Abstract
BackgroundThe relationship between hyperuricemia and chronic kidney disease (CKD) has been found in various observational studies. Although hypouricemia is associated with cardiovascular events, it has not been established as a risk factor for CKD. We investigated the relationship between serum uric acid level and the loss of kidney function and incident CKD in healthy people.Materials and MethodsHealthy people were enrolled in this community-based prospective cohort study, the Saitama Cardiometabolic Disease and Organ Impairment Study, Japan. The analysis was conducted on 4188 subjects followed up for at least 3 years, 3102 for 6 years and 1052 for 9 years. Their data including glomerular filtration rate (eGFR) decline were examined every three years. The outcome event was incident CKD or the decrease in eGFR by more than 25% in three years. Multivariate statistical models were adjusted for the baseline characteristics.ResultsThe following data was obtained: mean±SD age, male, 39.6±10.4 years, female 38.4±10.8 years; eGFR, male, 81.9±16.4 ml/min/1.73m2, female, 82.1±17.5 ml/min/1.73m2; serum uric acid level, male, 5.8±1.2 mg/dl, female, 4.1±0.9 mg/dl. Both low and high serum uric acid levels were associated with the outcome and eGFR decline in males (multivariate logistic additional additive models, linear p = 0.0001, spline p = 0.043; generalized additive models, linear p = 0.0001, spline p = 0.012). In subjects with low serum uric acid levels (male, <5 mg/dl; female, <3.6 mg/dl), multivariate linear mixed models showed that low serum uric acid levels were associated with eGFR decline in a time-dependent manner (male, p = 0.0001; female, p = 0.045).ConclusionThis study showed that low as well as high levels of uric acid are associated with the loss of kidney function. Hypouricemia is a candidate predictor of kidney function decline in healthy people.
Highlights
Hyperuricemia is frequently observed in patients with chronic kidney disease (CKD) and has been reported as a risk factor for the progression and development of CKD [1,2,3,4]
The following data was obtained: mean±SD age, male, 39.6±10.4 years, female 38.4±10.8 years; estimated glomerular filtration rate (eGFR), male, 81.9±16.4 ml/min/1.73m2, female, 82.1±17.5 ml/min/1.73m2; serum uric acid level, male, 5.8±1.2 mg/dl, female, 4.1±0.9 mg/dl. Both low and high serum uric acid levels were associated with the outcome and eGFR decline in males
N (%) Age body mass index (BMI) Uric acid eGFR Proteinuria (+) (%) diabetes mellitus (DM) (%) Hypertension (%) Hyperuricemia (%) cardiovascular diseases (CVDs) (%) Alcohol (%) Smoking (%) Exercise (%) Incident CKD (%) More than 25% decrease in eGFR (%) Outcome events (%) (%)
Summary
Hyperuricemia is frequently observed in patients with chronic kidney disease (CKD) and has been reported as a risk factor for the progression and development of CKD [1,2,3,4]. Serum uric acid level has been reported to be associated with cardiovascular death. A U-shaped association between serum uric acid level and cardiovascular mortality has been reported, suggesting that both hyperuricemia and hypouricemia are risk factors for cardiovascular death [5,6]. Hypouricemia is associated with cardiovascular events, it has not been established as a risk factor for CKD. We investigated the relationship between serum uric acid level and the loss of kidney function and incident CKD in healthy people
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