Uric Acid in the Follow-Up Determines 30% Decline in Estimated GFR Over 2 Years: a Propensity Score Analysis

Chang, Wenxiu; Xu, N.; Kumagai, Toru; Iijima, Ryutaro; Waki, Kaito; Yamanaka, Masaki; Nagura, Michito; Arai, Shigeyuki; Tamura, Yoshifuru; Shibata, Shigeru; Fujigaki, Yoshihide; Uchida, Shunya

doi:10.1159/000485593

Cited by 6 publications

(4 citation statements)

References 35 publications

(53 reference statements)

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“…Meanwhile, consistent with previous studies [4][5][6][7][8][9][10][11][12], we found that uric acid levels were negatively correlated with eGFR in all subjects. In the regression analysis, various potential confounders were added in sequential order, but the results revealed only a modest reduction effect (the regression coefficient changed from -0.20 to -0.22 after adjusting for a range of confounders), strengthening the notion of a relationship between uric acid and eGFR.…”

Section: Discussionsupporting

confidence: 93%

“…The association between uric acid and kidney disease has been previously investigated. Numerous studies reported a positive association between the levels of circulating uric acid and the risk of CKD progression [4][5][6][7][8][9][10][11][12], but this was negated in other studies [13][14][15]. Observational studies experience residual problems of poorly measured or unmeasured confounding factors and reverse causality when the disease process has a long latency period.…”

Section: Introductionmentioning

confidence: 99%

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Genetically Elevated Serum Uric Acid and Renal Function in an Apparently Healthy Population

Zhu

et al. 2019

Urol Int

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Background: The association between uric acid and kidney disease has been extensively investigated. Numerous studies have reported the association between circulating levels of uric acid and renal function. Objectives: To test, by the Mendelian randomization method, whether there is a causal association between circulating levels of uric acid and renal function. Methods: In 989 participants, estimated glomerular filtration rate (eGFR) was calculated, the circulating level of uric acid was tested, and the uric acid polymorphism (rs11722228) was genotyped. Results: After adjusting for age, gender, smoking history, alcohol intake, antihypertensive medication, body mass index, waist-to-hip ratio, and levels of urea nitrogen and creatinine, a significant allelic difference was found in uric acid levels for each genotype (p < 0.0001). Furthermore, the circulating levels of uric acid were negatively associated with eGFR after adjusting for cardiovascular risk factors and other potential confounders (p < 0.0001). Meanwhile, eGFR was significantly associated with the genotypes of rs11722228 (β = -0.07; p = 0.02). Conclu-sions: Evidence from the Mendelian randomization approach implied a causal relationship between uric acid and renal function in an apparently healthy population.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Genetically Elevated Serum Uric Acid and Renal Function in an Apparently Healthy Population

Zhu

et al. 2019

Urol Int

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“…In CKD and dialysis patients, the effects of serum TA-UA level on cardiovascular outcomes, mortality, and progression of kidney function remain controversial or unknown. A higher level of TA-UA is considered to be the risk factor of CKD progression [16][17][18]. In addition, only a few studies have explored the effect of serum TA-UA on mortality in dialysis patients, but the results are inconsistent [19,20].…”

Section: Discussionmentioning

confidence: 99%

A longitudinal analysis of the relationship between serum uric acid and residual renal function loss in peritoneal dialysis patients

Yang

Zhao

et al. 2020

Renal Failure

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Background: Hyperuricemia occurs frequently in patients with continuous ambulatory peritoneal dialysis (CAPD). This study aimed to evaluate the impact of serum uric acid (UA) over time on residual renal function (RRF) loss in a cohort of patients with CAPD. Methods: A total of 201 patients who started CAPD therapy between January 1, 2008 and April 30, 2016 were included in this single-center, retrospective cohort study. All patients were followed up until December 31, 2016. The median follow-up time was 23.43 ± 16.60 months. RRF loss was represented as the time to anuria. Results: Eighty-six patients developed anuria within 5 years. Multivariate Cox regression analysis showed that time-averaged serum UA and peritonitis were independent risk factors for RRF loss, while weekly Kt/V urea was a protective factor. Cox proportional hazard regression models showed that both patients with time-averaged uric acid (TA-UA) < 6.77 mg/dL [hazard ratio (HR) ¼ 1.165, 95% confidence interval (CI) 1.054-1.387; p < 0.05] and those with TA-UA! 7.64 mg/dL (HR ¼ 1.184, 95% CI 1.045-2.114; p < 0.05) had a higher risk of RRF than those with TA-UA in the range of 6.77-7.64 mg/dL. Penalized spline smoothing also showed a U-shaped relationship between continuous UA and RRF loss. Conclusion:The present study demonstrated that both high and low serum UA over time were associated with RRF loss in patients with CAPD.

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“…The British Society for Rheumatology recommends a target below 5 mg/dL, while the European League Against Rheumatism and the American College of Rheumatology suggest a target below 6 mg/dL [ 17 ]. Early intervention for sUA less than 6.0 mg/dL is recommended for slowing CKD progression in Japan [ 18 ]. In China, the optimal sUA level target for reducing CKD risk in different disease states remains unclear.…”

Section: Introductionmentioning

confidence: 99%

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

Zhu,

Li,

Zhang

et al. 2024

Renal Failure

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Introduction Hypertension and rising serum uric acid (sUA) played a pivotal role in the development of Chronic Kidney Disease (CKD). This study investigates the interactive effect of sUA and hypertension on CKD and identifies the optimal threshold of sUA among individuals with and without hypertension in the Chinese community population. Materials and methods The study included 4180 individuals aged 45–85 years, derived from the China Health and Retirement Longitudinal Study (CHARLS) between 2011 and 2015. Additionally, a hospital-based study enrolled subjects in the Department of Nephrology at Zhongshan Hospital, China from January 1, 2019, to December 31, 2021. The interaction effect analysis were used to assess the impact of sUA and hypertension on CKD. We also compared the distribution of sUA and the CKD risk in community populations, distinguishing between those with and without hypertension. For the hospital-based population, kidney injury was marked by a KIM-1 positive area. Results Our results indicate a higher prevalence of CKD in the community population with hypertension (10.2% vs. 3.9%, p < .001). A significant additive synergistic effects of the sUA and hypertension on the CKD risk were found. When the sUA level was < 4.55 mg/dL in the hypertensive population and < 5.58 mg/dL in the non-hypertensive population, the risk of CKD was comparable ( p = .809). In the propensity score matched (PSM) population, the result remained roughly constant. Conclusion Therefore, even moderate levels of sUA was associated with a higher risk of CKD in middle-aged hypertensive patients, who warrant stricter sUA control.

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Uric Acid in the Follow-Up Determines 30% Decline in Estimated GFR Over 2 Years: a Propensity Score Analysis

Cited by 6 publications

References 35 publications

Genetically Elevated Serum Uric Acid and Renal Function in an Apparently Healthy Population

Genetically Elevated Serum Uric Acid and Renal Function in an Apparently Healthy Population

A longitudinal analysis of the relationship between serum uric acid and residual renal function loss in peritoneal dialysis patients

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

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