Abstract
Since the association of serum uric acid and kidney transplant graft outcome remains disputable, we sought to evaluate the predictive value of uric acid level for graft survival/function and the factors could affect uric acid as time varies. A consecutive cohort of five hundred and seventy three recipients transplanted during January 2008 to December 2011 were recruited. Data and laboratory values of our interest were collected at 1, 3, 6, 12, 24 and 36 months post-transplant for analysis. Cox proportional hazard model, and multiple regression equation were built to adjust for the possible confounding variables and meet our goals as appropriate. The current cohort study lasts for 41.86 ± 15.49 months. Uric acid level is proven to be negatively associated with eGFR at different time point after adjustment for age, body mass index and male gender (standardized β ranges from -0.15 to -0.30 with all P<0.001).Males with low eGFR but high level of TG were on CSA, diuretics and RAS inhibitors and experienced at least one episode of acute rejection and diabetic issue were associated with a higher mean uric acid level. Hyperuricemia was significantly an independent predictor of pure graft failure (hazard ratio=4.01, 95% CI: 1.25-12.91, P=0.02) after adjustment. But it was no longer an independent risk factor for graft loss after adjustment. Interestingly, higher triglyceride level can make incidence of graft loss (hazard ratio=1.442, for each unit increase millimoles per liter 95% CI: 1.008-2.061, P=0.045) and death (hazard ratio=1.717, 95% CI: 1.105-2.665, P=0.016) more likely. The results of our study suggest that post-transplant elevated serum uric acid level is an independent predictor of long-term graft survival and graft function. Together with the high TG level impact on poor outcomes, further investigations for therapeutic effect are needed.
Highlights
For post-transplant recipients, the outcomes and mortality of kidney were the most critical problems
The variables in the regression equations for medium-long renal function were different in number at different time points
As previous reports [37, 38], obesity and metabolic syndrome are strongly associated with hyperuricemia likely as a consequence of insulin resistance, which explains larger BMI and higher TG level could elevate uric acid (UA) level
Summary
For post-transplant recipients, the outcomes and mortality of kidney were the most critical problems. Chronic allograft nephropathy (CAN), known as sclerosing allograft nephropathy, is the leading cause of kidney transplant failure[2] and happens months to years after the transplant. It is characterized by interstitial fibrosis, tubular atrophy, fibrotic intimal thickening of arteries and glomerulosclerosis. Death with functioning graft is another common causes of graft loss after transplantation, in which, the leading cause of death with functioning graft is cardiovascular event(CV)[3, 4] Given this situation, one can postulate that a management attempt of either could be beneficial for long-term outcome. An increasing number of evidence showed us serum uric acid (UA) level may probably associate with these pathological processes
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