Clinical study of hyperuricemia in patients with chronic kidney disease stages 3-5

Abstract

Objective To explore the prevalence and risk factors of hyperuricemia(HUA) in patients with chronic kidney disease(CKD) on stages 3-5 and to investigate the effect of uric acid on renal function during the past 15 years. Methods Patients with CKD on stages 3-5 who admitted to the Nephrology Department of Affiliated Hospital of Qingdao University from January 2000 to December 2014 were recruited.The prevalence of HUA in patients with CKD on stages 3-5 were analyzed statistically, the risk factors of HUA and the effect of uric acid on the estimated glomerular filtration rate(eGFR) were analyzed by regression analysis. Results (1)The prevalence of HUA was 55.6%, and there was no significant difference between male and female in the 3 547 patients who met the inclusion criteria(χ2=0.184, P=0.683). The prevalence of HUA for CKD on stage 3, 4, 5 was 42.6%, 59.1%, 61.2%, respectively.(2)The independent risk factors of HUA in patients with CKD on stages 3-5 were hypertension(OR: 1.209(95%CI: 1.002-1.458)), increased BMI(OR: 1.039(95%CI: 1.015-1.062)), increased total cholesterol(OR: 1.411(95%CI: 1.274-1.564)), increased CKD stage(OR: 1.891(95%CI: 1.515-2.359), OR: 1.898(95%CI: 1.481-2.431)) and decreased HDL-C(OR: 0.178(95%CI: 0.134-0.238))(P<0.05). (3)In patients with CKD on stages 3-5, multiple regression analysis showed that after adjusting for confounding factors, each 100 mol/L-higher uric acid at baseline led to a change in the rate of the baseline eGFR decline of 1.49 ml.min-1.(1.73 m2)-1[95% CI: -2.20 --1.05). (4)In 348 hyperuricemic patients with CKD on stage 3, Logistic regression analysis showed that persistent HUA was associated with a higher risk for eGFR decreasing more than 10 ml/min/(1.73 m2) 1 year later(hazard ratio(HR)=2.645, 95%CI: 1.388-5.039, P=0.003). Conclusion The prevalence of HUA in patients with CKD stages 3-5 is high.Hypertension, hyperlipidemia and overweight are risk factors of HUA.HUA is an independent risk factor for renal function deterioration. Key words: Uric acid; Chronic kidney disease; Prevalence; Risk factors; Glomerular filtration rate