1
|
Timsans J, Palomäki A, Kauppi M. Gout and Hyperuricemia: A Narrative Review of Their Comorbidities and Clinical Implications. J Clin Med 2024; 13:7616. [PMID: 39768539 PMCID: PMC11678569 DOI: 10.3390/jcm13247616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2024] [Revised: 11/09/2024] [Accepted: 12/11/2024] [Indexed: 01/11/2025] Open
Abstract
Gout is the most common form of inflammatory arthritis, caused by the deposition of monosodium urate crystals in the joints due to elevated serum uric acid levels. Its prevalence and associated healthcare burden have been rising in recent decades, a trend expected to continue. It is crucial to recognize that gout and hyperuricemia are not merely causes of painful joint flares, but systemic metabolic disorders linked to a broad spectrum of comorbidities such as cardiovascular diseases, chronic kidney disease, diabetes, insulin resistance, steatotic liver disease, osteoarthritis, and respiratory and eye diseases. Numerous risk factors for gout and hyperuricemia have been identified, with recent research uncovering further associations with other conditions. To optimize patient outcomes, gout and hyperuricemia must be addressed through a holistic approach that accounts for these risk factors while providing comprehensive management of related comorbidities affecting various organ systems. This review summarizes the current knowledge on the risk factors, comorbidities, and clinical implications of gout and hyperuricemia. Future research should focus on improving patient outcomes by tailoring treatments individually and addressing the underlying metabolic comorbidities of gout with multimodal treatment.
Collapse
Affiliation(s)
- Janis Timsans
- Department of Rheumatology, Päijät-Häme Central Hospital, Wellbeing Services County of Päijät-Häme, 15850 Lahti, Finland;
- Faculty of Medicine and Health Technology, Tampere University, 33100 Tampere, Finland
| | - Antti Palomäki
- Centre for Rheumatology and Clinical Immunology, Turku University Hospital, 20521 Turku, Finland
- Department of Medicine, University of Turku, 20014 Turku, Finland
| | - Markku Kauppi
- Department of Rheumatology, Päijät-Häme Central Hospital, Wellbeing Services County of Päijät-Häme, 15850 Lahti, Finland;
- Clinicum, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland
| |
Collapse
|
2
|
Timsans J, Kauppi JE, Kerola AM, Lehto TM, Kautiainen HJ, Kauppi MJ. Hyperuricaemia-associated all-cause mortality risk effect is increased by non-impaired kidney function - Is renal hyperuricaemia less dangerous? Eur J Intern Med 2024; 121:56-62. [PMID: 37852840 DOI: 10.1016/j.ejim.2023.10.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 09/19/2023] [Accepted: 10/04/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Both hyperuricaemia and chronic kidney disease are known mortality risk factors. This study examined the modifying effect of renal function on hyperuricaemia-associated mortality risk, which is an issue that has not been studied before. METHODS Data on levels of serum uric acid (SUA), creatinine, cystatin C and other variables of persons aged 52-76 years were collected. Persons with SUA >410 μmol/L (75th percentile) were classified as clearly hyperuricaemic and persons with eGFR of ≤67 ml/min (25th percentile) as having reduced kidney function. RESULTS Reduced kidney function was associated with higher mortality in both SUA groups. When compared to individuals with SUA ≤410 μmol/L and eGFR >67 ml/min the hazard ratio (HR) for all-cause mortality was 1.53 (95 % CI: 1.26-1.84) in clearly hyperuricaemic persons with reduced kidney function, 1.26 (95 % CI: 1.02-1.55) in clearly hyperuricaemic persons with eGFR of >67 ml/min and 1.15 (95 % CI: 0.96-1.39) in persons with SUA ≤410 μmol/L and reduced kidney function. The HR for hyperuricaemia-related premature death was lowest in individuals with reduced eGFR, and it rose strikingly as the eGFR increased above 90 ml/min. CONCLUSIONS Reduced kidney function is a risk factor for mortality both in individuals with normal and elevated SUA. The hyperuricaemia-associated mortality risk is remarkably higher in individuals with normal kidney function than in individuals with reduced kidney function. Presumably overproduction of uric acid (metabolic hyperuricaemia) is a separate and more deleterious entity than hyperuricaemia resulting from reduced renal excretion of uric acid (renal hyperuricaemia).
Collapse
Affiliation(s)
- Janis Timsans
- Department of Rheumatology, Päijät-Häme Central Hospital, Lahti, Finland.
| | - Jenni Emilia Kauppi
- Unit of Physiatry and Rehabilitation Medicine, Päijät-Häme Central Hospital, Lahti, Finland
| | - Anne Mirjam Kerola
- Department of Rheumatology, Päijät-Häme Central Hospital, Lahti, Finland; Inflammation Center, Rheumatology, Helsinki University Hospital, Helsinki, Finland; University of Helsinki, Helsinki, Finland
| | - Tiina Maarit Lehto
- Department of Clinical Chemistry, Fimlab Laboratoriot Oy, Lahti, Finland
| | | | - Markku Jaakko Kauppi
- Department of Rheumatology, Päijät-Häme Central Hospital, Lahti, Finland; University of Helsinki, Helsinki, Finland
| |
Collapse
|
3
|
Zhou Q, Ke S, Yan Y, Guo Y, Liu Q. Serum uric acid is associated with chronic kidney disease in elderly Chinese patients with diabetes. Ren Fail 2023; 45:2238825. [PMID: 37488934 PMCID: PMC10599260 DOI: 10.1080/0886022x.2023.2238825] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 07/15/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND The relationship between hyperuricemia and chronic kidney disease (CKD) has been investigated extensively. However, studies on elderly individuals are still limited. Moreover, there is no consensus on whether hyperuricemia or elevated serum uric acid (SUA) within the normal range is correlated with the new onset of CKD and whether there are differences between males and females. METHODS We included 39039 elderly diabetic patients without CKD at baseline from a community-based cohort in Wuhan, China. The outcome event was the new onset of CKD (defined as an estimated glomerular filtration rate < 60 mL/min/1.73 m2). Multivariate Cox models were used to assess the adjusted hazard ratio (HR). RESULTS During the 2-year follow-up period, 3162 (8.10%) patients with diabetes developed new-onset CKD. The optimal cutoff value of SUA for incident CKD was 347.4 μmol/L. The adjusted HRs of hyperuricemia for new-onset CKD were 1.925 (1.724-2.150) and 1.676 (1.520-1.848) for males and females, respectively. The risk of developing CKD increased across the Q4 group up to 2.242 times for their counterparts in the lowest SUA quartile, independent of age, sex, diabetes duration, obesity, hypertension, systolic blood pressure, diastolic blood pressure, smoking, drinking, dyslipidemia, triglyceride, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and fasting plasma glucose. CONCLUSIONS Hyperuricemia is an independent predictor of incident CKD. Elevated SUA was linearly correlated with CKD in elderly patients with diabetes, showing a relatively higher intensity among males compared with that among females. The optimal cutoff value of SUA for the risk of new-onset CKD in elderly patients with diabetes was 347.4 μmol/L.
Collapse
Affiliation(s)
- Qing Zhou
- Department of Epidemiology, School of Public Health, Wuhan University, Wuhan, Hubei, P.R. China
| | - Sisi Ke
- Wuhan Centers for Disease Control & Prevention, Wuhan, Hubei, P.R. China
| | - Yaqiong Yan
- Wuhan Centers for Disease Control & Prevention, Wuhan, Hubei, P.R. China
| | - Yan Guo
- Wuhan Centers for Disease Control & Prevention, Wuhan, Hubei, P.R. China
| | - Qing Liu
- Department of Epidemiology, School of Public Health, Wuhan University, Wuhan, Hubei, P.R. China
| |
Collapse
|
4
|
Timsans J, Kauppi JE, Kerola AM, Lehto TM, Kautiainen H, Kauppi MJ. Hyperuricaemia: prevalence and association with mortality in an elderly Finnish population. BMJ Open 2023; 13:e072110. [PMID: 37137562 PMCID: PMC10163549 DOI: 10.1136/bmjopen-2023-072110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
Abstract
OBJECTIVE To establish the prevalence of hyperuricaemia in an elderly Finnish cohort and to assess its association with comorbidities and mortality. DESIGN Prospective cohort study. SETTING Good Ageing in Lahti Region study, Finland 2002-2012 (mortality data analysed until 2018). PARTICIPANTS 2673 participants (mean age 64 years; 47% men). PRIMARY AND SECONDARY OUTCOME MEASURES Prevalence of hyperuricaemia in the study population was detected. Associations between hyperuricaemia and mortality were assessed using multivariable adjusted Cox proportional hazards models. METHODS Data from a prospective, population-based study of elderly people (52-76 years) in the Lahti region, Finland, were used. Information on serum uric acid (SUA) levels as well as several other laboratory variables, comorbidities, lifestyle habits and socioeconomic factors was collected, and the association between SUA level and mortality in a 15-year follow-up period was analysed. RESULTS Of 2673 elderly Finnish persons included in the study 1197 (48%) were hyperuricaemic. Hyperuricaemia was extremely prevalent in men (60%). There was an association between elevated SUA and mortality which remained after adjustment for potential confounding factors (age, gender, education, smoking status, body mass index, hypertension and dyslipidaemia). The adjusted HR for all-cause mortality among clearly hyperuricaemic individuals with SUA≥420 µmol/L compared with normouricaemic individuals (SUA<360 µmol/L) was 1.32 (95% CI 1.05 to 1.60) in women and 1.29 (95% CI 1.05 to 1.60) in men. In slightly hyperuricaemic individuals (SUA 360-420 µmol/L) the corresponding HRs were 1.03 (95% CI 0.78 to 1.35) and 1.11 (95% CI 0.89 to 1.39). CONCLUSIONS Hyperuricaemia is very prevalent in the elderly Finnish population and is independently associated with increased mortality.
Collapse
Affiliation(s)
- Janis Timsans
- Department of Rheumatology, Päijät-Häme Central Hospital, Lahti, Finland
- Centre for Rheumatic Diseases, Tampere University Hospital, Tampere, Finland
| | - Jenni Emilia Kauppi
- Unit of Physiatry and Rehabilitation Medicine, Päijät-Häme Central Hospital, Lahti, Finland
- University of Helsinki, Helsinki, Finland
| | - Anne Mirjam Kerola
- University of Helsinki, Helsinki, Finland
- Inflammation Center, Helsinki University Central Hospital, Helsinki, Finland
| | - Tiina Maarit Lehto
- Department of Clinical Chemistry, Fimlab Laboratoriot Oy, Lahti, Finland
| | - Hannu Kautiainen
- University of Helsinki, Helsinki, Finland
- Folkhälsan Research Center, Helsinki, Finland
| | - Markku Jaakko Kauppi
- Department of Rheumatology, Päijät-Häme Central Hospital, Lahti, Finland
- University of Helsinki, Helsinki, Finland
| |
Collapse
|
5
|
Miake J, Hisatome I, Tomita K, Isoyama T, Sugihara S, Kuwabara M, Ogino K, Ninomiya H. Impact of Hyper- and Hypo-Uricemia on Kidney Function. Biomedicines 2023; 11:biomedicines11051258. [PMID: 37238929 DOI: 10.3390/biomedicines11051258] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 04/18/2023] [Accepted: 04/19/2023] [Indexed: 05/28/2023] Open
Abstract
Uric acid (UA) forms monosodium urate (MSU) crystals to exert proinflammatory actions, thus causing gout arthritis, urolithiasis, kidney disease, and cardiovascular disease. UA is also one of the most potent antioxidants that suppresses oxidative stress. Hyper andhypouricemia are caused by genetic mutations or polymorphism. Hyperuricemia increases urinary UA concentration and is frequently associated with urolithiasis, which is augmented by low urinary pH. Renal hypouricemia (RHU) is associated with renal stones by increased level of urinary UA, which correlates with the impaired tubular reabsorption of UA. Hyperuricemia causes gout nephropathy, characterized by renal interstitium and tubular damage because MSU precipitates in the tubules. RHU is also frequently associated with tubular damage with elevated urinary beta2-microglobulin due to increased urinary UA concentration, which is related to impaired tubular UA reabsorption through URAT1. Hyperuricemia could induce renal arteriopathy and reduce renal blood flow, while increasing urinary albumin excretion, which is correlated with plasma xanthine oxidoreductase (XOR) activity. RHU is associated with exercise-induced kidney injury, since low levels of SUA could induce the vasoconstriction of the kidney and the enhanced urinary UA excretion could form intratubular precipitation. A U-shaped association of SUA with organ damage is observed in patients with kidney diseases related to impaired endothelial function. Under hyperuricemia, intracellular UA, MSU crystals, and XOR could reduce NO and activate several proinflammatory signals, impairing endothelial functions. Under hypouricemia, the genetic and pharmacological depletion of UA could impair the NO-dependent and independent endothelial functions, suggesting that RHU and secondary hypouricemia might be a risk factor for the loss of kidney functions. In order to protect kidney functions in hyperuricemic patients, the use of urate lowering agents could be recommended to target SUA below 6 mg/dL. In order to protect the kidney functions in RHU patients, hydration and urinary alkalization may be recommended, and in some cases an XOR inhibitor might be recommended in order to reduce oxidative stress.
Collapse
Affiliation(s)
- Junichiro Miake
- Division of Pharmacology, Department of Pathophysiological and Therapeutic Science, Tottori University Faculty of Medicine, Tottori 683-8503, Japan
| | - Ichiro Hisatome
- Department of Cardiology, Yonago Medical Center, Tottori 683-0006, Japan
| | - Katsuyuki Tomita
- Department of Respiratory Disease, Yonago Medical Center, Tottori 683-0006, Japan
| | - Tadahiro Isoyama
- Department of Urology, Yonago Medical Center, Tottori 683-0006, Japan
| | - Shinobu Sugihara
- Health Service Center, Shimane University, Matsue 690-0823, Japan
| | - Masanari Kuwabara
- Intensive Care Unit and Department of Cardiology, Toranomon Hospital, Tokyo 105-8470, Japan
| | - Kazuhide Ogino
- Department of Cardiology, Tottori Red Cross Hospital, Tottori 680-0017, Japan
| | - Haruaki Ninomiya
- Department of Biological Regulation, Tottori University Faculty of Medicine, Tottori 683-8503, Japan
| |
Collapse
|
6
|
Yu X, Gu M, Zhu Y, Zhang L, Kong W, Zou Y. Efficacy of Urate-Lowering Therapy in Patients With Chronic Kidney Disease: A Network Meta-Analysis of Randomized Controlled Trials. Clin Ther 2022; 44:723-735.e6. [PMID: 35610080 DOI: 10.1016/j.clinthera.2022.03.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 03/22/2022] [Accepted: 03/28/2022] [Indexed: 01/22/2023]
Abstract
PURPOSE The goal of this study was to systematically review the efficacy and safety of urate-lowering therapy in patients with chronic kidney disease (CKD). METHODS PubMed, the Cochrane Central Registration of Controlled Trials, and EMBASE databases and several websites were electronically searched to collect randomized clinical trials on the efficacy of urate-lowering therapy in CKD from inception to December 31, 2020. The key primary end points were uric acid or estimated glomerular filtration rate (eGFR) levels; the safety end points were death, renal event, cardiovascular event, and gastrointestinal event. A Bayesian network meta-analysis was conducted with the use of ADDIS and R software. FINDINGS A total of 17 randomized clinical trials involving 2059 patients were included. The results of network meta-analysis showed that urate-lowering therapy could reduce urate levels in patients with CKD. Febuxostat was the most effective treatment in lowering urate levels according to the rank probability. Urate-lowering therapy has the tendency to delay the decline of eGFR, but the difference was not statistically significant. Ranking probability showed that benzbromarone, febuxostat, and allopurinol ranked higher than placebo in reducing the decline of eGFR. There were no statistically significant differences between groups in the incidence of all adverse effects. IMPLICATIONS All urate-lowering therapies could reduce the urate level in patients with CKD, but the benefit of such therapy in renal disease is still unclear. PROSPERO identifier: CRD42020222601.
Collapse
Affiliation(s)
- Xiang Yu
- Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu, China
| | - Mingjia Gu
- Changshu Hospital affiliated to Nanjing University of Chinese Medicine, Jiangsu, China
| | - Yiye Zhu
- Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu, China
| | - Lixiang Zhang
- Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu, China
| | - Wei Kong
- Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Jiangsu, China
| | - Yanqin Zou
- Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu, China.
| |
Collapse
|
7
|
Yan M, Liu Y, Wu L, Liu H, Wang Y, Chen F, Pei L, Zhao Y, Zeng L, Dang S, Yan H, Mi B. The Association between Dietary Purine Intake and Mortality: Evidence from the CHNS Cohort Study. Nutrients 2022; 14:1718. [PMID: 35565687 PMCID: PMC9102343 DOI: 10.3390/nu14091718] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/16/2022] [Accepted: 04/18/2022] [Indexed: 02/01/2023] Open
Abstract
Objectives: To investigate the association between dietary purine intake and mortality among Chinese adults. Methods: Based on data from the 2004−2015 China Health and Nutrition Survey (CHNS) and the corresponding edition of China Food Composition, the average purine intake per day (mg/day) from 2004 to 2011 was calculated, and the surveyed population was divided into five groups by quintiles. The outcome event and timepoint of concern were defined as death and time, respectively, as reported by family members, recorded until the 2015 survey. Cox proportional hazards regression was used to estimate the hazard ratios (HRs) with 95% confidence intervals (CIs) for death. The possibly nonlinear relationship between purine intake and mortality was examined with restricted cubic splines. Results: We included 17,755 subjects, and the average purine intake among them was 355.07 ± 145.32 mg/day. Purine intake was inversely associated with mortality (Ptrend < 0.001). Compared with the lowest quintiles of purine intake, the highest quintiles (HR = 0.60; 95% CI: 0.46, 0.77) showed a significant association with lower mortality. The negative association with mortality was mainly found in plant-derived purine (Ptrend = 0.001) and, weakly, in animal-derived purine (Ptrend = 0.052). In addition, a U-shaped relationship between purine intake and mortality was observed in males; however, there was no statistically significant dose−response relationship in females. Conclusion: Considering the low-purine-intake levels of the Chinese population, we observed a U-shaped relationship between purine intake and mortality in males, but purine intake may not relate to mortality in females. Future studies should investigate the causal relationship between purine intake and disease burden in China.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Baibing Mi
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, No.76, Yanta West Road, Xi’an 710061, China; (M.Y.); (Y.L.); (L.W.); (H.L.); (Y.W.); (F.C.); (L.P.); (Y.Z.); (L.Z.); (S.D.); (H.Y.)
| |
Collapse
|
8
|
Koo BS, Kim D, Jun JB. Reliability and Quality of Korean YouTube Videos for Education Regarding Gout. J Korean Med Sci 2021; 36:e303. [PMID: 34811977 PMCID: PMC8608924 DOI: 10.3346/jkms.2021.36.e303] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 10/07/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND YouTube has become an increasingly popular educational tool and an important source of healthcare information. We investigated the reliability and quality of the information in Korean-language YouTube videos about gout. METHODS We performed a comprehensive electronic search on April 2, 2021, using the following keywords-"gout," "acute gout," "gouty arthritis," "gout treatment," and "gout attack"-and identified 140 videos in the Korean language. Two rheumatologists then categorized the videos into three groups: "useful," "misleading," and "personal experience." Reliability was determined using a five-item questionnaire modified from the DISCERN validation tool, and overall quality scores were based on the Global Quality Scale (GQS). RESULTS Among the 140 videos identified, 105 (75.0%), 29 (20.7%), and 6 (4.3%) were categorized as "useful," "misleading," and "personal experience," respectively. Most videos in the "useful" group were created by rheumatologists (70.5%). The mean DISCERN and GQS scores in the "useful" group (3.3 ± 1.0 and 3.8 ± 0.7) were higher than those in the "misleading" (0.9 ± 1.0 and 1.9 ± 0.6) and "personal experience" groups (0.8 ± 1.2 and 2.0 ± 0.8) (P < 0.001 for both the DISCERN and GQS tools). CONCLUSION Approximately 75% of YouTube videos that contain educational material regarding gout were useful; however, we observed some inaccuracies in the medical information provided. Healthcare professionals should closely monitor media content and actively participate in the development of videos that provide accurate medical information.
Collapse
Affiliation(s)
- Bon San Koo
- Department of Internal Medicine, Inje University Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Dam Kim
- Division of Rheumatology, Department of Internal Medicine, Myongji Hospital, Hanyang University College of Medicine, Goyang, Korea
| | - Jae-Bum Jun
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea.
| |
Collapse
|
9
|
Koo BS, Jeong HJ, Son CN, Kim SH, Kim GH, Jun JB. J-shaped Relationship Between Chronic Kidney Disease and Serum Uric Acid Levels: A Cross-sectional Study on the Korean Population. JOURNAL OF RHEUMATIC DISEASES 2021; 28:225-233. [PMID: 37476359 PMCID: PMC10324904 DOI: 10.4078/jrd.2021.28.4.225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/05/2021] [Accepted: 06/08/2021] [Indexed: 07/22/2023]
Abstract
Objective Both hypouricemia and hyperuricemia are reportedly associated with reduced kidney function This study investigated the association between uric acid levels and the risk of reduced renal function in men and women. Methods We conducted a cross-sectional study using data from a government-funded health examinee cohort of a Korean genome and epidemiological study A total of 172,970 participants (58,981 men, 113,989 women) aged 40∼79 years were included A logistic regression test was performed, and the odds ratio (OR) and 95% confidence interval (CI) were calculated to examine the relationship between stratified uric acid levels and the frequency of chronic kidney disease. Results As the uric acid level increased, the risk of reduced renal function increased Moreover, for uric acid levels ≤20 mg/dL, the risk of reduced renal function was higher than that of the reference group Among the total, man, and woman groups, a statistically significant association was observed in men (OR 171, 95% CI 0945∼3111, OR 5003, 95% CI 1405∼17809, and OR 1377, 95% CI 0696∼2724, respectively). Conclusion The OR of reduced renal function according to uric acid levels formed a J-shaped curve in both genders.
Collapse
Affiliation(s)
- Bon San Koo
- Department of Internal Medicine, Inje University Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Hye-Jin Jeong
- Department of Rheumatology, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Chang-Nam Son
- Department of Rheumatology, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Sang-Hyon Kim
- Department of Rheumatology, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Gheun-Ho Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Jae-Bum Jun
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| |
Collapse
|
10
|
Cang Y, Xu S, Zhang J, Ju J, Chen Z, Wang K, Li J, Xu Y. Serum Uric Acid Revealed a U-Shaped Relationship With All-Cause Mortality and Cardiovascular Mortality in High Atherosclerosis Risk Patients: The ASSURE Study. Front Cardiovasc Med 2021; 8:641513. [PMID: 34109223 PMCID: PMC8180559 DOI: 10.3389/fcvm.2021.641513] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 03/23/2021] [Indexed: 12/22/2022] Open
Abstract
Background: Previous studies have demonstrated an association between hyperuricemia and cardiovascular disease (CVD). The Framingham study confirmed that patients with high atherosclerotic risks (HARs) had worse prognoses. However, after adjusting for confounding factors, the association between serum uric acid (SUA) and all-cause mortality and cardiovascular mortality remains unclear, especially for HAR patients. Objective: The aim of this study was to reveal the relationship of SUA with all-cause and cardiovascular mortality in HAR patients. Methods: This multicenter cohort study enrolled 3,047 participants, and the follow-up was 68.85 ± 11.37 months. Factors related to cardiovascular and all-cause mortality were tested by multivariate Cox regression analysis. Restricted cubic splines (RCSs) with knots were used to explore the shape of the dose-response relationship with SUA and the hazard ratio (HR) of all-cause and CVD mortality. SUA transformed by RCS was added to the Cox regression model as an independent variable, and all-cause and CVD mortality scores were calculated. Survival receiver operating characteristic curves were produced using a regression model predicting the score. Results: SUA demonstrated a "U-shaped" relationship with all-cause and cardiovascular mortality. SUA predicted all-cause and CVD mortality, with cutoff values of values of >370.5 μmol/L for males and >327.65 μmol/L for females and <180.5 μmol/L for males and <165.7 μmol/L for females, respectively. The survival ROC curve indicated that SUA is able to predict all-cause and CVD mortality, with areas under the curve of 0.702 and 0.711, respectively. The HRs of all-cause mortality (male and female) with hyperuricemia and hypouricemia were 2.08 and 2.01 and 2.04 and 1.98, respectively, and the HRs of CVD mortality (male and female) were 2.09 and 1.79, and 2.02 and 1.89, respectively. Conclusion: Abnormal SUA levels were significant and independent risk factors for all-cause and CVD mortality. Hyperuricemia and hypouricemia increased mortality in both males and females. Routine SUA evaluation and intensive management are needed for HAR patients. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT03616769.
Collapse
Affiliation(s)
- Yan Cang
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Shaojie Xu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jingyin Zhang
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jingyi Ju
- Tongji University School of Medicine, Shanghai, China
| | - Zijun Chen
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.,Department of Cardiology, Clinical Medical College of Shanghai Tenth People's Hospital, Medical Department of Soochow University, Suzhou, China
| | - Keke Wang
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jue Li
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.,Tongji University School of Medicine, Shanghai, China
| | - Yawei Xu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| |
Collapse
|
11
|
Zhang J, Lu X, Li H, Wang S. Serum Uric Acid and Mortality in Patients with Chronic Kidney Disease: A Systematic Review and Meta-Analysis. Blood Purif 2021; 50:758-766. [PMID: 33744888 DOI: 10.1159/000513944] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 12/16/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Existing studies suggested conflicting relationships between serum uric acid (SUA) and mortality in CKD patients. The present meta-analysis aimed to determine whether SUA can be a predictor for mortality in CKD cohorts. METHOD A systematical search was conducted on PubMed, EMBASE, and The Cochrane Library to identify studies reporting the relationship between SUA level and all-cause and cardiovascular mortality in CKD populations. In addition, random-effects models were adopted to calculate the hazard ratios (HRs) and corresponding 95% confidence intervals (CIs). RESULTS On the whole, 29 studies were involved. In the present meta-analysis, patients exhibiting the maximum SUA level showed an association with a significantly higher risk for all-cause mortality (HR, 1.30; 95% CI, 1.06-1.59) compared with patients exhibiting the minimum SUA level. As revealed from the meta-analysis of 8 studies, low level of SUA was another predictor for all-cause mortality in patients with CKD (HR, 1.36; 95% CI, 1.20-1.54). No significant relationship was identified between SUA and cardiovascular mortality. CONCLUSIONS Higher and lower SUA levels are both associated with significantly increased risk of all-cause mortality in patients with CKD. A appreciate dose of treatment of lowering SUA agents should be confirmed.
Collapse
Affiliation(s)
- Jialing Zhang
- Department of Blood Purification, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xiangxue Lu
- Department of Blood Purification, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Han Li
- Department of Blood Purification, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China,
| | - Shixiang Wang
- Department of Blood Purification, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
12
|
Tanaka K, Yamanaga S, Hidaka Y, Nishida S, Kinoshita K, Kaba A, Ishizuka T, Hamanoue S, Okumura K, Kawabata C, Toyoda M, Miyata A, Kashima M, Yokomizo H. Long-term impact of baseline serum uric acid levels on living kidney donors: a retrospective study. BMC Nephrol 2021; 22:89. [PMID: 33711960 PMCID: PMC7953616 DOI: 10.1186/s12882-021-02295-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 03/04/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Preoperative characteristics of living kidney donors are commonly considered during donor selection and postoperative follow-up. However, the impact of preoperative uric acid (UA) levels is poorly documented. The aim of this study was to evaluate the association between preoperative serum UA levels and post-donation long-term events and renal function. METHODS This was a single-center retrospective analysis of 183 living kidney donors. The donors were divided into high (≥5.5 mg/dl) and low (< 5.5 mg/dl) UA groups. We analyzed the relationship between preoperative UA levels and postoperative estimated glomerular filtration rate (eGFR), as well as adverse events (cardiovascular events and additional prescriptions for hypertension, gout, dyslipidemia, and diabetes mellitus), over 5 years after donation. RESULTS In total, 44 donors experienced 52 adverse events over 5 years. The incidence of adverse events within 5 years was significantly higher in the high UA group than in the low UA group (50% vs. 24%, p = 0.003); this was true even after the exclusion of hyperuricemia-related events (p = 0.047). UA emerged as an independent risk factor for adverse events (p = 0.012). Donors with higher UA levels had lower eGFRs after donation, whereas body mass index, hemoglobin A1c, blood pressure, and low-density lipoprotein cholesterol did not have any impact on the eGFR. CONCLUSIONS The findings suggest that preoperative UA levels should be considered during donor selection and postoperative follow-up.
Collapse
Affiliation(s)
- Kosuke Tanaka
- Department of Surgery, Japanese Red Cross Kumamoto Hospital, 861-8520, 2-1-1 Nagamine Minami, Higashi-ku, Kumamoto, Japan
| | - Shigeyoshi Yamanaga
- Department of Surgery, Japanese Red Cross Kumamoto Hospital, 861-8520, 2-1-1 Nagamine Minami, Higashi-ku, Kumamoto, Japan.
| | - Yuji Hidaka
- Department of Surgery, Japanese Red Cross Kumamoto Hospital, 861-8520, 2-1-1 Nagamine Minami, Higashi-ku, Kumamoto, Japan
| | - Sho Nishida
- Department of Surgery, Japanese Red Cross Kumamoto Hospital, 861-8520, 2-1-1 Nagamine Minami, Higashi-ku, Kumamoto, Japan
| | - Kohei Kinoshita
- Department of Surgery, Japanese Red Cross Kumamoto Hospital, 861-8520, 2-1-1 Nagamine Minami, Higashi-ku, Kumamoto, Japan
| | - Akari Kaba
- Department of Surgery, Japanese Red Cross Kumamoto Hospital, 861-8520, 2-1-1 Nagamine Minami, Higashi-ku, Kumamoto, Japan
| | - Toshinori Ishizuka
- Department of Nephrology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Satoshi Hamanoue
- Department of Nephrology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Kenji Okumura
- Department of Surgery, Japanese Red Cross Kumamoto Hospital, 861-8520, 2-1-1 Nagamine Minami, Higashi-ku, Kumamoto, Japan
| | - Chiaki Kawabata
- Department of Nephrology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Mariko Toyoda
- Department of Nephrology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Akira Miyata
- Department of Nephrology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Masayuki Kashima
- Department of Nephrology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Hiroshi Yokomizo
- Department of Surgery, Japanese Red Cross Kumamoto Hospital, 861-8520, 2-1-1 Nagamine Minami, Higashi-ku, Kumamoto, Japan
| |
Collapse
|