Abstract
BackgroundInvestigations on the role of the time-mean serum uric acid (SUA) value in determining the risk of chronic kidney disease (CKD) are limited. We investigated whether the time-mean SUA value indicates the risk of CKD, and explored associations of the baseline and time-mean SUA levels with kidney function decline and incident CKD in a healthy population.MethodsWe initiated an inhabitant-based cohort study between January 2011 and December 2016. All participants completed a yearly medical check-up at the Zhejiang Province People’s Hospital and had baseline estimated glomerular filtration rates (eGFR) > 60 ml/min/1.73m2. The SUA level and eGFR were assessed every year in the follow-up period. A multivariate adjusted binary logistic regression analysis and Cox proportional hazards models were used to evaluate the risk of newly-developed CKD among different stratified groups.ResultsDuring the 6-year follow-up period, 227 (4.4%) participants developed CKD. In multivariable-adjusted analyses, the odds ratio (OR) for new-onset CKD increased, with higher time-mean SUA levels than at baseline (OR: 1.00 [reference], 2.709 [95% confidence interval: 1.836–5.293], 3.754 [1.898–7.428], and 7.462 [3.694–15.073]). After adjustment for potential cofounders, a multivariate Cox proportional hazard model showed that a higher SUA increased the risk of developing CKD (the adjusted hazard ratios of the highest and lowest quartiles for the baseline and time-mean SUA levels were 1.689 [1.058–2.696] and 6.320 [3.285–12.159], respectively).ConclusionAn increased time-mean and single SUA value were independently associated with an increased likelihood of eGFR decline and development of new-onset CKD in the general population.
Highlights
Investigations on the role of the time-mean serum uric acid (SUA) value in determining the risk of chronic kidney disease (CKD) are limited
To avoid the instability of a single test, which might not be sufficient for identifying patients at risk, we aimed to investigate whether the time-mean SUA value indicates the risk of CKD, and explored the association of the baseline and time-mean SUA levels with kidney function decline and incident CKD in an ostensibly healthy population
Our results show that in subjects who undergo annual health check-ups, the increase in the SUA level was associated with a slow decline in the estimated glomerular filtration rates (eGFR), but there was a high incidence of renal insufficiency
Summary
Investigations on the role of the time-mean serum uric acid (SUA) value in determining the risk of chronic kidney disease (CKD) are limited. We investigated whether the time-mean SUA value indicates the risk of CKD, and explored associations of the baseline and time-mean SUA levels with kidney function decline and incident CKD in a healthy population. With the gradual change of modern lifestyles and diets, the incidence of hyperuricemia is increasing. Based on observations of gout patients, Mahomed et al hypothesized that hyperuricemia is a possible mediator of hypertension [3]. Haig suggested that UA could lead to many diseases in addition to gout, such as rheumatism, hypertension, diabetes, and chronic kidney disease (CKD) [4]. Numerous epidemiologic studies have successively indicated that there is a relationship between elevated UA levels and metabolic syndrome [5], renal disease [5, 6], hypertension [7], and cardiovascular disease (CVD) [6, 8]
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