Abstract
An elevated serum urate concentration is associated with kidney damage. Men’s uric acid levels are usually higher than women’s. However, postmenopausal women have a higher risk of gout than men, and comorbidities are also higher than in men. This study examined the sex differences in the relationship between hyperuricemia and renal progression in early chronic kidney disease (CKD) and non-CKD, and further examined the incidence of CKD in non-CKD populations among patients over 50 years of age. We analyzed 1856 women and 1852 men participating in the epidemiology and risk factors surveillance of the CKD database. Women showed a significantly higher risk of renal progression and CKD than men within the hyperuricemia group. After adjusting covariates, women, but not men resulted in an hazard ratio (HR) for developing renal progression (HR = 1.12; 95% CI 1.01–1.24 in women and HR = 1.03; 95% CI 0.93–1.13 in men) and CKD (HR = 1.11; 95% CI 1.01–1.22 in women and HR = 0.95; 95% CI 0.85–1.05 in men) for each 1 mg/dL increase in serum urate levels. The association between serum urate levels and renal progression was stronger in women. Given the prevalence and impact of kidney disease, factors that impede optimal renal function management in women and men must be identified to provide tailored treatment recommendations.
Highlights
Accepted: 12 May 2021Uric acid is the final product of the breakdown of an exogenous pool of purines and endogenous purine metabolism [1], and most uric acid is excreted via the kidneys [2].Elevated serum urate concentrations are associated with gout [3], diabetes mellitus [4,5], hypertension [6,7], metabolic syndrome [8] and cardiovascular mortality [9,10]
Hyperuricemia is common in chronic kidney disease (CKD) patients [12], and several studies have shown a relationship between serum urate levels and kidney damage [13,14,15,16]
After applying inverse probability of treatment weighting (IPTW), the different sexes were well balanced with respect to key characteristics, such as fasting glucose, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), age, diabetes mellitus, total cholesterol, baseline estimated glomerular filtration rate (eGFR), dyslipidemia, stroke, hypertension, CKD, and gout
Summary
Elevated serum urate concentrations are associated with gout [3], diabetes mellitus [4,5], hypertension [6,7], metabolic syndrome [8] and cardiovascular mortality [9,10]. A metaanalysis of 1,134,073 participants showed a positive dose-response association between uric acid levels and cardiovascular disease mortality risk [11]. Hyperuricemia is common in chronic kidney disease (CKD) patients [12], and several studies have shown a relationship between serum urate levels and kidney damage [13,14,15,16]. Uric acid crystallizations induce endothelial dysfunction [19,20], systemic inflammation [21], oxidative stress, and renin-angiotensin-aldosterone system activity [22], which may provide a pathogenic mechanism for chronic urate nephropathy
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