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Uric acid is not associated with decline in renal function or time to renal replacement therapy initiation in a referred cohort of patients with Stage III, IV and V chronic kidney disease.
Nephrol Dial Transplant. 2015 Dec; 30(12):2039-45.ND

Abstract

BACKGROUND

Although many studies have suggested an association between higher uric acid (UA) and both development of chronic kidney disease (CKD) and faster decline in renal function in Stage I and II CKD, it is not clear whether this effect is consistent throughout higher CKD stages. The aim of this study was to investigate the association between baseline UA and renal outcomes in patients with established CKD (Stages III-V).

METHODS

We analysed data in the Swedish Renal Registry-Chronic Kidney Disease (SRR-CKD), which is a nationwide registry of referred CKD patients. Patients with a visit between January 1(st), 2005 and December 31(st), 2011 were followed until initiation of renal replacement therapy (RRT), death, referral to primary care or end of follow-up. Decline in renal function was assessed with a linear mixed model using all estimated glomerular filtration rate (eGFR) assessments recorded during median 28 months of follow-up, adjusting for important confounders such as demographic factors, primary renal disease, age, sex, relevant medication, diet, blood pressure and body mass index.

RESULTS

There were 2466 patients with a baseline UA measurement {mean [standard deviation (SD)] of 7.81 [1.98] mg/dL}. The mean decline in renal function was -1.48 (95% CI -1.65; -1.31) mL/min/1.73 m(2) per year. The overall adjusted change in decline in renal function per unit increase in baseline UA was 0.08 (95% CI -0.01; 0.17) mL/min/1.73 m(2) per year indicating no association between higher UA levels and decline in renal function. In Stage III, IV and V CKD patients, the mean decline in renal function was -1.52 (95% CI -1.96; -1.08), -1.52 (95% CI -1.72; -1.32) and -1.19 (95% CI -1.75; -0.64) mL/min/1.73 m(2) per year, respectively. The adjusted change in the decline in renal function per unit increase in baseline UA was -0.09 (95% CI -0.30; 0.13) in Stage III CKD, 0.16 (95% CI 0.04; 0.28) in Stage IV CKD and 0.18 (95% CI -0.09; 0.45) in Stage V CKD. The overall adjusted hazard ratio for start of RRT was 0.97 (95% CI 0.93-1.02). For Stage III, IV and V CKD, it was 0.99 (95% CI 0.73-1.34), 0.97 (95% CI 0.91-1.03) and 0.99 (95% CI 0.91-1.07), respectively.

CONCLUSION

UA is not associated with the rate of decline in renal function or time to start of RRT in Stage III, IV and/or V CKD patients.

Authors+Show Affiliations

The Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.The Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.Renal Medicine, CLINTEC, Karolinska Institutet, Stockholm, Sweden.Renal Medicine, CLINTEC, Karolinska Institutet, Stockholm, Sweden.The Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, The Netherlands.The Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.Renal Medicine, CLINTEC, Karolinska Institutet, Stockholm, Sweden.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26185050

Citation

Nacak, Hakan, et al. "Uric Acid Is Not Associated With Decline in Renal Function or Time to Renal Replacement Therapy Initiation in a Referred Cohort of Patients With Stage III, IV and V Chronic Kidney Disease." Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, vol. 30, no. 12, 2015, pp. 2039-45.
Nacak H, van Diepen M, Qureshi AR, et al. Uric acid is not associated with decline in renal function or time to renal replacement therapy initiation in a referred cohort of patients with Stage III, IV and V chronic kidney disease. Nephrol Dial Transplant. 2015;30(12):2039-45.
Nacak, H., van Diepen, M., Qureshi, A. R., Carrero, J. J., Stijnen, T., Dekker, F. W., & Evans, M. (2015). Uric acid is not associated with decline in renal function or time to renal replacement therapy initiation in a referred cohort of patients with Stage III, IV and V chronic kidney disease. Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, 30(12), 2039-45. https://doi.org/10.1093/ndt/gfv225
Nacak H, et al. Uric Acid Is Not Associated With Decline in Renal Function or Time to Renal Replacement Therapy Initiation in a Referred Cohort of Patients With Stage III, IV and V Chronic Kidney Disease. Nephrol Dial Transplant. 2015;30(12):2039-45. PubMed PMID: 26185050.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Uric acid is not associated with decline in renal function or time to renal replacement therapy initiation in a referred cohort of patients with Stage III, IV and V chronic kidney disease. AU - Nacak,Hakan, AU - van Diepen,Merel, AU - Qureshi,Abdul R, AU - Carrero,Juan J, AU - Stijnen,Theo, AU - Dekker,Friedo W, AU - Evans,Marie, Y1 - 2015/07/16/ PY - 2015/01/18/received PY - 2015/04/24/accepted PY - 2015/7/18/entrez PY - 2015/7/18/pubmed PY - 2016/6/22/medline KW - (progression of) CKD KW - hyperuricaemia SP - 2039 EP - 45 JF - Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association JO - Nephrol Dial Transplant VL - 30 IS - 12 N2 - BACKGROUND: Although many studies have suggested an association between higher uric acid (UA) and both development of chronic kidney disease (CKD) and faster decline in renal function in Stage I and II CKD, it is not clear whether this effect is consistent throughout higher CKD stages. The aim of this study was to investigate the association between baseline UA and renal outcomes in patients with established CKD (Stages III-V). METHODS: We analysed data in the Swedish Renal Registry-Chronic Kidney Disease (SRR-CKD), which is a nationwide registry of referred CKD patients. Patients with a visit between January 1(st), 2005 and December 31(st), 2011 were followed until initiation of renal replacement therapy (RRT), death, referral to primary care or end of follow-up. Decline in renal function was assessed with a linear mixed model using all estimated glomerular filtration rate (eGFR) assessments recorded during median 28 months of follow-up, adjusting for important confounders such as demographic factors, primary renal disease, age, sex, relevant medication, diet, blood pressure and body mass index. RESULTS: There were 2466 patients with a baseline UA measurement {mean [standard deviation (SD)] of 7.81 [1.98] mg/dL}. The mean decline in renal function was -1.48 (95% CI -1.65; -1.31) mL/min/1.73 m(2) per year. The overall adjusted change in decline in renal function per unit increase in baseline UA was 0.08 (95% CI -0.01; 0.17) mL/min/1.73 m(2) per year indicating no association between higher UA levels and decline in renal function. In Stage III, IV and V CKD patients, the mean decline in renal function was -1.52 (95% CI -1.96; -1.08), -1.52 (95% CI -1.72; -1.32) and -1.19 (95% CI -1.75; -0.64) mL/min/1.73 m(2) per year, respectively. The adjusted change in the decline in renal function per unit increase in baseline UA was -0.09 (95% CI -0.30; 0.13) in Stage III CKD, 0.16 (95% CI 0.04; 0.28) in Stage IV CKD and 0.18 (95% CI -0.09; 0.45) in Stage V CKD. The overall adjusted hazard ratio for start of RRT was 0.97 (95% CI 0.93-1.02). For Stage III, IV and V CKD, it was 0.99 (95% CI 0.73-1.34), 0.97 (95% CI 0.91-1.03) and 0.99 (95% CI 0.91-1.07), respectively. CONCLUSION: UA is not associated with the rate of decline in renal function or time to start of RRT in Stage III, IV and/or V CKD patients. SN - 1460-2385 UR - https://www.unboundmedicine.com/medline/citation/26185050/Uric_acid_is_not_associated_with_decline_in_renal_function_or_time_to_renal_replacement_therapy_initiation_in_a_referred_cohort_of_patients_with_Stage_III_IV_and_V_chronic_kidney_disease_ L2 - https://academic.oup.com/ndt/article-lookup/doi/10.1093/ndt/gfv225 DB - PRIME DP - Unbound Medicine ER -