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Lu Z, Lu F, Zhang R, Guo S. Interaction between anemia and hyperuricemia in the risk of all-cause mortality in patients with chronic kidney disease. Front Endocrinol (Lausanne) 2024; 15:1286206. [PMID: 38586465 PMCID: PMC10998448 DOI: 10.3389/fendo.2024.1286206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 03/04/2024] [Indexed: 04/09/2024] Open
Abstract
Aim Both hyperuricemia and anemia are not only the manifestation of chronic kidney disease (CKD) but also related to its occurrence and development. A recent study has found that there was a synergetic effect between hyperuricemia and anemia on new-onset CKD. Herein we aimed to explore the roles of hyperuricemia and anemia in the all-cause mortality in patients with CKD. Methods Data of adult patients with CKD were extracted from the National Health and Nutrition Examination Surveys (NHANES) database in 2009-2018 in this retrospective cohort study. Weighted univariate and multivariate COX regression analyses were used to investigate the associations of hyperuricemia and anemia with all-cause mortality, and the evaluation indexes were hazard ratios (HRs) and 95% confidence intervals (CIs). The interaction effect between hyperuricemia and anemia on the risk of all-cause mortality was assessed via relative excess risk due to interaction (RERI) and attributable proportion of interaction (AP). Subgroup analyses of age, gender, CVD, hypertension, DM, and cancer were also performed to assess this interaction effect. Results Among 3,678 eligible patients, 819 died from all causes. After adjusting for covariables, we found that CKD patients with anemia (HR = 1.72, 95%CI: 1.42-2.09) or hyperuricemia (HR = 1.21, 95%CI: 1.01-11.45) had a higher risk of all-cause mortality. There was a potential synergetic effect between anemia and hyperuricemia on all-cause mortality, with RERI of 0.630 and AP of 0.291. Moreover, this synergetic effect was also observed in ≥65 years old (AP = 0.330), male (AP = 0.355), hypertension (AP = 0.736), non-hypertension (AP = 0.281), DM (AP = 0.371), and cancer (AP = 0.391) subgroups. Conclusion A potential synergetic effect between anemia and hyperuricemia on all-cause mortality was found in patients with CKD. However, further studies are needed to clarify the causal relationship between them.
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Affiliation(s)
- Zhaoxuan Lu
- Blood Purification Center, Beijing Puren Hospital, Beijing, China
| | - Fangping Lu
- Department of Nephrology, The First Hospital of Tsinghua University, Beijing, China
| | - Ruixue Zhang
- Department of Rheumatology, The First Hospital of Tsinghua University, Beijing, China
| | - Shuting Guo
- Department of Rheumatology, The First Hospital of Tsinghua University, Beijing, China
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Zheng L, Zhu Y, Ma Y, Zhang H, Zhao H, Zhang Y, Yang Z, Liu Y. Relationship between hyperuricemia and the risk of cardiovascular events and chronic kidney disease in both the general population and hypertensive patients: A systematic review and meta-analysis. Int J Cardiol 2024; 399:131779. [PMID: 38218247 DOI: 10.1016/j.ijcard.2024.131779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/05/2024] [Accepted: 01/09/2024] [Indexed: 01/15/2024]
Abstract
BACKGROUND To explore the relationships between hyperuricemia and the risk of cardiovascular diseases (CVD) and chronic kidney disease (CKD) in both the general population and hypertensive patients through meta-analysis. METHODS AND RESULTS We systematically searched PubMed, Embase, and Cochrane Library databases from January 2012. The eligibility criteria were predefined, and quality was assessed using the Newcastle-Ottawa Scale (NOS). Stata 15.1 was used for meta-analysis, heterogeneity and sensitivity analysis. Subgroup analysis was used to explore heterogeneity, funnel plots and Egger tests were used to assesse publication bias and applicability. A total of 10,662 studies were retrieved, 45 of which were included in this meta-analysis utilizing a random effects model. Hyperuricemia was significantly associated with an increased risk of new-onset hypertension (RR = 1.36, 95% CI 1.16-1.59; I2 = 98.8%), total CVD (RR = 1.53, 95% CI 1.23-1.89; I2 = 93.7%), stroke (RR = 1.97, 95% CI 1.71-2.26, I2 = 0.0%), coronary heart disease (CHD) (RR = 1.56, 95% CI 1.06-2.30, I2 = 93.3%), and CKD (RR = 1.71, 95% CI 1.56-1.87; I2 = 87.3%). However, subgroup analysis showed no significant associations between hyperuricemia and hypertension in non-Asian populations (RR = 0.88, 95% CI 0.59-1.33), or between hyperuricemia and CVD with a follow-up duration <5 years (RR = 1.26, 95% CI 0.97-1.63). Among hypertensive patients, hyperuricemia was significantly associated with total CVD (RR = 2.32, 95% CI 1.31-4.12, I2 = 90.2%), but not with stroke (RR = 1.48, 95% CI 0.86-2.55; I2 = 90.7%) or CHD (RR = 1.51, 95% CI 0.98-2.33; I2 = 71.7%). CONCLUSION Hyperuricemia was significantly associated with an increased risk of new-onset hypertension, total CVD, stroke, CHD, and CKD in the general population. Among hypertensive patients, hyperuricemia was associated with an increased risk of CVD but not stroke or CHD alone. REGISTRATION NUMBER CRD42022370692.
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Affiliation(s)
- Li Zheng
- Department of Cardiology, the Sixth Medical Centre, Chinese PLA General Hospital, Beijing 100037, PR China; Department of Cardiology, the First Medical Centre, Chinese PLA General Hospital, Beijing 100853, PR China; School of Medicine, Nankai University, Tianjin 300071, China
| | - Yue Zhu
- Department of Cardiology, the Sixth Medical Centre, Chinese PLA General Hospital, Beijing 100037, PR China; Department of Cardiology, the First Medical Centre, Chinese PLA General Hospital, Beijing 100853, PR China
| | - Yuhan Ma
- Department of Cardiology, the Sixth Medical Centre, Chinese PLA General Hospital, Beijing 100037, PR China; Department of Cardiology, the First Medical Centre, Chinese PLA General Hospital, Beijing 100853, PR China; School of Medicine, Nankai University, Tianjin 300071, China
| | - Honghong Zhang
- Department of Cardiology, the Sixth Medical Centre, Chinese PLA General Hospital, Beijing 100037, PR China; Department of Cardiology, the First Medical Centre, Chinese PLA General Hospital, Beijing 100853, PR China
| | - Haijing Zhao
- Department of Cardiology, the Sixth Medical Centre, Chinese PLA General Hospital, Beijing 100037, PR China; Department of Cardiology, the First Medical Centre, Chinese PLA General Hospital, Beijing 100853, PR China
| | - Yingyue Zhang
- Department of Cardiology, the Sixth Medical Centre, Chinese PLA General Hospital, Beijing 100037, PR China; Department of Cardiology, the First Medical Centre, Chinese PLA General Hospital, Beijing 100853, PR China
| | - Zeng'ao Yang
- Department of Cardiology, the Sixth Medical Centre, Chinese PLA General Hospital, Beijing 100037, PR China; South China University of Technology, Guangzhou 510006, PR China
| | - Yuqi Liu
- Department of Cardiology, the Sixth Medical Centre, Chinese PLA General Hospital, Beijing 100037, PR China; Department of Cardiology, the First Medical Centre, Chinese PLA General Hospital, Beijing 100853, PR China; National Key Laboratory of Kidney Diseases, Beijing 100853, PR China; Department of Cardiology, National Clinical Research Center of Geriatric Disease, Beijing 100853, PR China; Beijing Key Laboratory of Chronic Heart Failure Precision Medicine, Beijing 100853, PR China.
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Georgoulis M, Mikhailidis DP, Panagiotakos DB. Are serum uric acid levels predictors of cardiovascular risk? An update. Curr Opin Cardiol 2023; 38:337-343. [PMID: 36789778 DOI: 10.1097/hco.0000000000001029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
PURPOSE OF REVIEW The aim of this review was to update the evidence regarding the link between serum uric acid and cardiovascular risk, as well as the role of nutrition in the prevention and management of hyperuricaemia. RECENT FINDINGS The review focuses on recent epidemiological evidence concerning the role of elevated serum uric acid levels in cardiovascular risk prediction. The dietary prevention and management of hyperuricaemia is also discussed with an emphasis on the adoption of prudent dietary patterns. SUMMARY There is evidence supporting that elevated serum uric acid levels are positively associated with cardiovascular disease risk and might represent a useful additional marker for risk stratification. The association of serum uric acid with all-cause and cardiovascular mortality seems to be U-shaped, suggesting that both very low and very high serum uric acid levels might be detrimental for survival, the former being mediated by malnutrition. Apart from medication, the dietary management of hyperuricaemia should focus on the adoption of a prudent dietary pattern, such as the Mediterranean diet, which can both prevent gout and mitigate cardiometabolic risk.
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Affiliation(s)
- Michael Georgoulis
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Athens, Greece
| | - Dimitri P Mikhailidis
- Department of Clinical Biochemistry and Department Surgical Biotechnology, Division of Surgery and Interventional Science, Medical School, University College London (UCL), London, UK
| | - Demosthenes B Panagiotakos
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Athens, Greece
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Han Y, Lu X, Xiao S, Qin J, Zheng L, Feng Y, Cai Y, Qiu R, Huang Q, Yang M. Association between serum uric acid level and systemic lupus erythematosus kidney outcome: An observational study in Southern Chinese population and a meta-analysis. Lupus 2023; 32:83-93. [PMID: 36396610 DOI: 10.1177/09612033221140267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The study aimed to explore the effect of serum uric acid (SUA) level on the progression of kidney function in systemic lupus erythematosus (SLE) patients. METHODS A total of 123 biopsy-proven lupus nephritis (LN) patients were included in this retrospective observational study. Cox proportional hazard regression analyses as well as restricted cubic spline analyses were performed to identify predictors of renal outcome in LN patients. We also performed a systematic review and meta-analysis for SUA and overall kidney outcomes in SLE patients. RESULTS Based on the laboratory tests at renal biopsy, 72 (58.5%) of the 123 patients had hyperuricemia. The median (IQR) follow-up duration was 3.67 years (1.79-6.63 years), and a total of 110 (89.4%) patients experienced progression of LN. Increased serum uric acid level, whether analyzed as continuous or categorical variable, was associated with higher risk of LN progression in Cox proportional hazard regression model (hazard ratio [HR]: 1.003, 95% confidence interval [CI]: 1.001-1.005; HR: 1.780, 95% CI: 1.201-2.639, respectively). This relationship maintained in women (HR: 1.947, 95% CI: 1.234-3.074) but not men (HR: 2.189, 95% CI: 0.802-5.977). The meta-analysis showed a similar result that both continuous and categorical SUA were positively associated with the risk of kidney function progression in LN (weighted mean difference [WMD]: 1.73, 95% CI: 0.97-2.49; odds ratio [OR]: 1.55, 95% CI: 1.20-2.01, respectively). CONCLUSIONS Our study found overall and especially in women that higher SUA in LN patients were associated with increased risk of renal progression. Meta-analysis yielded consistent results. Future studies are required to establish if uric acid can be used as a biomarker for risk assessment and/or as a novel therapeutic target in SLE.
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Affiliation(s)
- Yipeng Han
- Department of Rheumatology and Immunology, Nanfang Hospital, 198153Southern Medical University, Guangzhou, China
| | - Xiaoxi Lu
- Department of Rheumatology and Immunology, Nanfang Hospital, 198153Southern Medical University, Guangzhou, China
| | - Shibai Xiao
- Department of Rheumatology and Immunology, Nanfang Hospital, 198153Southern Medical University, Guangzhou, China
| | - Jiayu Qin
- Department of Rheumatology and Immunology, Nanfang Hospital, 198153Southern Medical University, Guangzhou, China
| | - Lijuan Zheng
- Department of Rheumatology and Immunology, Nanfang Hospital, 198153Southern Medical University, Guangzhou, China
| | - Yi Feng
- Department of Rheumatology and Immunology, Nanfang Hospital, 198153Southern Medical University, Guangzhou, China
| | - Yujie Cai
- Department of Rheumatology and Immunology, Nanfang Hospital, 198153Southern Medical University, Guangzhou, China
| | - Rong Qiu
- Department of Rheumatology and Immunology, Nanfang Hospital, 198153Southern Medical University, Guangzhou, China
| | - Qin Huang
- Department of Rheumatology and Immunology, Nanfang Hospital, 198153Southern Medical University, Guangzhou, China
| | - Min Yang
- Department of Rheumatology and Immunology, Nanfang Hospital, 198153Southern Medical University, Guangzhou, China
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Ding Z, Fan Y, Yao C, Gu L. The association between the serum uric acid to creatinine ratio and all-cause mortality in elderly hemodialysis patients. BMC Nephrol 2022; 23:177. [PMID: 35524224 PMCID: PMC9077848 DOI: 10.1186/s12882-022-02798-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 04/21/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Elderly hemodialysis patients have a higher rate of mortality than nonelderly hemodialysis patients. Recent studies shown that the serum uric acid to creatinine ratio (SUA/Scr) was associated with all-cause mortality in general adults. The purpose of the present study was to investigate the association between the SUA/Scr and all-cause and cardiovascular disease mortality among elderly hemodialysis patients. METHODS A total of 222 patients (≥ 60 years) who received hemodialysis more than 8 h per week at Taizhou Second People's Hospital for at least 3 months were enrolled in the present study from January 2015 to December 2019. Clinical characteristics including age, sex and height et. al, were obtained from the hemodialysis database. The laboratory data, including albumin (ALB), total cholesterol (TC), serum uric acid (SUA), serum creatinine (Scr) and so on, were collected before hemodialysis and analyzed by automatic biochemical analyzer. Survival information was recorded during the follow-up period. Multiple Cox regression was carried out to analyze the association between SUA/Scr and all-cause mortality. The survival rate of each group was calculated by the Kaplan-Meier method, and the ratio of survival curves was analyzed by the log-rank test. The contribution of SUA/Scr for predicting all-cause mortality risk was evaluated by net reclassification improvement (NRI). RESULTS During the 19-month observation period, 78 patients died. Individuals in the nonsurviving group had significantly older ages (P < 0.001), body mass index (BMI) (P = 0.004), serum creatinine (P = 0.005) and prealbumin (P = 0.006) than surviving patients. After adjusting for age, sex, BMI, prealbumin, dialysis vintage, dialysis frequency, single-pool Kt/V (spKt/V), DM, hypertension and comorbidities, a higher ratio of SUA/Scr was independently associated with a higher risk of all-cause mortality (HR: 1.292; 95% CI: 1.013-1.648; P = 0.039). The predict value on all-cause mortality of SUA/Scr was superior to SUA (additive NRI = 0.214, P = 0.015) and Scr (additive NRI = 0.476, P < 0.001) among elderly hemodialysis patients. CONCLUSION The serum uric acid to creatinine ratio is strongly associated with all-cause mortality in elderly hemodialysis patients which is more predictive than SUA or Scr alone.
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Affiliation(s)
- Zhihui Ding
- Department of Nephrology, Taizhou Second People's Hospital, Taizhou, China
| | - Yao Fan
- Division of Clinical Epidemiology, Affiliated Geriatric Hospital of Nanjing Medical University, Nanjing, China
| | - Chunlei Yao
- Department of Nephrology, Taizhou Second People's Hospital, Taizhou, China.
| | - Liubao Gu
- Division of Clinical Epidemiology, Affiliated Geriatric Hospital of Nanjing Medical University, Nanjing, China.
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