Hyperuricemia In Patients Research Articles

Effect and Mechanism of Rhein-praseodymium Complex on Intestinal Uric Acid Excretion in Rats with Renal Injury and Hyperuricemia.

Hyperuricemia (HUA) is a disease characterized by excessive uric acid production and/or insufficient uric acid excretion caused by abnormal purine metabolism in the human body. Uric acid deposition caused by hyperuricemia can cause complications, such as kidney damage. The current therapeutic drugs for HUA are not very targeted and usually have specific toxic side effects. This study aimed to synthesize a compound using rhein and praseodymium, which can effectively help hyperuricemia patients with kidney injury to excrete uric acid through the intestine and preliminarily explore its intestinal excretion mechanism. The natural active ingredient rhein and rare earth metal praseodymium were used to synthesize Rh-Pr. The possible chemical structure of Rh-Pr was deduced by UV, IR, 1H-NMR, conductivity method, and thermogravity analysis. Adenine (100 mg/kg) and ethambutol hydrochloride (250 mg/kg) were administered by gavage for three weeks to establish the hyperuricemia rat model of renal injury. Serum uric acid (UA), creatinine (Cr), urea nitrogen (BUN), and uric acid concentration in urine and feces were detected by biochemical methods. The protein expression levels of GLUT9, ABCG2, and MRP4 in the jejunum, ileum, and colon of rats were detected by Western Blotting. According to the characterization, the chemical composition formula of the complex is Pr(C15H7O6)3·2H2O. In vivo, activity tests showed that Rh-Pr could enhance the intestinal uric acid excretion level of rats, upregulate the expression of ABCG2 protein in the jejunum and ileum, down-regulate the expression of GLUT9 protein in the ileum and colon, and also had a good recovery effect on serum uric acid, creatinine, and urea nitrogen levels. Rh-Pr is different from other drugs in that it promotes intestinal uric acid excretion and has a renal recovery effect. It reduces the patient's kidney burden and is significant for hyperuricemia patients with kidney injury.

Time to redefine hyperuricemia? The serum uric acid cut-off level for precipitation might be lower: a pilot study.

Hyperuricemia is classically defined as serum uric acid (SUA) value higher than 6.8 mg∕dL; between hyperuricemic patients, only 15-20% will develop gout. Our first goal was to find if there is a specificity of the "snowstorm" feature on ultrasound (US) for hyperuricemia. Moreover, we aimed to determine if there is a level of SUA from which the urates tend to appear in the synovial fluid, without generating a typical clinical gouty flare. We conducted a cross-sectional, transverse study, including 108 consecutive patients that displayed a set of clinical and imaging features, such as swollen knee and US proof for knee joint effusion. Performing binary logistic regression, the relation between the explanatory variable (hyperechogenic spots) and the response variable (SUA) was demonstrated to be a significant one (p=0.005). The value of 0.397 for the statistical phi coefficient suggests a medium intensity association between the diagnosis of gout or asymptomatic hyperuricemia and whether the patients have hyperechogenic spots or not. We found the cut-off value for SUA equal to 4.815 mg∕dL, regardless of gender, from which, the urate starts to precipitate. Values for men tend to be higher in comparison to the ones found for women (4.95 mg∕dL vs. 3.9 mg∕dL). The "snowstorm" aspect of the fluid might be the result of an increased level of SUA and more than this, the cut-off level for SUA to precipitate might be lower than the fore used values.

Exploring the Relationship Between Different Obesity Metabolism Indices and Hyperuricemia in Patients with Hypertension and Coronary Heart Disease.

Previous studies have established a strong association between obesity, high metabolism, and the development of hyperuricemia. However, the relationship between obesity metabolism indices and hyperuricemia in high-risk patients with hypertension and coronary heart disease (CHD) remains unclear. The purpose of this study was to investigate this relationship in patients with both hypertension and CHD, and to identify the obesity metabolism index with the best diagnostic value. A two-center study encompassed 6344 participants with hypertension and CHD. Multiple logistic regression was utilized to examine the correlation between six obesity metabolism indices and hyperuricemia, with restricted cubic spline (RCS) analysis to identify non-linear relationships. Diagnostic value was assessed via receiver operating characteristic (ROC) curves and decision curve analysis (DCA). Multivariable logistic regression revealed a significant correlation between increased obesity metabolism indices and hyperuricemia. Furthermore, RCS analysis revealed a nonlinear dose-response relationship (P for nonlinear < 0.001). Moreover, ROC and DCA results showed that METS-VF index, which combined visceral obesity and metabolic parameters, became the most reliable diagnostic tool. The study underscores a strong association between elevated obesity metabolism indices and hyperuricemia in patients with hypertension and CHD. The METS-VF index, amalgamating visceral obesity and metabolic parameters, emerged as the most reliable diagnostic tool.

Prevalence and risk factors for hyperuricemia and hyperuricosuria in patients with hematologic malignancies.

Hyperuricemia is a common complication of hematologic malignancies, and hyperuricosuria in this population has shown conflicting results. This study aimed to determine the prevalence of hyperuricemia and parameters associated with serum uric acid (SUA) and urine uric acid (UUA) in patients with lymphoma and myeloproliferative neoplasms (MPN). This cross-sectional study included adult patients with newly diagnosed lymphoma and MPN at the university-based hospital. Clinical characteristics were collected, and independent risk factors for hyperuricemia and hyperuricosuria were determined using multiple logistic regression. One hundred and sixty-five patients were included with a median age of 55 years (45.5-64) and 51.5% were males. There were 91 patients (55.2%) with lymphoma and 74 cases (44.8%) of MPN. Overall, hyperuricemia was prevalent in 43.6% with a median SUA of 6.3 mg/dl (4.6-8) and hyperuricosuria was detected in 39.4% with a median 24-h UUA of 545 mg (365.4-991). Hyperuricemia was observed in patients with lymphoma and MPN in 20.9% and 71.6%, respectively, and hyperuricosuria in 15.4% and 68.9%, respectively. In lymphoma patients, estimated glomerular filtration rate (eGFR) <90 ml/min/1.73 m2 and serum lactate dehydrogenase (LDH) ≥ 250 U/L were associated with hyperuricemia with odds ratio (OR) 3.24, 95% confidence interval (CI) 1.95-11.07, p = 0.006 and OR 2.07, 95%CI 1.62-6.97, p = 0.039), and only elevated serum LDH was related to hyperuricosuria (OR 2.37, 95%CI 1.56-14.29, p = 0.036). In MPN patients, hemoglobin levels <10 g/dl and serum LDH ≥ 640 mg/dl were independent risk factors of hyperuricosuria (OR 1.88, 95%CI 1.42-8.39, p = 0.045 and OR 6.21, 95%CI 1.49-25.74, p = 0.012). Hyperuricemia in patients with hematologic malignancies was common, notably MPN, and parameters associated with hyperuricosuria were provided. In addition to the utilization of allopurinol in patients at high risk of tumor lysis syndrome, patients without hyperuricosuria may also be of significant interest.

Treatment efficacy of febuxostat compared with allopurinol in hyperuricemia patients with hypertensive: A randomized, single-blind controlled trial

Treatment of hyperuricemia with allopurinol and Febuxotate has been shown to be effective in hypertensive patients. Studies comparing the effects of both drugs in hypertensive patients were very limited, especially in the Vietnam population. Evaluating the treatment outcome of febuxostat when compared with allopurinol in hyperuricemia patients with hypertension in Vietnam. We conducted a randomized controlled clinical trial with an allocation ratio of 1:2 on 108 hyperuricemia outpatients with hypertension ≥40 years old. Group A was treated with allopurinol 100 mg, increased to 300 mg if treatment results were not achieved. Group B used febuxostat 40 mg, which increased to 80 mg. The endpoint was to control serum uric acid levels &lt;6.0 mg/dl (&lt;360 μmol/l). Primary outcomes were re-evaluated after 4 and 8 weeks, comparing the reaching endpoint proportion between the two groups. The secondary outcomes were subgroup analysis on characteristic groups of age, gender, and serum lipid indices such as non-HDL-c and triglyceride (TG)/non-HDL-c ratio to evaluate the impact on treatment outcomes within and between two groups. The primary outcomes evaluating the effectiveness between the two regimens showed that the uric acid concentrations after 4 weeks in groups A and B were 343.5 ± 104.0 and 378.0 ± 90.0 μmol/l, respectively (p = 0.008), after 8 weeks it was 268.0 ± 97.8 and 310.0 ± 52.8 μmol/l (p &lt; 0.001). After 8 weeks of intervention, the reaching endpoint proportion in the A and B groups was 91.7% and 97.1%, respectively [risk ratio (RR) = 1.06, 95% confidence interval (CI) 0.97–1.16, p = 0.297]. The secondary outcome was analized subgroup showed that there was a statistically significant difference when comparing group A and group B at age &lt;60 (p = 0.020), male gender (p = 0.021), non-HDL ≥ 3.37 (p = 0.042), TG/HDL-c &lt; 4.5 (p = 0.006), in which the allopurinol group showed more optimal serum uric acid lowering results. Both regimens had good outcomes in the ability to reduce serum uric acid and a high proportion of reaching endpoints. Therefore, it could be applied in the clinical of treating hyperuricemia patients with hypertension in Vietnam. When analyzed between the two groups, there was no large difference in treatment outcomes between the two regimens, so preference among the two regimens was not necessary.

Rising Incidence of Hyperuricemia in Patients with Urolithiasis

Rising Incidence of Hyperuricemia in Patients with Urolithiasis

Effect of the Xanthine Oxidase Inhibitor, Febuxostat, on WBC Count in Asymptomatic Hyperuricemia: Subanalysis of the Randomized PRIZE Study.

The anti-inflammatory effects of the xanthine oxidase inhibitor, febuxostat, a urate-lowering agent, have been reported in animal studies. However, the anti-inflammatory effects of urate-lowering therapy and its associated cardiovascular protective effects have not been fully determined in actual clinical practice. This study aimed to investigate the effect of febuxostat on white blood cell (WBC) count in patients with asymptomatic hyperuricemia and to assess for potential correlations between changes in WBC count and inflammatory biomarkers and atherosclerosis in this patient population. This was a post hoc subanalysis of the PRIZE study, a multicenter, prospective, randomized, open-label clinical trial. In the PRIZE study, asymptomatic hyperuricemia patients were randomized to febuxostat group or control group with non-pharmacological therapy and evaluated the effect on vascular. The primary endpoints of this study were the assessment of the time course of WBC count over 24 months and its changes from baseline. Correlations of WBC count with high-sensitivity C-reactive protein (hs-CRP) and mean common carotid artery (CCA)-IMT were also exploratorily examined in the febuxostat group. A total of 444 patients (febuxostat group, n=223; control group, n=221) with WBC measurements available at baseline and at least one of the follow-up time points of 12 or 24 months, were enrolled. Febuxostat modestly, but significantly, reduced WBC counts at 12 and 24 months compared with the baseline levels (P=0.002 and P=0.026, respectively). Notably, the WBC count in the febuxostat group at 12 and 24 months was significantly lower than that in the control group (P=0.007 and P=0.023, respectively). The changes in WBC count were associated with those of hs-CRP (P=0.038), but not with CCA-IMT (P=0.727). Febuxostat therapy for 24 months modestly, but significantly, decreased WBC count in patients with asymptomatic hyperuricemia. This might potentially reflect a modest anti-inflammatory action of febuxostat in clinical settings.

The impact of AIM2 inflammasome-induced pyroptosis on acute gouty arthritis and asymptomatic hyperuricemia patients.

This study aimed to evaluate the role of absent in melanoma 2 (AIM2) inflammasome-mediated pyroptosis in the pathogenesis of acute gouty arthritis (AGA) and asymptomatic hyperuricemia(AHU). A cohort of 30 AGA patients, 30 AHU individuals, and 30 healthy controls (HC) was assembled. Demographic and biochemical data, along with blood samples, were collected. Serum double-stranded DNA (dsDNA) levels were quantified using a fluorescent assay. Transcriptomic and proteomic analysis of AIM2, Caspase-1, GSDMD, IL-1β, and IL-18 in peripheral blood mononuclear cells was performed using qRT-PCR and Western blot. Enzyme-linked immunosorbent assay (ELISA) was employed to measure serum IL-1β and IL-18. Spearman correlation analysis was utilized to assess relationships between variables. Both AGA and AHU groups demonstrated elevated metabolic indicators and serum levels of dsDNA, IL-1β, and IL-18 compared to the HC group. AGA patients exhibited higher inflammatory markers than the AHU group. In the AGA group, there was a significant increase in the mRNA and protein levels of AIM2, Caspase-1, GSDMD, IL-1β, and IL-18 (P<0.05 to P<0.001). The AHU group showed higher AIM2, Caspase-1, GSDMD, and IL-18 mRNA levels than the HC group (P<0.001 to P<0.01), with a non-significant increase in AIM2, GSDMD, and IL-1β proteins (P>0.05). In contrast, Caspase-1 and IL-18 proteins were significantly higher in the AHU group (P<0.05). Notable correlations were observed between AIM2 protein expression and levels of Caspase-1 and GSDMD in both AGA and AHU groups. In the AGA group, AIM2 protein correlated with IL-1β, but not in the AHU group. The AIM2 protein in the AHU group was positively associated with IL-18, with no such correlation in the AGA group. AIM2 inflammasome may play a role in the inflammatory processes of AGA and AHU and that its activation may be related to the pyroptosis pathway.

The Effects of Xanthine Oxidase Inhibitors on the Management of Cardiovascular Diseases

The Effects of Xanthine Oxidase Inhibitors on the Management of Cardiovascular Diseases

Hyperuricemia and testosterone deficiency: An underestimated correlation

Hyperuricemia and testosterone deficiency (TD) are two relatively common conditions in clinical practice. We conducted the present study on 9573 men to evaluate the association between the two conditions and establish a hypothetic explanation. Compared with the normal group, the hyperuricemia group has lower testosterone level (14.79 ± 5.55 vs. 17.12 ± 6.24, p &lt; 0.001) and lower LH level (5.57 ± 3.31 vs. 5.75 ± 3.21, p = 0.003). There is a weak negative correlation between testosterone and serum uric acid (SUA) after adjusting for confounding factors (Spearman's Rho = -0.2, p &lt; 0.001). On linear regression, serum uric acid corresponds to testosterone with the formula: Testosterone = -0.015 x SUA + 22.37. We hypothesize that the mechanism underlying testosterone deficiency in hyperuricemia patients is due to an inhibition of LH release of the pituitary. Further studies are needed to examine this hypothesis.

A Meta-Analysis for Comparing the Effects of Febuxostat and Allopurinol on Kidney Function in Hyperuricemia Patients Complicated with Chronic Kidney Disease

A Meta-Analysis for Comparing the Effects of Febuxostat and Allopurinol on Kidney Function in Hyperuricemia Patients Complicated with Chronic Kidney Disease

Alterations in lipidome profiles distinguish early-onset hyperuricemia, gout, and the effect of urate-lowering treatment

BackgroundCurrently, it is not possible to predict whether patients with hyperuricemia (HUA) will develop gout and how this progression may be affected by urate-lowering treatment (ULT). Our study aimed to evaluate differences in plasma lipidome between patients with asymptomatic HUA detected ≤ 40 years (HUA ≤ 40) and > 40 years, gout patients with disease onset ≤ 40 years (Gout ≤ 40) and > 40 years, and normouricemic healthy controls (HC).MethodsPlasma samples were collected from 94 asymptomatic HUA (77% HUA ≤ 40) subjects, 196 gout patients (59% Gout ≤ 40), and 53 HC. A comprehensive targeted lipidomic analysis was performed to semi-quantify 608 lipids in plasma. Univariate and multivariate statistics and advanced visualizations were applied.ResultsBoth HUA and gout patients showed alterations in lipid profiles with the most significant upregulation of phosphatidylethanolamines and downregulation of lysophosphatidylcholine plasmalogens/plasmanyls. More profound changes were observed in HUA ≤ 40 and Gout ≤ 40 without ULT. Multivariate statistics differentiated HUA ≤ 40 and Gout ≤ 40 groups from HC with an overall accuracy of > 95%.ConclusionAlterations in the lipidome of HUA and Gout patients show a significant impact on lipid metabolism. The most significant glycerophospholipid dysregulation was found in HUA ≤ 40 and Gout ≤ 40 patients, together with a correction of this imbalance with ULT.

Pseudohypoadrenalism, a subclinical cortisol metabolism disorder in hyperuricemia.

Hyperuricemia is a known risk factor of lipid metabolism disorder. However, the mechanisms have not been fully understood. The serum samples from hyperuricemia subjects were used to analyze the correlation between serum uric acid and clinical characteristics. Hyperuricemia mice induced by potassium oxonate (PO) and adenine were used to explore glucocorticoid metabolism. In hyperuricemia patients, the levels of serum uric acid were positively correlated with the levels of γ-glutamyltransferase, associated with a cortisol metabolism disorder. In hyperuricemia state, the adrenal glands failed to respond to adrenocorticotropic hormone properly, leading to low cortisol, but not corticosterone production, and decreased mRNA levels of aldosterone synthase, 11β-hydroxylase, and 3β-hydroxysteroid dehydrogenase 1, three key enzymes for cortisol synthesis. The expression of both hepatic 5α-reductase and renal 11β-hydroxysteroid dehydrogenase 2 was significantly reduced, which led to low cortisol clearance. We denominated this cortisol metabolism disorder in hyperuricemia as pseudohypoadrenalism (PHAL). PHAL increased exposure to the bioavailable cortisol in the liver, leading to local amplification of the biological action of corticosteroids. Unregulated biosynthesis pathway of bile acid expanded bile acid pool, and further aggravated cholestatic liver injury.

Interleukin-41 as a biomarker of the anti-inflammatory response associated with hyperuricemia

BackgroundInterleukin (IL)-41 is a recently discovered secreted protein that is expressed in a variety of tissues, and it is associated with several immune and metabolic diseases. However, IL-41 has not been studied in hyperuricemia (HUA). MethodsForty-four HUA patients and 44 healthy controls (HCs) were included in this study, and we collected theirgeneral and biochemical parameters, including white blood cell, neutrophil, lymphocyte, and platelet counts, mean platelet volume, platelet distribution width, serum creatinine, blood urea nitrogen, fasting blood glucose, total triglyceride, total cholesterol, high-density lipoprotein, low-density lipoprotein, total protein, albumin, alkaline phosphatase, gamma-glutamyltransferase, and hemoglobin concentration. The level of serum IL-41 was determined using an enzyme-linked immunosorbent assay. Multivariate logistic regression analysis was exploited to identify the independent risk factors associated with HUA, and the clinical diagnostic value of IL-41 was analyzed by applying the receiver operating characteristic (ROC) curve. We assessed the association between IL-41 and clinical parameters with Spearman's rank correlation. ResultsCirculating IL-41 levels were significantly higher in HUA patients than in the HCs group (460.3 pg/mL vs. 261.3 pg/mL, respectively; P < 0.001). The area under the ROC curve (AUC) for IL-41 in HUA patients was 0.7443 (with a cut-off value of 311.055 pg/mL, a sensitivity of 68.18 %, and a specificity of 72.73 %), while the AUC for IL-41 combined with the platelet count was 0.8109. Correlation analysis revealed that the circulating IL-41 level was positively correlated with age in HCs and HUA patients. ConclusionsWe herein demonstrated that serum IL-41 was elevated in HUA patients and that it may constitute a novel biomarker of anti-inflammatory response related to HUA.

Insulin resistance and hyperuricemia in patients with type 1 diabetes mellitus: clinical and biochemical correlates

Background. Some patients with type 1 diabetes mellitus (DM) have clinical symptoms that are characteristic of the type 2 DM: obesity, insulin resistance, hypertension, hyperuricemia (HU), dyslipidemia, or the metabolic syndrome, which has been called double diabetes. It is associated with an increased frequency of chronic micro- and macrovascular complications (nephropathy, arteriosclerosis obliterans and ischemic heart disease). The purpose of the study is quantitative assessment of insulin resistance severity using indirect (non-insulin) methods and determination of its correlation with serum uric acid (UA) levels in patients with type 1 DM. Materials and methods. One hundred and eighty-one patients with type 1 DM were examined, their average age was 42.5 ± 12.1 years. Anthropometric research was conducted. Indirect methods for quantitative assessment of insulin resistance were used. The analysis was conducted using non-parametric and parametric statistical methods. Results. In patients with HU, anthropometric indices were significantly higher than in those with normouricemia, which indicated an abdominal type of fat deposition. In HU, a more pronounced insulin resistance was observed compared to that in normouricemia. It was found that in type 1 DM, the serum UA level positively correlated with body mass index, waist circumference, waist-to-hip ratio, triglycerides/high-density lipoprotein cholesterol and negatively with the estimated rate of glucose utilization, sensitivity to insulin and the natural logarithm of the rate of glucose utilization. A group of variables with the greatest contribution to the variation of the serum UA level was selected by stepwise multifactorial regression analysis of models from the studied predicates. Conclusions. It has been shown that patients with type 1 DM and HU have a significantly more severe insulin resistance. There was a correlation between anthropometric and calculated indices, reflecting the severity of insulin resistance, with the serum level of UA. The group of predicates with the greatest contribution to the variance of the serum UA level in patients with type 1 DM was selected.

To Assess the Association Between Decreased Uric Acid Level and Blood Pressure

Background: Asymptomatic hyperuricemia is commonly viewed as an entity that should not be treated. Treatment of asymptomatic hyperuricemia in patients with renal impairment is still in debate. There is no evidence to rationalize pharmacotherapy for patients with hyperuricemia with no complication and serum uric acid concentration is below 10 mg/dL. Objectives: To evaluate the association between decreased uric acid level and blood pressure. Methods: This was a single-center, single (patient blinded, placebo-controlled study conducted in chattogram medical college hospital over 1 year. Patients of both sexes aged above 18 years with eGFRs of 15 to 60 mL/ min/1.73 m2 (as calculated with the 4-variable MDRD) and serum uric acid levels ≥7 mg/dL were included. Patients were selected in purposive technique divided randomly by lottery into two groups. One group received febuxostat 40-mg tablet once daily and another group received placebo tablets at the same time. Both groups received antihypertensive and antidiabetic medication and diuretics as per needed. Drugs and placebo were continued throughout the study period. Patients were evaluated at baseline, 3rd and 6th months for history, physical examination, assessment of any adverse events or end points and relevant investigations. Results: 35 patients in each group were analyzed. Baseline characteristics were similar between the two groups. In febuxostat group the mean uric acid was decreased from 8.55 (±1.05) to 4.92 (±0.64) mg/dl, which was statistically significant (p &lt;0.001) and in placebo group increased from 8.10 (±0.6) to 8.99 (±0.27) mg/dl which was statistically significant (P=0.001) after 6 months follow up. In case of mean eGFR in the febuxostat showed a nonsignificant increased from 25.28 (± 7.59) to 27.01 (±8.29) ml/min/1.73 m2, but in placebo group there was decreased mean eGFR from 26.81 (± 7.31) to 23.32(±7.72) ml/min/1.73 m2 which was statistically significant (p &lt;0.001) and between group difference in eGFR was significant at 6 months (p = 0.048). Moreover after 6 months of treatment systolic and diastolic blood pressure were significantly lower in febuxostat group than placebo (p &lt;0.05). Conclusion: Compared to placebo, febuxostat slowed the decline in eGFR in CKD stage 3 and 4

Gout and the Prevalence of Dementia: A Nationwide Population-Based Study.

Hyperuricemia in patients with gout is associated with a low risk of neurodegenerative diseases, including dementia. However, the prevalence of dementia in patients with gout has not yet been reported. To analyze the prevalence of dementia among patients diagnosed with gout by utilizing the Health Insurance and Review Assessment database, a nationwide registry of the South Korean population. Data from the Health Insurance and Review Assessment database of patients diagnosed with gout between 2011 and 2018 were extracted. The annual prevalence of dementia according to age and sex was analyzed. We investigated whether there was an association between comorbidities and gout medication in patients with both gout and dementia and in patients with only gout. Between 2011 and 2018, the age-adjusted prevalence of dementia per 100,000 persons ranged from 54.0 (95% confidence interval: 47.7-60.2) to 69.9 (95% confidence interval: 65.3-74.5). Compared to previous studies, the prevalence of dementia was lower in patients with gout than in the general population. Patients with both gout and dementia were more likely to be women, have a wide range of comorbidities, and be prescribed gout-related drugs, including allopurinol, febuxostat, nonsteroidal anti-inflammatory drugs, and steroids than patients with gout without dementia. This study demonstrated a relatively low prevalence of dementia in patients with gout. Gout, characterized by hyperuricemia, might be associated with a reduced risk of dementia.

Hip circumference has independent association with the risk of hyperuricemia in middle-aged but not in older male patients with type 2 diabetes mellitus

BackgroundObesity and type 2 diabetes mellitus (T2DM) are risk factors for hyperuricemia. However, which anthropometric indices can better predict incident hyperuricemia in patients with T2DM remains inconsistent. This study aimed to examine the associations between hyperuricemia and different anthropometric indices in middle-aged and older male patients with T2DM.MethodsIn this retrospective study, a total of 1447 middle-aged (45—65 years, n = 791) and older (≥ 65 years, n = 656) male patients with T2DM were collected from December 2015 to January 2020 at Shanghai Xinhua Hospital. Hyperuricemia was defined as a serum uric acid level above 7.0 mg/dL. Weight, height, waist circumference (WC) and hip circumference (HC) were measured by trained nurses at visit.ResultsThe median uric acid level of subjects was 5.6 (interquartile ranges: 4.7—6.7) mg/dl, and 279 (19.3%) were hyperuricemia, with 146 (18.5%) in the middle-aged group, and 133 (20.3%) in the older group. After adjusting for age, duration of T2DM, fasting plasma glucose and insulin, homeostasis model assessment-β, aspartate aminotransferase, triglycerides, high-density lipoprotein cholesterol and estimated glomerular filtration rate, body mass index (BMI), WC, HC, and waist-to-height ratio (WHtR) were associated with a higher risk of hyperuricemia in both middle-aged and older group (P < 0.05). After further adjusting for BMI and WC, HC still showed a positive relationship with the risk of hyperuricemia (Odds Ratio = 1.51, 95% confidence intervals: 1.06—2.14) in the middle-aged group, but such relationship was not found in the older group. Moreover, according to receiver operating characteristic analysis, the optimal cutoff value was 101.3 cm of HC for hyperuricemia screening in the middle-aged male patients with T2DM.ConclusionIn middle-aged male patients with T2DM, more attention should be paid to HC with the cutoff value of 101.3 cm in clinical practice for early recognition of individuals with a high risk of hyperuricemia for targeted guidance on disease prevention, such as community screening.

Analysis of Clinical Characteristics of Patients with Different Types of Primary Hyperuricemia

Objective: This paper aims to study the clinical characteristics of patients with different types of primary hyperuricemia (HUA). Methods: Using a retrospective research method, 200 patients with primary HUA in the hospital from June 2020 to January 2023 were selected as the research objects. Patients were grouped according to the detection results of 24-hour urinary uric acid excretion (UUE) and fractional excretion of uric acid (FEUA) (renal insufficiency type, renal overload type, mixed type, and other types). The general information of patients in the four groups (gender, age, body mass index, living habits, etc.), underlying diseases (hypertension, diabetes), blood test results [uric acid (UA), creatinine (Cre)], urine test results (24-hour urine UA, 24-hour urine Cre) were summarized and the differences between the groups were analyzed. Results: The 200 cases of HUA patients were divided into 54.00% with renal insufficiency type, 38.50% with mixed type, 6.00% with renal overload type, and 1.50% with other types. The age of patients with mixed HUA was younger than that of patients with other types, renal overload type, and renal insufficiency type, and the difference was statistically significant (P &lt; 0.05). The UA level of patients with other types of HUA was lower than that of patients with mixed type HUA, and there was statistical significance (P &lt; 0.05). The Cre level of patients with mixed type HUA was lower than that of patients with renal insufficiency type and renal overload type, and the difference was statistically significant (P &lt; 0.05). The 24-hour urinary UA level in patients with renal insufficiency type HUA was lower than that in patients with renal overload type and mixed type HUA, and the difference was statistically significant (P &lt; 0.05). The 24-hour urinary Cre level of patients with other types of HUA was lower than that of patients with renal overload type and mixed HUA, the difference was statistically significant (P &lt; 0.05). The estimated glomerular filtration rate (eGFR) level of patients with other types of HUA was lower than that of patients with mixed type HUA, and the difference was statistically significant (P &lt; 0.05). There was no significant difference in the proportions of hypertension, diabetes, coronary heart disease, and urinary calculi among patients with renal insufficiency type, renal overload type, mixed type, and other types of HUA (P &gt; 0.05). Conclusion: The primary HUA patients are mainly of renal insufficiency type, followed by mixed type. There are significant differences in the clinical characteristics of patients with different types of HUA. Among them, patients with other types of HUA are the oldest and have the lowest uric acid levels. Patients with mixed HUA had the best renal function but the highest 24-hour urine creatinine level. This study can be used as a basis for rational selection of urate-lowering drugs for different HUA patients.

Clinical Significance of Elevated Xanthine Dehydrogenase Levels and Hyperuricemia in Patients with Sepsis.

Patient outcomes for severe sepsis and septic shock remain poor. Excessive oxidative stress accelerates organ dysfunction in severe acute illnesses. Uric acid (UA) is the most abundant antioxidant. We hypothesized that UA and related molecules, which play a critical role in antioxidant activity, might be markers of oxidative stress in sepsis. The study aimed to clarify the clinical significance of UA and the relationship between UA, molecules related to UA, and outcomes by measuring blood UA, xanthine dehydrogenase (XDH), and 8-hydroxy-2-deoxyguanosine (8-OHdG) levels over time. Blood UA levels in septic patients were correlated with the SOFA score (ρ = 0.36, p < 0.0001) and blood XDH levels (ρ = 0.27, p < 0.0001). Blood XDH levels were correlated with the SOFA score (ρ = 0.59, p < 0.0001) and blood 8-OHdG levels (ρ = -0.32, p < 0.0001). Blood XDH levels were persistently high in fatal cases. Blood XDH level (OR 8.84, 95% CI: 1.42-91.2, p = 0.018) was an independent factor of poor outcomes. The cutoff of blood XDH level was 1.38 ng/mL (sensitivity 92.8%, specificity 61.9%), and those 1.38 ng/mL or higher were associated with a significantly reduced survival rate (blood XDH level > 1.38 ng/mL: 23.7%, blood XDH level < 1.38 ng/mL: 96.3%, respectively, p = 0.0007). Elevated UA levels due to elevated blood XDH levels in sepsis cases may reduce oxidative stress. Countermeasures against increased oxidative stress in sepsis may provide new therapeutic strategies.