleus [histones, high-mobility group box 1 protein (HMGB1)] and cytosol parts. DAMPs trigger innate immunity by activating the NRLP3 inflammasome, G-protein coupled class receptors or the Toll-like receptor. Tubular necrosis leads to acute kidney injury (AKI) in either septic, ischemic or toxic conditions. Tubular necrosis releases DAMPs such as histones and HMGB1 and increases vascular permeability, which perpetuates shock and hypoperfusion via Toll Like Receptors. In acute tubular necrosis, intracellular abundance of NADPH may explain a chain reaction where necrosis spreads from cell to cell. The nature AKI in intensive care units does not have preclinical models that meet a variation of blood perfusion or a variation of glomerular filtration within hours before catecholamine infusion. However, the dampening of several DAMPs in AKI could provide organ protection. Research should be focused on the numerous pathophysiological pathways to identify the relative contribution to renal dysfunction. The therapeutic perspectives could be strategies to suppress side effect of DAMPs and to promote renal function regeneration.

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Uric Acid and Acute Kidney Injury in the Critically Ill

Cited by 9 publications

References 50 publications

Serum uric acid and mortality thresholds among men and women in the Irish health system: A cohort study

Serum uric acid and mortality thresholds among men and women in the Irish health system: A cohort study

Significance of hyperuricemia on the early diagnosis of disease severity in sepsis

Role of Damage-Associated Molecular Patterns in Septic Acute Kidney Injury, From Injury to Recovery

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