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Impact of Uric Acid Levels on Kidney Disease Progression.
Am J Nephrol. 2017; 46(4):315-322.AJ

Abstract

BACKGROUND

Hyperuricemia is associated with the progression of chronic kidney disease (CKD), but it is not known whether the relationship is causal. We examined the association of hyperuricemia and uric acid lowering therapy (UALT) with progression of CKD in patients with CKD 3 and 4 in the Cleveland Clinic CKD registry.

METHODS

We included 1,676 patients with CKD stages 3 and 4 from Ohio, who had measured their uric acid (UA) levels a year prior to the recording of the second eGFR <60 mL/min/1.73 m2, and follow-up eGFR, between 2005 and 2009. Our primary composite outcome included a 50% drop in eGFR or progression to ESRD. Secondary outcomes included the rate of decline in eGFR, all-cause mortality, progression to ESRD, and a composite measure of progression to ESRD or death. We assessed the association between UA, UALT, and outcomes using Cox models and competing risks regression models.

RESULTS

In multivariable models, higher UA was associated with the composite endpoint, but it reached statistical significance only in the 4th quartile (≥8.9 mg/dL). Receipt of UALT was significantly associated with increased risk of the composite outcome. Neither UA nor UALT (considered a time-dependent covariate) was significantly associated with mortality. The inference was similar for UA as high vs. low, quartiles, or continuous. Similarly, neither high UA nor UALT were significantly associated with ESRD, the composite of ESRD and mortality, or eGFR decline.

CONCLUSIONS

Hyperuricemia is associated with increased risk of progression to ESRD in patients with CKD stages 3 and 4, but UALT does not ameliorate the risk, suggesting that the relationship is not causal.

Authors+Show Affiliations

Department of Nephrology, Cleveland Clinic Foundation, Cleveland, Ohio, USA.Department of Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA.Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio, USA.Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio, USA.Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio, USA.Department of Nephrology, Cleveland Clinic Foundation, Cleveland, Ohio, USA.Baylor College of Medicine, Houston, Texas, USA. Houston Veterans Affairs Medical Center, Houston, Texas, USA.Department of Nephrology, Cleveland Clinic Foundation, Cleveland, Ohio, USA.Department of Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA. Cleveland Clinic Foundation Center for Value-Based Care Research, Cleveland, Ohio, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29032376

Citation

Rincon-Choles, Hernan, et al. "Impact of Uric Acid Levels On Kidney Disease Progression." American Journal of Nephrology, vol. 46, no. 4, 2017, pp. 315-322.
Rincon-Choles H, Jolly SE, Arrigain S, et al. Impact of Uric Acid Levels on Kidney Disease Progression. Am J Nephrol. 2017;46(4):315-322.
Rincon-Choles, H., Jolly, S. E., Arrigain, S., Konig, V., Schold, J. D., Nakhoul, G., Navaneethan, S. D., Nally, J. V., & Rothberg, M. B. (2017). Impact of Uric Acid Levels on Kidney Disease Progression. American Journal of Nephrology, 46(4), 315-322. https://doi.org/10.1159/000481460
Rincon-Choles H, et al. Impact of Uric Acid Levels On Kidney Disease Progression. Am J Nephrol. 2017;46(4):315-322. PubMed PMID: 29032376.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of Uric Acid Levels on Kidney Disease Progression. AU - Rincon-Choles,Hernan, AU - Jolly,Stacey E, AU - Arrigain,Susana, AU - Konig,Victoria, AU - Schold,Jesse D, AU - Nakhoul,Georges, AU - Navaneethan,Sankar D, AU - Nally,Joseph V,Jr AU - Rothberg,Michael B, Y1 - 2017/10/13/ PY - 2017/06/30/received PY - 2017/09/08/accepted PY - 2017/10/17/pubmed PY - 2018/6/15/medline PY - 2017/10/17/entrez KW - Adults KW - Chronic kidney disease progression KW - Hyperuricemia KW - Uric acid SP - 315 EP - 322 JF - American journal of nephrology JO - Am J Nephrol VL - 46 IS - 4 N2 - BACKGROUND: Hyperuricemia is associated with the progression of chronic kidney disease (CKD), but it is not known whether the relationship is causal. We examined the association of hyperuricemia and uric acid lowering therapy (UALT) with progression of CKD in patients with CKD 3 and 4 in the Cleveland Clinic CKD registry. METHODS: We included 1,676 patients with CKD stages 3 and 4 from Ohio, who had measured their uric acid (UA) levels a year prior to the recording of the second eGFR <60 mL/min/1.73 m2, and follow-up eGFR, between 2005 and 2009. Our primary composite outcome included a 50% drop in eGFR or progression to ESRD. Secondary outcomes included the rate of decline in eGFR, all-cause mortality, progression to ESRD, and a composite measure of progression to ESRD or death. We assessed the association between UA, UALT, and outcomes using Cox models and competing risks regression models. RESULTS: In multivariable models, higher UA was associated with the composite endpoint, but it reached statistical significance only in the 4th quartile (≥8.9 mg/dL). Receipt of UALT was significantly associated with increased risk of the composite outcome. Neither UA nor UALT (considered a time-dependent covariate) was significantly associated with mortality. The inference was similar for UA as high vs. low, quartiles, or continuous. Similarly, neither high UA nor UALT were significantly associated with ESRD, the composite of ESRD and mortality, or eGFR decline. CONCLUSIONS: Hyperuricemia is associated with increased risk of progression to ESRD in patients with CKD stages 3 and 4, but UALT does not ameliorate the risk, suggesting that the relationship is not causal. SN - 1421-9670 UR - https://www.unboundmedicine.com/medline/citation/29032376/Impact_of_Uric_Acid_Levels_on_Kidney_Disease_Progression_ L2 - https://www.karger.com?DOI=10.1159/000481460 DB - PRIME DP - Unbound Medicine ER -