Hyperuricemia, Acute and Chronic Kidney Disease, Hypertension, and Cardiovascular Disease: Report of a Scientific Workshop Organized by the National Kidney Foundation

Investigation of the connection between triglyceride-glucose (TyG) index and the risk of acute kidney injury in septic patients - a retrospective analysis utilizing the MIMIC-IV database

The TyG index serves as a valuable tool for evaluating insulin resistance. An elevated TyG has shown a strong association with the occurrence of acute kidney injury (AKI). Nevertheless, existing literature does not address the relationship between the TyG index and acute kidney injury in patients with sepsis. Sepsis patients were identified from the MIMIC-IV database and categorized into four groups according to quadrilles of their TyG index values. The primary outcome of this study was the incidence of AKI. The relationship between the TyG index and the risk of AKI in septic patients was evaluated using Cox proportional hazards and restricted cubic spline models. Subgroup analyses were conducted to investigate the prognostic value of the TyG index in different subgroups. A total of 2,616 patients with sepsis (57% of whom were male) were included in this study. The incidence of AKI was found to be 78%. Cox proportional hazards analysis revealed a significant correlation between the TyG index and the occurrence of AKI in septic patients. Furthermore, a restricted cubic spline model revealed an approximately linear relationship between a higher TyG index and an elevated risk of AKI in septic patients. The trend of the hazard ratio (HR) remained consistent across various subgroups. These findings emphasize the reliability of the TyG index as an independent predictor for the occurrence of AKI and unfavorable renal outcomes in sepsis patients. Nevertheless, establishing a causal relationship between the two requires demonstration through larger prospective studies.

Long-term exposure to ambient PM2.5 and its components associated with hyperuricemia: Evidence from a rural cohort study

BACKGROUND

Current research lacks the association of PM2.5 and its components exposure with hyperuricemia (HUA). This study aimed to explore the association of PM2.5 and its components with HUA and to identify harmful components as well as susceptible populations.

METHODS

A total of 22,765 participants were derived from the Henan rural cohort. PM2.5 and its components data were obtained from the Tracking Air Pollution (TAP) dataset in China. Generalized linear models (GLM) were utilized to evaluate the association between PM2.5 and its components with HUA. Restricted cubic splines were employed to explore the dose-response relationship. Additionally, the weighted quantile sum (WQS) method was used to assess the joint effect of PM2.5 components and their relative contribution to HUA.

RESULTS

After adjusting for confounders, the odds ratios (OR) and 95 % confidence interval (CI) for per standard deviation (SD) increase in PM2.5, black carbon (BC), nitrate (NO3-), sulfate (SO42-), ammonium (NH4+), and organic matter (OM) were 1.81 (1.43, 2.30), 1.69 (1.38, 2.07), 1.70 (1.39, 2.08), 1.73 (1.40, 2.14), 1.67 (1.38, 2.04), and 1.58 (1.30, 1.92), respectively. Joint exposure to the five major chemical components also showed a positive association with the risk of HUA [1.09 (1.04, 1.15)], with NO3- contributing most significantly to the combined effect of the pollutant mixture. Additionally, exposure to PM2.5 and its components showed a nonlinear dose-response relationship with HUA (P nonlinear < 0.05). Stratified analysis indicated that men may be more susceptible to the effects of environmental PM2.5 and BC.

CONCLUSION

PM2.5 and its components increased the risk of HUA, with NO3- being the primary contributor, and men were more susceptible to the effects of PM2.5 and BC. The findings suggests that reducing PM2.5 levels could bring significant public health benefits.

Design, synthesis and biological evaluation of 2-[1-(pyridin-2-ylmethyl)-1H-pyrazole-3-carboxamido]benzoic acids as promising urate transporter 1 inhibitors with potential nephroprotective efficacy for the treatment of hyperuricemic nephropathy

Hyperuricemic nephropathy (HN) is considered an important risk factor for mortality in patients with hyperuricemia. Reducing serum uric acid (UA) levels and mitigating kidney injury are essential components in the treatment of HN. Thus, UA-lowering drugs that can also protect the kidneys are urgently needed. We identified a urate transporter 1 (URAT-1) inhibitor, T29, with cytoprotective efficacy through screening an internal library against hyperuricemia using a UA-induced HK-2 cell injury model. A bioisosteric strategy was then employed to replace the indole core of T29 with pyrazole moieties; this resulted in a series of 2-[1-(pyridin-2-ylmethyl)-1H-pyrazole-3-carboxamido]benzoic acids. Among them, compound 18 demonstrated the best cytoprotective efficacy (cell viability = 92.2 % vs. model = 31.5 %), and the IC50 value of compound 18 against URAT-1 was 3.36 μM; both of these values exceeded T29. In an HN mice model induced by a 0.75 % adenine diet and intraperitoneal injection of potassium oxonate (400 mg/kg), compound 18 significantly reduced the serum UA levels by inhibiting URAT-1 activity. Furthermore, compound 18 improved kidney function by lowering serum creatinine (CRE) and urea nitrogen (BUN) levels while attenuating tubular dilation and inflammatory cell infiltration in the kidneys. Additionally, it suppressed the release of the proinflammatory cytokines IL-1β and TNF-α and reduced kidney fibrosis by downregulating the expression of α-SMA and TGF-β. In conclusion, compound 18 ameliorated HN by inhibiting URAT-1, alleviating immune-inflammatory responses and mitigating fibrosis; the results from this study demonstrate its potential as a therapeutic agent for HN.

Hyperuricemia and adverse outcomes in patients with cardiorenal syndrome: A nationwide prospective cohort study in China

Background

Serum uric acid (UA) has been associated with adverse outcomes in patients with heart failure. However, it remains inconclusive whether such association persists in patients with cardiorenal syndrome (CRS).

Methods

In a nationwide prospective cohort from China, 4907 adults hospitalized for heart failure were enrolled. Of them, 1284 had an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 at admission were included in this study. The Cox regression model was employed to evaluate the relationship between UA levels and mortality, major cardiovascular events (MACE), and hospitalization for heart failure (HHF). Additionally, Harrell's concordance index was utilized to assess the incremental value of UA levels in predicting mortality.

Results

During a median follow-up of 3.28 years, hyperuricemia was associated with a 27 % increased risk of all-cause mortality (HR 1.27, 95 % confidence interval [CI] 1.08-1.49) and a 36 % increased risk of cardiovascular mortality (HR 1.36, 95 % CI 1.11-1.65), regardless of patients' eGFR levels. This relationship remained consistent throughout the whole follow-up period. Hyperuricemia increased the risk of 3-month MACE by 39 % (HR 1.39, 95 % CI 1.03-1.88), 3-month HHF by 47 % (HR 1.47, 95 % CI 1.11-1.95), and 1-year MACE by 26 % (HR 1.26, 95 % CI 1.02-1.57). The additive effect of uric acid levels in predicting mortality was also confirmed.

Conclusions

Serum UA levels possess significant value in prognosis of mortality, MACE, and HHF among patients with CRS. These findings underscore the importance of monitoring serum UA in the management of patients with CRS, as UA may provide valuable insights into risk stratification.

JAK2/STAT3/HMGCS2 signaling aggravates mitochondrial dysfunction and oxidative stress in hyperuricemia-induced cardiac dysfunction

BACKGROUND

High uric acid levels play a critical role in cardiovascular disease pathophysiology, being closely linked to their occurrence, progression, and prognosis. To enhance prevention and treatment of hyperuricemia-related cardiovascular diseases, understanding underlying mechanisms and identifying novel therapeutic targets are essential.

METHODS

A hyperuricemic mouse model was established, and transcriptomic analysis of myocardial tissue was conducted using RNA sequencing. The role of HMGCS2 in hyperuricemia-induced cardiomyocytes was investigated through HMGCS2 knockout. The transcriptional regulation of HMGCS2 by STAT3 was explored via STAT3 knockdown, overexpression, and dual-luciferase reporter assays. To further elucidate the role of the JAK2/STAT3/hmgcs2 signaling pathway in hyperuricemia-induced cardiomyocytes, we overexpressed HMGCS2 while intervening in the JAK2/STAT3 pathway in vitro. The therapeutic potential of targeting the JAK2/STAT3/HMGCS2 pathway was evaluated in hyperuricemic mice using STAT3 and JAK inhibitors to assess effects on cardiac dysfunction.

RESULTS

RNA sequencing showed significant upregulation of HMGCS2 mRNA in hyperuricemic mouse cardiac tissue. Increased HMGCS2 protein levels were observed in cardiac tissue and AC16 cardiomyocytes. HMGCS2 knockdown alleviated uric acid-induced mitochondrial dysfunction, oxidative stress, and abnormal energy metabolism in AC16 cardiomyocytes. And high uric acid levels activate the IL-6/JAK2/STAT3 signaling pathway in AC16 cardiomyocytes, which regulates HMGCS2 expression. By modulating JAK2 and STAT3 expression and subsequently overexpressing HMGCS2, we identified the involvement of the JAK2/STAT3/HMGCS2 pathway in uric acid-induced mitochondrial dysfunction, oxidative stress, and energy metabolism abnormalities in AC16 cardiomyocytes. In vitro experiments demonstrated that intervention with the ruxolitinib and S3I-201 could ameliorate mitochondrial dysfunction, oxidative stress, and ATP levels in the heart tissue of hyperuricemic mice. Moreover, these treatments also reversed cardiac function abnormalities.

CONCLUSIONS

The JAK2/STAT3/HMGCS2 pathway may contributes to uric acid-induced cardiac dysfunction by affecting mitochondrial function, oxidative stress, and ATP metabolism, offering a potential therapeutic strategy for mitigating high uric acid-induced cardiac damage.

Volatile organic compound exposure is associated with hyperuricemia in the general population: an analysis of 6878 adults from the NHANES

BACKGROUND

Hyperuricemia is clinically significant as the primary risk factor for gout and is strongly associated with cardiovascular diseases, hypertension, and chronic kidney disease. However, its relationship with exposure to volatile organic compounds (VOCs) remains unclear. This study explores the association between urinary VOC metabolite concentrations and the prevalence of hyperuricemia.

RESEARCH DESIGN AND METHODS

Data from adults aged ≥ 18 years with at least one urinary VOC measurement were obtained from the 2011-2018 National Health and Nutrition Examination Survey (NHANES). Associations between sixteen urinary VOC metabolite levels and hyperuricemia were analyzed using univariate and multivariable logistic regression, adjusted for demographic and clinical covariates.

RESULTS

Data of a total of 6,878 participants were analyzed. Multivariable analysis revealed that, after adjusting for relevant confounders, there were significant associations between higher levels of certain urinary VOC metabolites and hyperuricemia. Specifically, as compared to the lowest level (tertile 1), higher levels (tertile 3) of BMA (aOR = 1.38), CEMA (aOR = 1.59), CYMA (aOR = 1.41), 3HPMA (aOR = 1.34), PGA (aOR = 1.41), HPMMA (aOR = 1.48), MA (aOR = 1.33), 2HPMA (aOR = 1.34), and DHBMA (aOR = 1.35) were significantly associated with increased odds of hyperuricemia.

CONCLUSIONS

The findings indicate that specific urinary VOC metabolites are independently associated with an increased likelihood of hyperuricemia. These findings provide a direction for future experimental studies to investigate the underlying mechanisms and confirm causal relationships.

Unraveling the effects of uric acid on endothelial cells: A global proteomic study

This work aims to understand how normouricemic levels of uric acid can induce endothelial dysfunction seeking global proteomic alterations in Human Umbilical Vein cells (HUVEC). It reveals significant alterations in redox-sensitive and antioxidant proteins, chaperones, and proteins associated with cell migration and adhesion in response to uric acid exposure. Monitoring cellular oxidation with the roGFP2-Grx1 probe proved increased oxidation levels induced by uric acid, which can be attenuated by peroxidasin (PXDN) inhibition, suggesting a regulatory role for PXDN in mitigating oxidative stress induced by uric acid. As a consequence of uric acid oxidation and the formation of reactive intermediate, we identified adducts in proteins (+140 kDa) in a novel post-translation modification named uratylation. Increased misfolded protein levels and p62 aggregation were also found, indicating disturbances in cellular proteostasis. Furthermore, uric acid promoted monocyte adhesion and upregulated ICAM and VCAM protein levels, implicating a pro-inflammatory response in endothelial cells. These findings provide critical insights into the molecular mechanisms underlying vascular damage associated with uric acid.

Phytochemical compounds for treating hyperuricemia associated with gout: a systematic review

Gout is a prevalent metabolic disorder characterized by increased uric acid (UA) synthesis or decreased UA clearance from the bloodstream, leading to the formation of urate crystals in joints and surrounding tissues. Hyperuricemia (HUA), the underlying cause of gout, poses a growing challenge for healthcare systems in developed and developing countries. Currently, the most common therapeutic approaches for gouty HUA primarily involve the use of allopathic or modern medicine. However, these treatments are often accompanied by adverse effects and may not be universally effective for all patients. Therefore, this systematic review aims to provide a comprehensive outline of phytochemical compounds that have emerged as alternative treatments for HUA associated with gout and to examine their specific mechanisms of action. A systematic search was conducted to identify phytochemicals that have previously been evaluated for their effectiveness in reducing HUA. From a review of > 800 published articles, 100 studies reporting on 50 phytochemicals associated with the management of HUA and gout were selected for analysis. Experimental models were used to investigate the effects of these phytochemicals, many of which exhibited multiple mechanisms beneficial for managing HUA. This review offers valuable insights for identifying and developing novel compounds that are safer and more effective for treating HUA associated with gout.

Gut microbiota Lactobacillus johnsonii alleviates hyperuricemia by modulating intestinal urate and gut microbiota-derived butyrate

BACKGROUND

Gut microbiota are important for uric acid (UA) metabolism within hyperuricemia (HUA); however, the underlying mechanisms of how the gut microbiota regulate intestinal UA metabolism remain unclear. This study aimed to explore the function of the intestine in HUA and to further reveal the possible mechanism.

METHODS

We conducted gut microbiota depletion to validate the role of gut microbiota in UA metabolism. A mouse model of HUA was established, and the gut microbiota and microbiome-derived metabolites were analyzed via 16S RNA gene sequencing and metabolomics analysis. The mechanism of the gut microbiota in HUA was elucidated by in vivo and in vitro experiments.

RESULTS

Antibiotic treatment elevated serum UA, disturbed purine metabolism, and decreased the relative abundance of Lactobacillus. HUA mice had a lower relative abundance of Lactobacillus johnsonii (L. johnsonii) and decreased gut butyrate concentration. Supplementation of L. johnsonii significantly reduces serum UA in hyperuricemia mice by preventing UA synthesis and promoting the excretion of gut purine metabolites. In addition, L. johnsonii enhanced intestinal UA excretion by heightening the urate transporter ABCG2 (adenosine triphosphate-binding cassette transporter, subfamily G, member 2) expression, and increasing the levels of butyrate, which upregulated ABCG2 expression via the Wnt5a/b/β-catenin signaling pathway.

CONCLUSION

Our results suggest that gut microbiota and microbiota-derived metabolites directly regulate gut UA metabolism, highlighting potential applications in the treatment of diet-induced HUA by targeting gut microbiota and its metabolites.

Uric acid reduces the expression of aquaporins in renal collecting ducts to increase urine output in hyperuricemia

Background

Hyperuricemia (HUA) has attracted wide attention due to its close relationship with gout, hypertension, hypertriglyceridemia, obesity, atherosclerotic heart disease, type 2 diabetes and chronic kidney disease. Clinical observations suggest that people with high levels of serum uric acid (sUA) exhibits impaired urine concentration. We speculate that UA may regulate the expression of AQPs through inflammatory pathways, resulting in impaired renal urine concentration.

Methods and results

We revealed that patients and mice with HUA had a polyuria phenotype and found that the expression of aquaporin 2 (AQP2), AQP3 and AQP4 were significantly reduced in the kidneys of mice with HUA. Similarly, uric acid (UA) treatment markedly suppressed the expression of AQP2, AQP3 and AQP4 in cultured inner medullary collecting duct cells (IMCDs). We observed an increased expression of NF-κB in the kidneys of mice with HUA and in the IMCD cells treated with UA. Blockade of NF-κB by its inhibitor Bay 11-7082 dramatically attenuated UA-suppressed expression of AQP2, AQP3 and AQP4. Furthermore, the luciferase reporter, CHIP and EMSA assays showed that NF-κB can directly bind to the promoter regions of AQP2, AQP3 and AQP4 genes to suppress their transcription.

Conclusion

Our findings demonstrate that UA reduces the expression of AQP2, AQP3 and AQP4 in an NFκB-dependent manner, which contributes to the polyuria phenotype in the subjects with HUA.

The role of Triglyceride Glucose-Waist Circumference (TyG_WC) in predicting metabolic dysfunction-associated steatotic liver disease among individuals with hyperuricemia

BACKGROUND/AIMS

The incidence of metabolic dysfunction-associated steatotic liver disease (MASLD) among individuals with hyperuricemia is significantly high. The aim of this study was to identify effective biomarkers for the detection of MASLD among patients with hyperuricemia.

METHOD

We conducted an analysis involving 3424 participants with hyperuricemia from the National Health and Nutrition Examination Survey (1999-2020). To identify potential significant variables, we employed Boruta's algorithm, SHapley Additive exPlanations (SHAP) and random forests. Multivariable logistic regression models were utilized to assess the odds ratio (OR) of developing MASLD. To evaluate the accuracy and clinical value of our prediction model, we employed receiver operating characteristic (ROC) curves and decision curve analysis (DCA) curves.

RESULTS

Among the study population of 3424 participants (mean [SD] age, 54 [20] years, 1788 [52.22%] males) with hyperuricemia, 1670 participants had MASLD. Using Boruta's algorithm, SHAP and random forests, our analysis suggested that Triglyceride Glucose-Waist Circumference (TyG_WC) was one of the most significant variables in predicting MASLD risk, with an area under the receiver operating characteristic (AUROC) of 0.865. The restricted curve spline (RCS) revealed a positive association between the odds ratio of TyG_WC and MASLD, when compared with lowest quantile of TyG_WC, the risk of MASLD for highest quantile was 137.96 times higher. The predictive strategy incorporating TyG_WC notably enhanced the clinical model, with threshold probabilities spanning from approximately 0% to 100%, resulting in a significant improvement of the net benefit.

CONCLUSIONS

Our analysis found that TyG_WC was one of the most significant variables in predicting MASLD risk among individuals with hyperuricemia.

The associations between serum carotenoids and hyperuricemia among U.S. National Health and Nutrition Examination Survey

BACKGROUND

Hyperuricemia is a risk factor for various metabolic disorders. We aimed to investigate the association between serum carotenoid levels and hyperuricemia using data from the National Health and Nutrition Examination Survey (NHANES).

METHODS

We conducted a cross-sectional analysis utilizing data from three specific NHANES cycles (2003-2004, 2005-2006, 2017-2018), containing the most complete serum carotenoid data from 12,253 participants aged 20 years and older. Serum carotenoids were quantified using high-performance liquid chromatography, while hyperuricemia was defined as serum uric acid levels ≥ 416 μmol/L (7.0 mg/dL) in men and ≥ 357 μmol/L (6.0 mg/dL) in women. Multivariable logistic regression models were employed to assess the relationship between carotenoids and hyperuricemia.

RESULTS

The mean age of participants was 50.1 ± 18.7 years, with a hyperuricemia prevalence of 20.5%. Higher serum carotenoids were associated with a lower prevalence of hyperuricemia, with each 1-unit increase in total carotenoids being inversely associated with hyperuricemia (odds ratio [OR] = 0.77, 95% confidence interval [CI]: 0.72-0.82) in multivariable analyses. Compared to participants with the lowest quartile, reduced ORs for hyperuricemia odds were observed for those with the highest quartile for total carotenoids (0.55 [0.47-0.64]), α-carotene (0.60 [0.52-0.71]), β-carotene (0.56 [0.48-0.65]), β-cryptoxanthin (0.58 [0.49-0.67]), trans-lycopene (0.75 [0.65-0.87]), cis-lycopene (0.83 [0.65-1.06]), total-lycopene (0.75 [0.64-0.87]), and lutein + zeaxanthin (0.66 [0.57-0.77]). Subgroup analyses indicated stronger associations among younger individuals, women, and those without any history of diabetes or cardiovascular disease.

CONCLUSIONS

Higher serum carotenoid levels are associated with reduced odds of hyperuricemia. These results underscore the potential role of carotenoids in managing hyperuricemia and its related health complications.

Evaluation of the safety and probiotic properties of Limosilactobacillus fermentum BGI-AF16, a uric acid-lowering probiotic strain

Some beneficial microorganisms in the intestine have the potential to degrade uric acid, offering a novel strategy for the prevention of hyperuricemia. In this study, the safety and probiotic potentials of Limosilactobacillus fermentum BGI-AF16 were evaluated by whole genome sequence analysis and in vitro experiments. Based on the gene analysis of antibiotic resistance and virulence factors, L. fermentum BGI-AF16 has been shown to be safe. We identified probiotic-related genes by genome annotation tools and conducted in vitro experiments to evaluate the ability of L. fermentum BGI-AF16 to inhibit pathogenic bacteria, tolerate a simulated gastrointestinal environment, and degrade uric acid. The results from in vitro experiments showed that L. fermentum BGI-AF16 had inhibitory effects on four clinically relevant pathogens and was highly tolerant to the gastrointestinal environment. In addition, L. fermentum BGI-AF16 was able to rapidly degrade uric acid within the first hour, and the strain could degrade 56.36 ± 2.32 % of uric acid by the third hour. The genome of the strain contains genes encoding flavin adenine dinucleotide (FAD)-dependent urate hydroxylase (EC.1.14.13.113), an enzyme that directly metabolizes uric acid. And the strain has a complete uric acid metabolic pathway. These results suggest that L. fermentum BGI-AF16 is a probiotic candidate with significant potential for reducing uric acid level.

Associations of body mass index and remnant cholesterol with hyperuricemia in patients with hypertension

BACKGROUND

There is a paucity of prior research on residual cholesterol (RC) and hyperuricemia, and it remains unclear whether body mass index (BMI) functions as a mediating factor between them or intensifies lipid metabolic dysregulation, thereby elevating the risk of hyperuricemia. This study aims to investigate whether BMI mediates the association between RC and hyperuricemia, as well as the interaction or joint effect of BMI and RC on hyperuricemia.

METHODS

This is a cross-sectional study, involving a total of 14,218 hypertensive patients. Exposure factors include RC and BMI. The outcome was Hyperuricemia, defined as serum uric acid (SUA) ≥ 420 µmol/L. Multivariable logistic regression models and causal mediation analysis were used to examine the association between RC and BMI and the prevalence of hyperuricemia.

RESULTS

A total of 14,218 hypertensive patients were enrolled in this cross-sectional study, comprising 6,713 (47.2%) males, with a mean age of 63.8 (9.36) years. The prevalence of diabetes mellitus was found to be 10.4% (1,473), while hyperuricemia accounted for approximately 44.4% (6,319). The results show that there is a linear positive correlation between RC and hyperuricemia (P for trend < 0.01). RC and BMI only had significant additive interaction on hyperuricemia, but there was no multiplicative interaction (Additive: RERI = 0.45, 95%CI: 0.13-0.78; Multiplicative, OR = 1.09, 95% CI 0.92-1.3, P = 0.308). There are direct and indirect effects between RC and hyperuricemia [estimate (95% CI): DE = 0.063 (0.048, 0.070), IE = 0.005 (0.003, 0.001)]. In the aforementioned causal mediation analysis, among the hyperuricemia caused by RC, BMI mediates 7.1%.

CONCLUSION

The intermediary role of BMI and its interaction with RC play a pivotal role in augmenting the prevalence of hyperuricemia.

TRIAL REGISTRATION

Registered prospectively in the Chinese Clinical Trial Registry (ChiCTR1800017274) on July 20, 2018. Access at https://www.chictr.org.cn/showproj.html?proj=28262 .

Association between prebiotic, probiotic consumption and hyperuricemia in U.S. adults: a cross-sectional study from NHANES 2011-2018

Aim

This study aims to provide evidence for an association between the consumption of prebiotics and probiotics and hyperuricemia in U.S. adults.

Methods

A total of 7,176 adults who participated in the National Health and Nutrition Examination Survey (NHANES) during 2011-2018 were included in the study. First, the baseline characteristics of the data were described for the weighted data, using the presence or absence of hyperuricemia as the classification criterion. Second, binary logistic regression analyses were performed to establish crude models and regression models adjusted for relevant covariates, and odds ratios (OR) and 95% confidence intervals (95% CI) were calculated to explore the relationship between prebiotics, probiotic intake, and hyperuricemia. Subsequently, receiver operating characteristic (ROC) curves were plotted to assess probiotic consumption's role in the hyperuricemia prediction model. Finally, subgroup analyses were performed.

Results

Participants who consumed probiotics had a lower prevalence of hyperuricemia than those who did not (3.48% vs. 6.25%, p = 0.082). In logistic regression analyses, prebiotics' effect on hyperuricemia was insignificant (p > 0.05), regardless of whether covariates were considered. In contrast, the crude model for probiotics and the adjusted model 1, which was constructed by adjusting for age, sex, and ethnicity, showed ORs less than 1 (crude model: OR = 0.54, 95% CI [0.34, 0.83], p = 0.008; adjusted model 1: OR = 0.54, 95% CI [0.34, 0.83], p = 0.008). The predictive model, including age, sex, race, body mass index (BMI), hypertension, chronic kidney disease, and probiotics, had 76.7% sensitivity and 68.0% specificity with an area under the ROC curve of 0.7886 for detecting hyperuricemia in US adults.

Conclusion

These results suggest that probiotic consumption may reduce the incidence of hyperuricemia in the US adult population, but prebiotics have not shown the same effect.

Association of Metabolic Score for Visceral Fat (METS-VF) with Gout Risk in Patients with Hypertension and Hyperuricemia: A Multicenter Study Based on the Chinese Population

Background

Gout, a rheumatic disease precipitated by hyperuricemia, has become a global health concern due to its increasing prevalence, especially in China. Hyperuricemia and hypertension are significant risk factors for gout, and their coexistence amplifies this risk. Visceral adipose tissue (VAT) plays a crucial role in cardiometabolic diseases, and the metabolic score for visceral fat (METS-VF) is a non-invasive tool for estimating VAT and predicting cardiometabolic risk.

Methods

We conducted a multicenter cross-sectional study involving 8877 patients with hypertension and hyperuricemia from three Chinese medical centers between March 2021 and September 2024. We calculated the METS-VF and other obesity indices and analyzed their associations with gout risk using logistic regression models. The predictive performance of these indices was evaluated using receiver operating characteristic (ROC) curve analysis and clinical decision curve analysis (DCA).

Results

The METS-VF demonstrated a significant positive association with gout risk, independent of traditional risk factors. Each 1-standard deviation increase in the METS-VF was associated with an 82% higher odds of gout (OR=1.82, 95% CI: 1.62 to 2.03). The METS-VF outperformed other obesity indices in predicting gout risk, with a higher area under the ROC curve (AUC) value. DCA indicated that the METS-VF provided a significant net benefit across a wide range of threshold probabilities for predicting gout risk in both genders.

Conclusion

The METS-VF's robust association with gout risk in our multicenter study, independent of conventional risk factors, positions it as a potent predictor for gout. Further investigation is warranted to clarify the underlying mechanisms and the long-term predictive validity of the METS-VF across diverse populations.

Oleanolic Acid Alleviates Hyperuricemia via Gut Microbiota Control the Integrity of Gut Barrier and the Expressions of Urate Transporter in Mice

Hyperuricemia (HUA) is a globally prevalent metabolic disorder characterized by an imbalance in uric acid (UA) production and excretion. In this study, we found that oleanolic acid (OA), a natural pentacyclic triterpene, effectively reduced HUA and associated kidney injury in C57BL/6J mice. A 12-week OA treatment significantly and dose-dependently reduced UA and creatinine levels in serum and urine while suppressing hepatic xanthine oxidase activity in HUA mice. Mechanistic analysis revealed that OA modulates the expression of urate transporters including ABCG2, GLUT9, and URAT1 in the kidney and small intestine. Furthermore, OA restored gut microbiota imbalances, increased short-chain fatty acid production, and enhanced the expressions of intestinal tight junction proteins in HUA mice, thereby improving gut barrier integrity in HUA mice. Consequently, fecal microbiota transplantation (FMT) was employed to illustrate the major mediating role of gut microbiota in OA's alleviation of HUA in mice. Recipient HUA mice transplanted with feces from OA-treated HUA mice exhibited significantly lower blood and urinary UA levels, reduced kidney inflammation, and improved gut microbiota balance compared to those receiving feces from untreated HUA mice (p < 0.05). Additionally, FMT normalized urate transporter expression and reinforced intestinal tight junctions in recipient mice. These findings underscore that OA mitigates HUA primarily by modulating gut microbiota, regulating urate transporter expression, and reinforcing gut barrier integrity, offering novel insights into its preventive potential for managing HUA and related complications.

Association between serum uric acid levels and bone mineral density in Chinese and American: a cross-sectional study

Despite extensive studies conducted on the relationship between serum uric acid (UA) and bone mineral density (BMD), their association remains controversial. In this study, we investigated whether UA levels are independently associated with BMD in Chinese and American populations to elucidate their association. Herein, the data of 12,344 individuals (age > 20 years) from the National Health and Nutrition Examination Survey (2005-2018) and those of 768 individuals from the inpatient medical records and physical examination center systems of the Tertiary Class A Hospital (2021-2023) from China were included. The association between UA and BMD was analyzed by employing multivariate regression models with covariate adjustments. In addition, population description, stratified analysis, single-factor analysis, smooth-curve fitting, and threshold and saturation effect analyses were performed. After covariate adjustments, UA exhibited an association with BMD of the femur (β = 0.008, 95% confidence interval [CI] 0.001-0.015, P = 0.02), femoral neck (β = 0.011, 95% CI 0.004-0.018, P = 0.002), and lumbar spine (β = 0.014, 95% CI 0.06-0.022, P < 0.001) in American subjects. Similarly, UA exhibited association with BMD of the femur (β = 0.079, 95% CI 0.042-0.117, P < 0.001), femoral neck (β = 0.171, 95% CI 0.121-0.22, P < 0.001), and lumbar spine (β = 0.052, 95% CI 0.007-0.097, P = 0.024) in Chinese subjects. Notably, the relationship between UA levels and BMD was nonlinear. The saturated utility values for determining the UA level with BMD of the femur and femoral neck using a two-stage linear regression model were 429.9 and 468 μmol/L, respectively, in the Chinese population. In the American population, the saturated utility values of UA level with BMD of the femur, femoral neck, and lumbar spine were 410.4, 410.4, and 452 μmol/L, respectively. Altogether, the present findings suggested a positive association between the UA levels and overall BMD in adults, implying that maintaining saturated UA levels can facilitate osteoporosis prevention.China Clinical Trials Registry: MR-51-23-051741. https://www.medicalresearch.org.cn/search/research/researchViewid=c0e5f868-eca9-4c68-af58-d73460c34028 .

Universal Thermal Climate Index influences on uric acid levels and hyperuricemia: Insights from a large-scale population study

BACKGROUND

Hyperuricemia is a well-established risk factor for renal and cardiovascular diseases, as well as a key contributor to gout, and its levels are influenced by meteorological conditions.

OBJECTIVE

This study aims to investigate the relationship between the Universal Thermal Climate Index (UTCI), uric acid (UA) levels, and the risk of hyperuricemia.

METHODS

A retrospective analysis was conducted on data from 211,327 participants who underwent health examinations at Taizhou Hospital, Zhejiang Province from 2019 to 2023. The analysis primarily examined the associations between UTCI, UA levels, and hyperuricemia prevalence.

RESULTS

A total of 209,826 participants were included in the study, with a hyperuricemia prevalence of 18.4 %. The prevalence of hyperuricemia was significantly higher in males (31.5 %) compared to females (3.4 %). The mean UA level in males was 387.5 ± 82.6 μmol/L, significantly higher than in females (287.2 ± 64.7 μmol/L). UA levels in males showed a gradual decline with age, reaching their lowest point in individuals aged over 65 years (351.9 ± 87.3 μmol/L). Conversely, UA levels in females increased with age, peaking in those aged over 65 years old (312.9 ± 75.0 μmol/L). Month and season had a significant influence on UA levels (P < 0.001), with the highest levels observed in August and summer, and the lowest levels in January and winter. Furthermore, the analysis revealed a positive correlation between increasing UTCI classes and elevated UA levels and hyperuricemia risk. At UTCI class 9, the risk of hyperuricemia increased by 1.722-fold in males (P = 0.001) and 1.997-fold in females (P = 0.002).

CONCLUSION

The UTCI classes are strongly associated with UA levels and hyperuricemia risk. As a comprehensive biometeorological indicator, UTCI demonstrates substantial potential for predicting UA fluctuations. These findings provide valuable insights into the pathogenesis of hyperuricemia, aiding in the development of personalized prevention and management strategies.

Risk acceleration by gout on major adverse cardiovascular events and all-cause death in patients with diabetes and chronic kidney disease

AIMS

We aimed to examine the impact of gout on cardiovascular disease (CVD) and mortality risk in patients with type 2 diabetes and explore whether chronic kidney disease (CKD) modifies this association.

MATERIALS AND METHODS

Using the Korean National Health Insurance Service database, 757 378 individuals with type 2 diabetes were classified into the CKD-Gout-, CKD-Gout+, CKD+Gout-, and CKD+Gout+ groups. Cox proportional hazard models were used to assess the risk of myocardial infarction (MI), ischemic stroke, and mortality, after adjusting for cardiometabolic factors.

RESULTS

Over a median follow-up of 9.3 years, 25 618, 38 691, and 78 628 individuals experienced MI, stroke, and mortality, respectively. The risk of MI or stroke progressively increased across the groups, with the highest adjusted hazard ratio (HR) in the CKD+Gout+ group (HR: 1.57, 95% confidence interval [CI]: 1.46-1.69), followed by the CKD+Gout- group (HR: 1.23, 95% CI 1.20-1.26). The CKD+Gout+ group showed the greatest risks for MI (HR: 1.71), stroke (HR: 1.46), and mortality (HR: 1.78). Individuals with gout alone did not exhibit a significant increase in risk compared with those without gout or CKD. Interaction analyses indicated that the effect of gout on the outcomes was more pronounced in patients with CKD. Subgroup analyses yielded consistent findings across diverse demographic and clinical characteristics.

CONCLUSIONS

CKD with or without gout increased the risk of CVD and mortality, with the highest risk observed in the CKD+Gout+ group. The interaction between CKD and gout significantly influenced these outcomes.

Molecular mechanisms of Lycii Fructus (Goji berries) against xanthine dehydrogenase in hyperuricemia management: Integrating computational, metabolomic, and experimental approaches

Lycii Fructus (LF), commonly known as Goji berries, has shown potential for managing hyperuricemia, though its underlying mechanisms remain poorly understood. This study employs a combination of network-based systems pharmacology, computer-aided drug discovery, untargeted metabolomics and experiments to explore the urate-lowering effects of LF. Molecular docking simulations of 3,760 LF compound-target interactions identified xanthine dehydrogenase (XDH) as a key target. Among the compounds, glycitein exhibited the highest binding affinity in molecular dynamics simulations. Metabolomics confirmed the presence of glycitein in LF particles, and it significantly reduced urate levels in hyperuricemia zebrafish models. Further in vitro assays and Cellular Thermal Shift Assays corroborated its inhibitory effect on xanthine oxidase. These findings suggest that glycitein may serve as a novel inhibitor of xanthine oxidase, with potential applications in nutraceuticals, functional foods, and drug development for hyperuricemia.

Inhibition of METTL3 Attenuates Renal Fibrosis by Upregulating ABCG2 m6A Modifications via IGF2BP2-Dependent Mechanisms in Hyperuricemic Nephropathy

Hyperuricemia has been linked to kidney problems including hyperuricemic nephropathy (HN), which is characterised by inflammation and fibrosis in the kidneys. HN is frequently observed in patients with chronic gout. However, the causes of HN are not fully understood and effective treatments are limited. The status of RNA m6A, expression, and location of METTL3 in the kidney was evaluated in mice with HN. The mechanism of the METTL3-associated ABCG2 downregulation was further studied in mTEC cells and a potassium oxazinate + adenine-induced mice model and adeno-associated virus 9 (AAV9)-mediated METTL3 silencing mice. Expressions of ABCG2, α-SMA, collagen-1, TGF-β1, IL-1β, IL-6, and TNF-α were analysed using real-time PCR and western blotting. Hyperuricemia led to elevated m6A levels and METTL3 expression in mouse kidneys. METTL3 was mainly located in mTEC cells. METTL3-specific inhibitor STM2457 alleviated uric acid-induced inflammatory and fibrotic responses in mTEC cells. Mechanistically, ABCG2 was identified as a target of METTL3 by RNA sequencing. The stability of ABCG2 was decreased through the binding of IGF2BP2 (insulin-like growth factor 2 binding protein 2) to its m6A-modified stop codon regions. Silencing or inhibition of METTL3 significantly reduced uric acid-induced cell injury and increased ABCG2 expression, leading to uric acid excretion. In vivo data showed that AAV9-mediated METTL3 silencing significantly alleviated renal dysfunction and fibrosis in HN mice. Our study provides the first evidence that METTL3 regulates uric acid excretion by controlling the m6A levels of ABCG2 through the binding of IGF2BP2, and inhibiting METTL3 can effectively alleviate kidney damage caused by hyperuricemia, showing potential as a therapy for HN.

Hyperuricemia, A new cardiovascular risk

BACKGROUND AND AIMS

Hyperuricemia is strongly linked to increased cardiovascular risk, including hypertension, coronary artery disease, arrythmia, and heart failure. Uric acid, as the end-product of purine metabolism, plays a critical role in cellular processes, but elevated levels can drive inflammation and oxidative stress. This review aims to emphasize the robust association between hyperuricemia and cardiovascular diseases, exploring whether uric acid-lowering therapies can mitigate cardiovascular events and improve patient outcomes.

METHODS AND RESULTS

A comprehensive review of PubMed sources was conducted, underscoring the significant link between high uric acid levels and cardiovascular events, particularly in patients with gout. Gender differences were observed, where premenopausal women have lower uric acid levels, likely due to hormonal effects, suggesting the potential need for gender-specific definitions in assessing cardiovascular risk. Epidemiological studies demonstrate a consistent correlation between hyperuricemia and adverse cardiovascular outcomes. However, interventional trials using xanthine oxidase inhibitors, such as allopurinol and febuxostat, have shown mixed results regarding their impact on reducing cardiovascular events. Additionally, emerging evidence suggests a "xanthine oxidase withdrawal syndrome" upon discontinuation of these therapies, highlighting the need for cautious management.

CONCLUSION

The strong association between elevated uric acid levels and cardiovascular diseases is well-documented. While lowering uric acid shows potential for reducing cardiovascular risk, current evidence from interventional trials remains inconclusive. Future research should focus on patient-specific therapeutic strategies, particularly for those at high cardiovascular risk with hyperuricemia and/or gout, to better define the benefits of targeted treatments.

Association of Chinese visceral adiposity index with asymptomatic hyperuricemia incidence in type 2 diabetes: a cross-sectional study

Background

Previous research has shown a correlation between high visceral fat levels and hyperuricemia incidence. The Chinese Visceral Adiposity Index (CVAI) assessed visceral fat status in the Chinese population. Our study investigates the correlation between CVAI and asymptomatic hyperuricemia in type 2 diabetes patients.

Methods

This cross-sectional study analyzed 1,588 hospitalized type 2 diabetes patients to investigate the association between CVAI and hyperuricemia. CVAI was included in the logistic regression analysis as both a continuous and categorical variable, and restricted cubic splines were used to assess the dose-response relationship. Additionally, subgroup analyses were performed to investigate potential interactions among variables. The predictive capability of CVAI was assessed using the receiver operating characteristic (ROC) curve based on the basic model.

Results

The CVAI quartile group analysis revealed a higher prevalence of hyperuricemia with increasing CVAI levels. CVAI is significantly associated with hyperuricemia, as identified through multifactorial logistic regression analysis. After adjusting for all covariates, the odds ratios for CVAI in the second, third, and fourth quartiles were significantly higher than in the lowest quartile, with values of 2.688 (95% CI [1.301-5.554], p = 0.008), 2.752 (95% CI [1.320-5.739], p = 0.007), and 4.990 (95% CI [2.392-10.409], p < 0.001), respectively. No significant interactions were observed in the subgroup analysis. Incorporating CVAI into the basic model increased the ROC curve's area under the curve to 0.714.

Conclusion

This study found a positive correlation between CVAI and hyperuricemia incidence in type 2 diabetes patients. Consequently, CVAI may reliably indicate hyperuricemia in this patient population.

Association between cardiometabolic index and albuminuria: Evidence from NHANES 2017-2020

INTRODUCTION

Albuminuria is a crucial marker of kidney damage and serves as an early indicator of the risk for chronic kidney disease (CKD). Recent studies have suggested that the cardiometabolic index (CMI), could be valuable for screening renal insufficiency. However, the relationship between CMI and albuminuria remains underexplored. Therefore, the aim of this study was to investigate the association between CMI and albuminuria, with the goal of providing new insights for the clinical diagnosis, assessment, and early intervention of kidney disease.

METHODS

The National Health and Nutrition Examination Survey (NHANES) for the period between 2017-2020 provided the data for this cross-sectional investigation. Triglyceride (TG) (mmol/L)/High density lipid-cholesterol (HDL-C) (mmol/L) ×  Waist height ratio (WHtR) was the formula used for calculating CMI. Using multifactorial logistic regression, the independent connection between albuminuria and CMI was investigated. The threshold effect was determined by means of a two-stage linear regression model. Additionally, subgroup analysis and interaction tests were carried out.

RESULTS

A total of 3,339 participants were included, and 12.38% of them had albuminuria. As the CMI quartiles grew (quartile 1: 7.78%, quartile 2: 13.43%, quartile 3: 12.93%, quartile 4: 17.01%), so did the probability of albuminuria. The results of adjusted model 3 showed that a greater probability of albuminuria prevalence was strongly correlated with CMI (OR =  2.26, 95% CI: 1.58-3.23). This association held true for all subgroups (all P for trend >  0.05). Furthermore, with a two-stage linear regression model with an inflection point of 0.92, we discovered a nonlinear relationship between CMI and albuminuria.

CONCLUSIONS

Our findings indicate that CMI levels are significantly associated with the risk of albuminuria prevalence, suggesting that CMI could serve as a valuable biomarker for assessing the risk of albuminuria.

Association between RC/HDL-C and hyperuricemia in adults: evidence from NHANES 2005-2018

Background

The incidence of hyperuricemia is growing in the world, with a significant influence on the survival and healthy condition of the patient. The connection between serum residual cholesterol (RC) to high-density lipoprotein cholesterol (HDL-C) ratio and hyperuricemia is uncertain. Consequently, we tried to elucidate the connection between the hyperuricemia and RC/HDL-C ratio.

Methods

Based on the National Health and Nutrition Examination Survey (NHANES) database, data from 2005 to 2018 were utilized in this cross-sectional research. RC/HDL-C index was calculated by (TC - HDL-C - LDL-C)/HDL-C. Participants were diagnosed with hyperuricemia when the serum uric acid concentration reached 6 mg/dL in women and 7 mg/dL in men. Our researcher utilized smoothed curve fitting and multivariate logistic regression analysis to examine between RC/HDL-C and hyperuricemia among adults. The consistency of these results was examined in various population subgroups.

Results

2376 individuals (19.1%) were stratified into the hyperuricemia group. We observed statistically significant differences (P values < 0.05) in the hyperuricemia population for remaining variables, except for economic level and alcohol drinking. After correcting for potential confounders, our researchers discovered the strong positive connection between the RC/HDL-C and the possibility of incurring hyperuricemia. The incidence of RC/HDL-C elevated by 98% with each additional unit of the RC/HDL-C. Subgroup analyses showed correlations for the majority of subgroups remained stable. However, gender and several diseases may modify this association.

Conclusions

Higher RC/HDL-C is correlated with higher prevalence rate of developing hyperuricemia. However, further research is still required to confirm the causal association.

The role of hyperuricemia in the progression of end-stage kidney disease and its molecular prospective in inflammation and cardiovascular diseases: A general review

With the ongoing development of the Chinese economy, the occurrence of chronic kidney disease (CKD) has experienced a remarkable upsurge recently, and due to uremia caused by CKD, the number of patients undergoing dialysis has shown a dramatic increase. China has been ranked first in the world for patients undergoing hemodialysis (HD) and peritoneal dialysis (PD) with approximately one million patients across the country. Due to the loss of kidney function caused by CKD, the kidneys tend to lose their ability to excrete uric acid (UA) out of the body; therefore, most patients undergoing dialysis are complicated with hyperuricemia (HUA). HUA is an abnormal disease of purine metabolism, and it's considered a chronic disease. More than 90% of patients suffering from HUA will not show any symptoms on physical examination. According to statistics, if high serum UA is left untreated, 55% of patients will develop severe problems due to the purine crystallization in the body, and the kidneys are the most affected organs by HUA causing renal insufficiency that can promote end-stage kidney disease (ESKD) by activating the renin-angiotensin system (RAS), which will lead to inflammation, arteriosclerosis, cardiovascular diseases (CVD), and other diseases. Lifestyle modifications and pharmacological interventions are the first primary choice for lowering UA, although dialysis will tend to reduce the high UA levels in the blood, drugs are also necessary. This review will summarize the mechanisms and metabolism of UA, the relationship between HUA and ESKD progression, HUA and inflammation, HUA and CVD, and pharmacological treatment of HUA.

The link between hyperuricemia and diabetes: insights from a quantitative analysis of scientific literature

Background

Hyperuricemia (HUA) is a significant public health issue, ranking second only to diabetes in prevalence. While existing research demonstrates a robust correlation between these two conditions, the precise etiological mechanisms remain inadequately elucidated. This study utilized scientometric analysis to investigate the global association between HUA and diabetes.

Methods

Data on HUA and diabetes were retrieved from the Web of Science Core Collection database, encompassing the period from its inception until September 30, 2024. Collaboration networks were examined using VOSviewer, cluster analysis was executed with CiteSpace, and systematic mapping was conducted using Bibliometrix.

Results

By September 30, 2024, 1,464 studies indicated a consistent yearly increase in publications connecting HUA and diabetes despite some fluctuations. The lead authors were Richard J. Johnson, Miguel A. Lanaspa, and Masanari Kuwabara, with most contributors from China, the United States, and Japan. Key institutions include China Medical University, Shanghai Jiao Tong University, and Capital Medical University. The most published journal was Nutrition, Metabolism and Cardiovascular Diseases (CVDs), whereas the most cited journal was Diabetes Care. The reference network from 1987 to September 30, 2024, identified 19 clusters highlighting key research areas in HUA and diabetes, such as metabolic syndrome, uropathology, chronic kidney disease (CKD), and CVD. Exploring pathological mechanisms and pharmacological interventions linked to diabetes concomitant with HUA has emerged as a focal point of research and a burgeoning trend within the field.

Conclusion

This study is the first scientometric analysis to synthesize research trends on HUA and diabetes, revealing molecular mechanisms and treatment strategies and providing theoretical insights for future clinical use.

Serum uric acid/creatinine ratio and 1-year stroke recurrence in patient with acute ischemic stroke and abnormal renal function: results from the Xi'an stroke registry study of China

Background

The relationship between abnormal renal function and serum uric acid levels in patients with acute ischemic stroke (AIS) remains insufficiently explored. Although uric acid is associated with cardiovascular and cerebrovascular risk, the specific link between normalized serum uric acid (SUA/SCr) and stroke recurrence in patients with impaired renal function has not been well studied. This study aims to fill this gap by investigating the association between SUA/SCr and 1-year stroke recurrence in patients with AIS and abnormal renal function.

Methods

This study utilized the ratio of serum uric acid (SUA) to serum creatinine (SCr) to represent SUA levels normalized for renal function. Abnormal Renal function was defined by the estimated glomerular filtration rate (eGFR) < 90 mL/min/1.73 m2. Multivariable Cox regression, curve fitting, and stratified analyses were employed to assess the relationship between SUA/SCr and 1-year stroke recurrence in patients with AIS and abnormal renal function, considering SUA/SCr as both a continuous variable and in quartiles (Q1-Q4).

Results

Of 1,932 enrolled patients (65.3% male; mean age 66.7 ± 11.3 years), each unit of increase in SUA/SCr was associated with a 17% decrease in 1-year stroke recurrence (HR = 0.83, 95% CI 0.73 to 0.96, P = 0.009). Compared to Q1, the Q2 and Q4 groups showed significantly reduced risk in 1-year stroke recurrence (Q2: HR = 0.46, 95% CI 0.27 to 0.79, P = 0.005; Q4: HR = 0.47, 95% CI 0.27 to 0.81, P = 0.007), with a significant trend across all quartiles (P = 0.01 for trend tests). Curve fitting revealed a negative but non-linear correlation. Subgroup analyses showed that in patients with eGFR < 60 ml/min/1.73 m2, Q4 had significantly lower 1-year stroke recurrence risk than Q1 (HR = 0.19, 95% CI 0.04 to 0.86, P = 0.031).

Conclusion

Low SUA/SCr independently predicts 1-year stroke recurrence in patients with AIS and abnormal renal function, particularly in those with eGFR < 60 mL/min/1.73 m2.

Consumption of fruits, vegetables, and nuts influences the association between serum uric acid and hypertension in Korean adults: A nationwide survey (KNHANES 2016-2021)

BACKGROUND AND OBJECTIVES

This study investigated the influence of dietary intake on the relationship between serum uric acid (SUA) levels and the risk of hypertension.

METHODS AND STUDY DESIGN

Data from the 7th and 8th Korean National Health and Nutrition Examination Survey, a nationally representative survey, were analyzed. A total of 19,140 adults aged 19-64 years were included. Dietary intake was assessed using a 24-hour recall method. SUA levels were measured using a Hitachi Automatic Analyzer 7600-210. Hyperten-sion was defined as a systolic blood pressure ≥ 140 mmHg, diastolic blood pressure ≥ 90 mmHg, or the use of antihypertensive medication. Statistical analyses included generalized linear regression, Cochran-Mantel-Haenszel analysis, and multivariate logistic regression.

RESULTS

The highest SUA quartile (Q4) had an odds ratio (OR) of 1.68 (95% CI: 1.41-1.99) for hypertension compared to the lowest quartile (Q1). Additionally, the association between elevated SUA levels and increased hypertension risk was stronger in participants who consumed fewer fruits (OR: 1.79, 95% CI: 1.44-2.21), vegetables (1.80, 1.43-2.25), nuts (1.87, 1.51-2.33), and milk (2.20, 1.73-2.79). The ORs (95 % CI) for the highest SUA quartile on hypertension were 1.68 (1.39-2.04), 1.35 (1.13-1.62), and 1.89 (1.57-2.27) in those consuming more seafood, meat, and alcohol, respectively.

CONCLUSIONS

Reduced intake of fruits, vegetables, nuts, and milk, and increased consumption of seafood and alcohol, exacerbates the positive association between SUA levels and the risk of hypertension. These findings suggest dietary modifications as a potential strategy for hypertension prevention and management.

A patent review of xanthine oxidase inhibitors (2021-present)

INTRODUCTION

Xanthine oxidase (XO) catalyzes the oxidation of both hypoxanthine and xanthine in the last two steps of the purine metabolic pathway, serving as a rate-limiting enzyme for uric acid production as well as a key target for the treatment of gout and other hyperuricemia-related conditions.

AREAS COVERED

This paper reviews XO inhibitors in patents from 2021 to the present. We summarize in detail the structural classes and characteristics, in vitro and in vivo biological results, and structure‒activity relationships of synthetic inhibitors, as well as the sources, specific structures, research methods, and biological activities of XO inhibitors from natural products.

EXPERT OPINION

(1) Benefiting from the discovery of many high-affinity inhibitors, the binding modes of small molecules in the active pocket of XO have been further elucidated, and this information will contribute to future development; (2) natural products remain one of the important sources in the discovery of XO inhibitors; (3) with a deeper exploration of XO and URAT1 targets, XO/URAT1 dual target inhibitors may be a future research hotspot; and (4) the search for high-affinity, small-molecule scaffolds remains a key challenge and an important direction for the future development.

Uric Acid to Albumin Ratio: A Predictive Marker for Acute Kidney Injury in Isolated Tricuspid Valve Surgery

Background

The plasma uric acid/albumin ratio (UAR) has emerged as a novel inflammatory biomarker for predicting the development of acute kidney injury (AKI) following percutaneous coronary intervention. However, the potential of the UAR to serve as a predictive marker for AKI in patients undergoing isolated tricuspid valve (TV) surgery remains unknown. This study aimed to explore the association between the UAR and AKI and to assess whether the UAR can predict AKI in these patients.

Methods

We conducted a retrospective analysis of patients who underwent isolated TV surgery between January 2018 and June 2019. The patients were divided into three groups based on the tertiles of the UAR. We utilized multivariate logistic regression and restricted cubic spline analysis to examine the association between the UAR and AKI. Additionally, we used the receiver operating characteristic (ROC) curve analysis to assess the predictive accuracy of the UAR for AKI.

Results

A total of 224 patients were enrolled in this study, of whom 41 developed AKI. The incidence of AKI across the three UAR tertiles was 3.8%, 22.2%, and 29.7%, with a significant difference between the group (p < 0.001). In the multivariate analysis, UAR ≥8.5 was associated with a 7-fold increased risk of AKI (odds ratio (OR): 7.73, 95% confidence interval (CI): 1.61-37.14), while a UAR ≥10.8 was a linked to a 9-fold increased risk (OR: 9.34, 95% CI: 1.96-44.60). The restricted cubic spline model showed a linear association between the UAR and AKI development. The area under the curve (AUC) value for the UAR was 0.713 (95% CI: 0.633-0.793; p < 0.001) with a cutoff value of 8.89.

Conclusions

An increased UAR was significantly associated with a higher risk of AKI in patients undergoing isolated TV surgery; however, while the UAR could serve as a marker to predict AKI, it was not superior to uric acid alone.

Integrated analysis of long non‑coding RNA megacluster, microRNA‑132 and microRNA‑133a and their implications for cardiovascular risk and kidney failure progression in diabetic patients

Inefficient control of elevated blood sugar levels can lead to certain health complications such as diabetic nephropathy (DN) and cardiovascular disease (CVD). The identification of effective biomarkers for monitoring diabetes was performed in the present study. The present study aimed to investigate the implications of long non-coding RNA megacluster (lnc-MGC), microRNA (miR)-132 and miR-133a, and their correlation with lactate dehydrogenase (LDH) activity and glycated hemoglobin (HbA1C) levels to identify biomarkers for the early diagnosis of diabetes mellitus, induced DN and CVD. The present study included a total of 200 patients with type 2 diabetes, as well as 40 healthy subjects as controls. The diabetic patients were classified into six groups based on their estimated HbA1c level, glomerular filtration rate and LDH activity, while the healthy controls constituted the seventh group. Diabetic patients exhibited significant increases in parameters related to diabetes as fasting blood sugar, HbA1c levels, cardiac injury and kidney failure. Furthermore, the expression levels of TNF-α were significantly increased in the diabetic groups compared with healthy controls. Diabetic patients with cardiovascular dysfunction showed significantly increased expression levels of miR-132, miR-133a and lnc-MGC, compared with the healthy group. The expression of circulating miR-132 in blood was low in the groups of diabetic patients compared with the healthy controls, and demonstrated a negative correlation with LDH and HbA1C levels. Expression levels of miR-132, miR-133a and lnc-MGC, along with their correlations with LDH and HbA1C levels, could be used to distinguish diabetic patients with reduced CVD from those at early stage diabetes, which indicated their potential as biomarkers for CV complications associated with diabetes mellitus in the future.

Exploring the link between serum betaine levels and hyperuricemia risk in middle-aged and older adults: insights from a prospective cohort study

PURPOSE

Betaine is connected to various cardio-metabolic outcomes, yet its relationship with hyperuricemia remains uncertain. We aimed to longitudinally investigate the association between serum betaine levels and the risk of hyperuricemia in middle-aged and older adults.

METHODS

This study utilized data from the Guangzhou Nutrition and Health Study (GNHS). Participants were enrolled between 2008 and 2010, with follow-ups conducted every three years, comprised an analysis sample of 2204 adults aged 40-75. Baseline serum betaine levels were assessed using high-performance liquid chromatography-tandem mass spectrometry. Serum uric acid (SUA) levels were measured at baseline and every three years thereafter. Linear mixed-effects models (LMEMs) and generalized estimating equations (GEEs) were employed to examine the longitudinal association between serum betaine levels and SUA levels, as well as hyperuricemia risk, respectively.

RESULTS

LMEMs indicated that compared to individuals in the lowest quartile (Q1) of serum betaine levels, those in the highest quartile (Q4) exhibited the lowest SUA levels (Q4 vs. Q1: β -8.19, 95% CI -16.32 to -0.06, P-trend = 0.023). Each standard deviation increase in betaine (16.5 µmol/L) was associated to SUA levels decrease of -3.28 (-6.10, -0.45). Results from the GEE model suggested a 19% reduction in the odds of hyperuricemia (OR = 0.81; 95% CI: 0.68, 0.95, P-trend = 0.051) in the Q4 group compared to the Q1 category.

CONCLUSION

Our findings highlight a negative association between serum betaine levels and SUA levels, as well as the risk of hyperuricemia in middle-aged and older adults, which is more pronounced in individuals with better dietary quality.

TRIAL REGISTRATION

This trial was registered at clinicaltrials.gov as NCT03179657. Website: https://clinicaltrials.gov/ct2/show/NCT03179657.

Tinospora crispa (L.) Hook.f. & Thomson vines ameliorates hyperuricemia by inhibiting synthesis and promoting excretion of uric acid through targeting NLRP3/caspase-1/IL-1β pathway

ETHNOPHARMACOLOGICAL RELEVANCE

Tinospora crispa (L.) Hook.f. & Thomson (T. crispa), is widely distributed in Xishuangbanna, Yunnan Province, China. According to the "Selected Medicinal Plants of Yunnan", T. crispa is recognized for its versatile medicinal properties, including promoting diuresis, reducing swelling, relieving pain, relaxing tendons, and promoting blood circulation, suggesting that their extracts can be used to exhibit a range of beneficial activities such as immune regulation, blood sugar reduction, and anti-inflammatory effects. In the Dai ethnic areas of China, T. crispa is commonly employed in the herbal prescription of treatment of hyperuricemia and gouty arthritis. However, further study is needed to enucleate the potential pharmacological mechanism of T. crispa.

AIM OF THE STUDY

This study aimed to investigate the effects and mechanisms of T. crispa vines extract (TC) in alleviating hyperuricemia.

MATERIALS AND METHODS

A hyperuricemia mouse model was established through intraperitoneal injection of potassium oxonate to evaluate the hypouricemic effects of TC. To explore the underlying mechanisms of TC, network pharmacology analysis was employed. Additionally, a series of experimental approaches-including serum biomarker assays, ELISA, reverse transcription-quantitative PCR (RT-qPCR), histopathological staining, metabolomics analysis and western blotting-were performed to assess the capability of TC in modulating uric acid levels.

RESULTS

TC treatment markedly lowered serum biomarkers by inhibiting xanthine oxidase (XOD) activity and modulating the expression of urate transporters, while also alleviating renal injury in hyperuricemic mice. Through bioinformatics and network pharmacology analyses, the NOD-like receptor signaling pathway was identified as a critical mechanism underlying the therapeutic impact of TC. Metabolomics analysis uncovered 14 differential metabolites and seven metabolic pathways linked to the anti-hyperuricemic action of TC. Further experimental validation confirmed that TC attenuated renal inflammation and suppressed activation of the NLRP3/caspase-1/IL-1β signaling pathway.

CONCLUSION

Our findings demonstrate that TC exerts a significant uric acid-lowering effect in hyperuricemic mice. This therapeutic effect can be attributed to the suppression of uric acid synthesis and the modulation of urate transporters. Moreover, the inhibition of the NLRP3/caspase-1/IL-1βsignaling pathway further contributes to the regulatory action of TC on uric acid homeostasis.

Examining Prenylated Xanthones as Potential Inhibitors Against Ketohexokinase C Isoform for the Treatment of Fructose-Driven Metabolic Disorders: An Integrated Computational Approach

Background/Objectives: Fructose-driven metabolic disorders, such as obesity, non-alcoholic fatty liver disease (NAFLD), dyslipidemia, and type 2 diabetes, are significant global health challenges. Ketohexokinase C (KHK-C), a key enzyme in fructose metabolism, is a promising therapeutic target. α-Mangostin, a naturally occurring prenylated xanthone, has been identified as an effective KHK-C inhibitor, prompting exploration of its analogs for enhanced efficacy. This study aimed to identify α-Mangostin analogs with improved inhibitory properties against KHK-C to address these disorders. Methods: A library of 1383 analogs was compiled from chemical databases and the literature. Molecular docking, binding free energy calculations, pharmacokinetic assessments, molecular dynamics simulations, and quantum mechani-cal analyses were used to screen and evaluate the compounds. α-Mangostin's binding affinity (37.34 kcal/mol) served as the benchmark. Results: Sixteen analogs demonstrated binding affinities superior to α-Mangostin (from -45.51 to -61.3 kcal/mol), LY-3522348 (-45.36 kcal/mol), and reported marine-derived inhibitors (from -22.74 to -51.83 kcal/mol). Hits 7, 8, 9, 13, and 15 not only surpassed these benchmarks in binding affinity, but also exhibited superior pharmacokinetic properties compared to α-Mangostin, LY-3522348, and marine-derived inhibitors, indicating strong in vivo potential. Among these, hit 8 emerged as the best performer, achieving a binding free energy of -61.30 kcal/mol, 100% predicted oral absorption, enhanced metabolic stability, and stable molecular dynamics. Conclusions: Hit 8 emerged as the most promising candidate due to its superior binding affinity, favorable pharmacokinetics, and stable interactions with KHK-C. These findings highlight its potential for treating fructose-driven metabolic disorders, warranting further experimental validation.

The association between body roundness index and new-onset hyperuricemia in Chinese population: the Kailuan cohort study

BACKGROUND

This study aimed to investigate the potential relationship between the newly defined adiposity metric, the Body Roundness Index (BRI), which assesses central obesity, and the development of new-onset hyperuricemia.

METHODS

In the Kailuan cohort study from 2006 to 2019, 91,804 eligible participants were included. A multivariate Cox regression model was used to test the correlation between BRI and hyperuricemia. At the same time, the restricted cubic spline was applied to solve the dose-response relationship between BRI and the risk of hyperuricemia.Then, stratified analysis was carried out using multivariate Cox regression according to age, sex, hs-CRP level, TG level, education level, smoking status and hypertension status.

RESULTS

The results showed that the risk of new-onset hyperuricemia was significantly increased in the highest quartile compared with the lowest quartile. After adjusting for confounders, compared with Q1, the HR (95% CI) for new-onset hyperuricemia was 1.24 (1.18-1.30), 1.32 (1.25-1.40), and 1.40 (1.29-1.52) for Q2, Q3, and Q4, respectively. Restricted cubic spline analysis showed a J-curve relationship between baseline BRI levels and new-onset hyperuricaemia. Age, sex, hs-CRP level, TG level, income level, education level, smoking, and hypertension each had a multiplicative interaction with BRI at baseline.

CONCLUSION

We found that elevated BRI increased the risk of developing new-onset hyperuricaemia. In addition, the association between elevated BRI and the risk of new-onset hyperuricemia showed dependency on age, sex, hs-CRP level, TG level, education level, smoking status and hypertension status.

Exploring the application of dietary antioxidant index for disease risk assessment: a comprehensive review

Oxidative stress contributes to the development of cardiometabolic diseases and cancers. Numerous studies have highlighted the adverse effects of high reactive oxygen species (ROS) levels in the progression of chronic noncommunicable diseases and also during infections. On the other hand, antioxidants play a crucial role in preventing oxidative stress or postponing cell damage via the direct scavenging of free radicals or indirectly via the Keap1/Nrf2/ARE pathway, among others. Dietary antioxidants can be obtained from various sources, mainly through a plant-based diet, including fruits and vegetables. The dietary antioxidant index (DAI) has been developed to assess total antioxidant intake from diet. This review delineated the performance of DAI in the risk assessment of different diseases. It is suggested that a high DAI score prevents obesity-related diseases, including diabetes mellitus, hyperuricemia, dyslipidemia, and metabolic (dysfunction)-associated steatotic liver disease (MASLD). Additionally, DAI is negatively associated with Helicobacter pylori and Human papillomavirus infection, thus reducing the risk of gastric and cervical cancer. Also, a high intake of antioxidants prevents the development of osteoporosis, miscarriage, infertility, and mental illnesses. However, further prospective observations and clinical trials are warranted to confirm the application of DAI in preventing diseases that have been studied.

Asymptomatic Hyperuricemia and the Kidney: Lessons from the URRAH Study

Chronic kidney disease (CKD) is a prevalent global health concern affecting approximately 850 million people worldwide, with a significant and rising mortality rate. CKD often coexists with hyperuricemia (HSUA), which is also increasingly common due to its association with hypertension, obesity, and diabetes. The interplay between hyperuricemia and CKD is complex; while in vitro studies and animal models support a role for uric acid mediating glomerular and tubule-interstitial damage, and HSUA has been shown to predict the onset and progression of CKD, the expectations of renal protection by the use of urate lowering treatment (ULT) are inconsistent. A significant challenge in managing asymptomatic HSUA in CKD patients lies in determining the appropriate SUA threshold values. Recent research, including the URRAH project, has sought to identify SUA cut-offs predictive of cardiovascular mortality, but these thresholds may vary depending on the severity of CKD. This variability complicates the establishment of universal guidelines for treating asymptomatic HSUA, leading to a lack of specific recommendations in clinical practice. In conclusion, while hyperuricemia is recognized as a prognostic factor for CKD and cardiovascular risk, more research is needed to refine the threshold values for SUA and to identify which patients may benefit from ULT. Stratification based on glomerular filtration rate may be necessary to tailor the treatments and improve outcomes in this population.

Effect of cumulative uric acid to high-density lipoprotein cholesterol ratio on myocardial infarction in prospective cohorts

OBJECTIVE

This study aimed to investigate the effect of the ratio of cumUHR on MI, based on the hypothesis that higher exposure to the ratio of cumUHR is associated with a higher risk of MI.

METHODS

Participants who underwent three examinations between 2006 and 2010 were selected. The cumUHR from baseline to the third check was calculated, multiplying the mean between consecutive checks by the time interval between visits. The association between cumUHR and MI and its progression was evaluated by Cox proportional hazards regression model. The cumulative incidence of endpoint events between cumUHR groups was compared using a log-rank test. Stratification by age, sex, and BMI was further performed.

RESULTS

A total of 53,697 people, with an average age of 53.08 years, 78 % of whom were male, with a median follow-up of 10.51 years and 744 myocardial infarction events, were enrolled. The highest cumUHR quartile, MI, had the highest cumulative incidence (log-rank P < 0.01). Multivariate COX regression analysis showed that in the fully adjusted model, there was a high level of concentration in the highest cumUHR quartile (HR, 1.52; 95 % CI, 1.20-1.92) and participants with longer duration of high UHR exposure (HR, 1.55; 95 % CI, 1.22-1.97).

CONCLUSIONS

The risk of MI increases with cumUHR and is influenced by the time course of cumUHR. In particular, in people aged ≥ 60 years, males, and BMI < 28 kg/m2, the risk of MI is more affected by the level of UHR, and more attention should be paid to controlling the level of UHR.

Predictors of acute kidney injury in chronic kidney disease patients treated for cardiovascular disease in the cardiac intensive care unit (MORCOR-TURK subgroup analysis)

BACKGROUND

Acute kidney injury (AKI) is a common complication in chronic kidney disease (CKD) patients in the cardiac intensive care unit (cardiac ICU). In this study, we aimed to identify predictors of AKI in CKD patients treated in the cardiac ICU for cardiovascular diseases.

METHODS

The MORCOR-TURK trial was conducted as a multicenter, prospective, cross-sectional, and noninterventional investigation. A total of 3157 patients treated in the cardiac ICU were enrolled from 50 centers over the course of one month. In this subgroup analysis, 615 patients with CKD treated in the cardiac ICU for cardiovascular disease were included in the study. The primary outcome of this study was the development of AKI. During hospitalization, patients who developed AKI were identified.

RESULTS

AKI developed in 288 patients (46%). After multivariable analysis, decompensated heart failure (OR: 3.72, p = 0.005), primary percutaneous coronary intervention (OR: 3.75, p = 0.004), non-primary percutaneous coronary intervention (OR: 2.85, p = 0.033), troponin levels (OR: 1.04, p = 0.031), and need for mechanical ventilation (OR: 3.11, p < 0.001) were identified as independent predictors of AKI development in CKD patients.

CONCLUSION

Our efforts to identify AKI predictors in cardiac ICU patients with CKD have yielded directly applicable results in clinical practice. AKI can be prevented by developing personalized strategies to follow up and treat cardiac ICU patients with CKD who have decompensated heart failure, are undergoing percutaneous coronary intervention (primary and non-primary), have high troponin levels, and need mechanical ventilation.

Mendelian Randomization Studies: Opening a New Window in the Study of Metabolic Diseases and Chronic Kidney Disease

It is widely recognized that a strong correlation exists between metabolic diseases and chronic kidney disease (CKD). Based on bibliometric statistics, the overall number of Mendelian randomization (MR) analysis in relation to metabolic diseases and CKD has increased since 2005. In recent years, this topic has emerged as a significant area of research interest. In clinical studies, RCTs are often limited due to the intricate causal interplay between metabolic diseases and CKD, which makes it difficult to ascertain the precise etiology of these conditions definitively. In MR studies, genetic variation is incorporated as an instrumental variable (IV). They elucidate the possible causal relationships between associated risk factors and disease risks by including individual innate genetic markers. It is widely believed that MR avoids confounding and can reverse effects to the greatest extent possible. As an increasingly popular technology in the medical field, MR studies have become a popular technology in causal relationships investigation, particularly in epidemiological etiology studies. At present, MR has been widely used for the investigation of medical etiologies, drug development, and decision-making in public health. The article aims to offer insights into the causal relationship between metabolic diseases and CKD, as well as strategies for prevention and treatment, through a summary of MR-related research on these conditions.

Intestinal FXR deficiency induces dysregulation of xanthine oxidase and accounts for sex difference in hyperuricemia

Overproduction of uric acid caused by increased expression and/or enhanced activity of xanthine oxidase (XO) is one of the major etiologies of hyperuricemia, which had a significant sex differences. As an important enzyme involved in production of reactive oxygen species and uric acid, activity of XO is highly correlated with hyperuricemia and its complications. However, the mechanisms underlying XO dysregulation remain unclear, and sex difference in the prevalence of hyperuricemia has been well known. To explore the potential role of intestinal farnesoid X receptor (FXR) on XO regulation and production, and the mechanisms of sex differences in this pathological process. Two hundred and sixty-one dyslipidemia participants and intestine-specific FXR-knockout mice were used to study the relationship between the intestinal FXR and the serum uric acid level. Western blotting, quantitative real-time PCR, and dual-luciferase reporter assay, were applied to clarify the regulatory role of FXR deficiency on XO. Special inhibitors, agonists, siRNA, sex hormones were used to investigate the mechanism of sex difference in FXR deficiency induced hyperuricemia in cell and animal model. Serum fibroblast growth factor 19 (FGF19) levels were lower in hyperuricemia patients in a sex difference manner. Increased local TNFα level driven by intestinal FXR deficiency/inhibition induced overexpression and hyperactivity of intestinal XO, leading to elevated intestinal uric acid synthesis, and subsequently resulting in hyperuricemia. We found that estrogens inhibited XO expression and activity, whereas androgens enhanced XO activity, leading to the sex difference in FXR deficiency induced hyperuricemia. Infliximab treatment eliminated the sex difference in uric acid levels in intestinal FXR-knockout mice. This study demonstrated the role of intestinal FXR in the pathogenesis of hyperuricemia, and partially elucidated the mechanisms underlying the sex differences of hyperuricemia.

Wnt/β-catenin and notch signaling pathways in cardiovascular disease: Mechanisms and therapeutics approaches

Wnt and Notch signaling pathways play crucial roles in the development and homeostasis of the cardiovascular system. These pathways regulate important cellular processes in cardiomyocytes, endothelial cells, and smooth muscle cells, which are the key cell types involved in the structure and function of the heart and vasculature. During embryonic development, Wnt and Notch signaling coordinate cell fate specification, proliferation, differentiation, and morphogenesis of the heart and blood vessels. In the adult cardiovascular system, these pathways continue to maintain tissue homeostasis and arrange adaptive responses to various physiological and pathological stimuli. Dysregulation of Wnt and Notch signaling has been involved in the pathogenesis of numerous cardiovascular diseases, including atherosclerosis, hypertension, myocardial infarction, and heart failure. Abnormal activation or suppression of these pathways in specific cell types can contribute to endothelial dysfunction, vascular remodeling, cardiomyocyte hypertrophy, impaired cardiac contractility and dead. Understanding the complex interplay between Wnt and Notch signaling in the cardiovascular system has led to the investigation of these pathways as potential therapeutic targets in clinical trials. In conclusion, this review summarizes the current knowledge on the roles of Wnt and Notch signaling in the development and homeostasis of cardiomyocytes, endothelial cells, and smooth muscle cells. It further discusses the dysregulation of these pathways in the context of major cardiovascular diseases and the ongoing clinical investigations targeting Wnt and Notch signaling for therapeutic intervention.

Association of circadian syndrome with risk of hyperuricemia among middle-aged and older adults in China: The first nationwide cohort study

OBJECTIVES

No studies have been conducted to explore the association of circadian syndrome (CircS) and hyperuricemia. We addressed the gap by investigating the association of CircS and the risk of hyperuricemia among middle-aged and older adults in China.

STUDY DESIGN

Prospective cohort study.

METHODS

We utilized a nationwide cohort from the China Health and Retirement Longitudinal Study, 7009 adults aged at least 45 years were enrolled at baseline in 2011, and 4415 participants followed up to 2015. CircS was assessed using seven components including five components used to define metabolic syndrome and two components of lack of sleep and depression. Multivariable logistic regression analysis was applied to examine the association of CircS and hyperuricemia. Stratified analyses were used to identify the vulnerable subgroup.

RESULTS

Among the 7009 participants (mean age: 60.6 [SD: 9.8] years), 52.8 % were women. Compared to participants without CircS, those with CircS had a higher risk of hyperuricemia (adjusted odds ratio, aOR 2.246, 95 % CI:1.819-2.773). After 4-year follow-up, 457 (10.4 %) cases developed as hyperuricemia. The longitudinal analyses showed that CircS had a higher risk of incident hyperuricemia (aOR 2.136, 1.740-2.620). The association was stronger in women and those with kidney disease. Sensitivity analysis showed that individuals with ≥ six CircS components had the highest risk of hyperuricemia.

CONCLUSIONS

This nationwide cohort first revealed that CircS was related to an increased risk of hyperuricemia among Chinese adults. Our findings provide epidemiological evidence regarding the importance of CircS management as a preventative strategy for hyperuricemia.

The Association of Persistent Hyperuricemia With Liver Function and the Management of Uric Acid Levels: Insights From a Three-Year Prospective Cohort Study

OBJECTIVE

The association of long-term hyperuricemia with liver function remains less well understood. This prospective cohort study aimed to investigate the relationship between hyperuricemia and liver function as well as other metabolic and cardiovascular parameters.

METHODS

We enrolled 375 participants with hyperuricemia and 599 normouricemic controls. Participants were followed up for 3 years, and data on liver indicators, including alanine aminotransferase (ALT), aspartate aminotransferase (AST), and liver ultrasonography were collected. Additionally, we assessed other parameters, such as renal function, lipid profile, blood pressure, fasting blood-glucose (FBG), and body mass index (BMI).

RESULTS

The highest prevalence of hyperuricemia was observed in the 20-29 age groups for the participants. Among the comorbidities of patients with hyperuricemia, the proportion of dyslipidemia is the highest (58.13%), followed by fatty liver (50.13%) and liver function impairment (33.07%). During the three-year follow-up period, compared to the baseline, patients with persistent hyperuricemia showed significant increases in BMI, triglycerides, total cholesterol, AST, and ALT levels (p < 0.05). Meanwhile, patients with improved hyperuricemia for 2 years exhibited significant decreases in FBG, total cholesterol, serum creatinine (p < 0.05), along with a significant increase in eGFR (p < 0.05). Correlation analysis revealed that levels of uric acid were positively correlated with ALT, FBG, and triglycerides in persistent hyperuricemia (p < 0.05).

CONCLUSION

Hyperuricemia shows a notable trend of younger age onset. Persistent hyperuricemia, correlated with elevated ALT levels, indicates an increasing risk of liver damage that should be concerned about. Effective management of hyperuricemia could improve metabolic disorders and renal dysfunction.

Uric acid mediates kidney tubular inflammation through the LDHA/ROS/NLRP3 pathway

PURPOSE

Hyperuricemia (HUA) is an important factor leading to chronic kidney disease (CKD). The kidney tubular inflammatory response is activated in HUA. This study aimed to investigate whether lactate dehydrogenase A (LDHA) is involved in mediating uric acid-induced kidney tubular inflammatory response.

METHODS

In vivo, an HUA mouse model was established by continuous intraperitoneal injection of potassium oxonate (PO) for one week. A total of 18 C57BL/6J male adult mice were divided into three groups: control group, HUA group, and HUA+oxamate group, with six mice in each group. Oxamate was intraperitoneally injected into the mice one hour after PO injection. In vitro, an HUA model was simulated by stimulating HK-2 cells with uric acid. Oxamate and tempol inhibited LDHA and reactive oxygen species (ROS) in HK-2 cells.

RESULTS

In HUA mice, blood uric acid levels were significantly elevated. LDHA in kidney tubular cells was significantly increased in both in vivo and in vitro HUA models, accompanied by an increase in kidney tubular inflammation and ROS. Mechanistically, LDHA mediates uric acid-induced inflammation to kidney tubular cells through the ROS/NLRP3 pathway. Pharmacologic inhibition of LDHA or ROS in kidney tubular cells can significantly ameliorate inflammation response caused by uric acid.

CONCLUSIONS

LDHA in kidney tubular cells significantly was increased in HUA models. LDHA mediates kidney inflammation response induced by uric acid through the ROS/NLRP3 pathway. This study may provide a new intervention target for preventing kidney tubular inflammation caused by uric acid.

Associations of aldehyde exposure with serum uric acid and hyperuricemia among U.S. adults from NHANES 2013-2014

Background

Aldehyde is a kind of important environmental pollutant, which has been demonstrated to be associated with increased risks of various chronic diseases with the economic and social development. However, the effects of aldehydes on serum uric acid (SUA) and hyperuricemia remained inexplicit, and the potential mediating pathways for this relationship needed to be addressed.

Methods

This study investigated the associations of individual and mixed aldehydes with SUA and hyperuricemia among 1588 U S. adults from the National Health and Nutrition Examination Survey 2013-2014. The generalized linear regression model was applied to assess the effects of individual aldehydes and the Bayesian kernel machine regression were incorporated to examine the impacts of mixed aldehydes. Mediation analyses were performed to explore the roles of inflammation and oxidative stress indices in aldehyde-induced SUA and hyperuricemia. Moreover, we conducted subgroup analyses for demographic and physical factors to detect disparity between groups.

Results

Propanaldehyde, butyraldehyde, and hexanaldehyde were associated with higher SUA level and butyraldehyde was correlated with increased hyperuricemia prevalence after multiple correction. Positive relationships between aldehyde mixtures and SUA level were also observed and hexanaldehyde contributed most. In addition, lymphocyte count and gamma glutamyl transferase partially mediated the associations between propanaldehyde, butyraldehyde, hexanaldehyde and SUA level, with mediation proportions ranging from 19.105 % to 27.316 %. Subgroup analyses showed that SUA level of participants with obesity, hypercholesterolemia, and hypertension tended to be more sensitive to aldehyde exposure.

Conclusions

Our results highlighted that multiple aldehydes mixtures exposure might increase SUA level, and revealed underlying mediating role of inflammation and oxidative stress. These findings provided crucial evidence for the impacts of environmental pollutants on human health and further prospective studies are still required to verify the findings.

Nonlinear association between the serum uric acid-to-creatinine ratio and all cause mortality in patients with hypertension: a ten-year cohort study using the NHANES database

The serum uric acid-to-creatinine ratio (UCR) may be a simple method for assessing xanthine oxidase overactivation, which may contribute to an increase in serum uric acid production and oxidative stress. In this study, we investigated the nonlinear association between the UCR and long-term mortality in patients with hypertension. Data were acquired from the National Health and Nutrition Examination Survey database, and a total of 11,346 patients with hypertension were included. We explored the nonlinear link between the UCR and all-cause mortality via spline smoothing, threshold saturation, and log-likelihood ratio tests. The results were validated through a competing risk model. A nonlinear pattern emerged between the UCR and all-cause mortality in hypertensive patients, with an inflection point at 4.3. Below this point, an increased UCR was associated with a decreased mortality risk (OR = 0.80, 95% CI: 0.68-0.94, P = 0.008), whereas above this point, the risk increased (OR = 1.21, 95% CI: 1.07-1.36, P = 0.004). The competing risk model yielded similar findings for cardiovascular and chronic kidney disease-related deaths. In patients with hypertension, the UCR nonlinearly predicted all-cause mortality, with a notable inflection at 4.3. These findings suggest that the UCR is a valuable prognostic indicator for assessing long-term outcomes in patients with hypertension.

Linear and non-linear relationships between red blood cell indices and cardiovascular risk factors: findings from the China National Health Survey

INTRODUCTION

Cardiovascular diseases (CVDs) are a leading cause of mortality worldwide. Red blood cell indices (RBIs) are associated with CVD risk factors (CRFs) and easy to test, making them useful as a screening tool for early identification of individuals at high risk for CVDs.

METHODS

Data from 31,781 participants in the China National Health Survey conducted from 2012 to 2017 were analyzed. Linear and non-linear relationships between RBIs and CRFs (hyperuricemia, diabetes, dyslipidemia) were assessed using restricted cubic splines. Propensity score weighting was used to balance confounders between RBI groups in the multivariable logistic regression models.

RESULTS

Hemoglobin concentration, red blood cell count and hematocrit all showed a significant linear dose-response association with all CRFs (p values < 0.001). Higher RBIs levels were associated with increased risk of hyperuricemia, diabetes, high LDL, high triglycerides, and high total cholesterol, but decreased HDL. For example, compared to the lowest quantile of HGB, the highest quantile had a 26% (13-40%) higher risk for hyperuricemia, a 43% (25-63%) higher risk of diabetes, 87% (61%-1.18 fold) higher risk of high LDL, and 68% (52-85%) higher risk of high triglycerides. Non-linear relationships were revealed between RBIs and most CRFs except uric acid and glucose. Sex differences were observed, with stronger associations between RBIs and hyperuricemia in women but stronger links with high LDL in men.

CONCLUSIONS

Elevated RBIs indicated higher risk of multiple CRFs. These findings suggest incorporating RBIs into CVD screening strategies to facilitate early prevention efforts, with consideration of sex differences.