Abstract
BackgroundAlthough hyperuricemia is common after orthotopic liver transplantation (OLT), its relationship to mortality, progressive kidney disease, or the development of end stage renal disease (ESRD) is not well-described.MethodsData from 304 patients undergoing OLT between 1996 and 2010 were used to assess the association of mean serum uric acid (UA) level in the 3-months post-OLT with mortality, doubling of creatinine, and ESRD incidence. Post-OLT survival to event outcomes according to UA level and eGFR was assessed using the Kaplan Meier method and multivariate Cox proportional hazards models.ResultsMean UA level among the 204 patients with an eGFR level ≥60 ml/min/1.73 m2 was 6.4 mg/dl compared to 7.9 mg/dl among the 100 patients with eGFR <60 (p < 0.0001). During a median of 4.6 years of follow-up, mortality rate, doubling of creatinine, and ESRD incidence were 48.9, 278.2, and 20.7 per 1000 person-years, respectively. In the first 5 years of follow-up, elevated UA was associated with mortality (Hazard Ratio, HR = 1.7; p = 0.045). However, among those with eGFR ≥ 60, UA level did not predict mortality (HR = 1.0; p = 0.95), and among those with eGFR < 60, elevated UA was a strong predictor of mortality (HR = 3.7[1.1, 12.0]; p = 0.03). UA was not associated with ESRD, but was associated with doubling of creatinine among diabetics (HR = 2.2[1.1, 4.3]; p = 0.025).ConclusionIn this post-OLT cohort, hyperuricemia independently predicted mortality, particularly among patients with eGFR < 60, and predicted doubling of creatinine among diabetics.
Highlights
Hyperuricemia is common after orthotopic liver transplantation (OLT), its relationship to mortality, progressive kidney disease, or the development of end stage renal disease (ESRD) is not well-described
To assess the representativeness of the 304 patients included in this study, comparison was made with the eligible patients (n = 177) who underwent OLT during the same calendar period but did not have any uric acid levels measured during the 3-month period after OLT
The study group was comparable to the group without uric acid values with respect to mean age (52 vs. 52, respectively), male sex (66% vs. 68%), white race (71% vs. 74%), prevalent diabetes (28% vs. 27%), hypertension (19% vs. 25%), and median estimating glomerular filtration rate (eGFR) during the year after OLT (70 vs. 67 ml/min/1.73 m2)
Summary
Hyperuricemia is common after orthotopic liver transplantation (OLT), its relationship to mortality, progressive kidney disease, or the development of end stage renal disease (ESRD) is not well-described. Hyperuricemia often accompanies declining renal function, both of which are commonly seen in the post-OLT population [5]. Several studies have reported an association between hyperuricemia and cardiovascular mortality in the general population [6, 7], and in patients with chronic kidney disease (CKD) [8]. General population studies have reported that hyperuricemia is prospectively associated with worsening renal disease and progression to ESRD [9]. A recent study of patients with moderate to severe CKD found that hyperuricemia is not prospectively associated with decline in renal function [10]
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