Uric acid elevation is frequently seen in patient with metabolic syndrome. It can lead to gout and kidney stones. In the current study, researchers monitored and analyzed a group of 4,000 participants suffering from chronic kidney disease, stages 2-4.
Authors found that higher baseline uric acid levels were a strong independent predictor of renal failure in adults with initial eGFR > 45 (stage 3a CKD), marginally in those with eGFR 30-45 (stage 3b), and not a predictor at all in subjects with eGFR < 30 (stage 4).
Future interventional studies would be useful in determinining if hyperuricemia is a causative and modifiable risk factor.
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Background: Serum uric acid concentrations increase in chronic kidney disease (CKD) and may lead to tubular injury, endothelial dysfunction, oxidative stress, and intrarenal inflammation. Whether uric acid concentrations are associated with kidney failure and death in CKD is unknown.
Study Design: Prospective observational cohort study.
Settings & Participants: 3,885 individuals with CKD stages 2-4 enrolled in the Chronic Renal Insufficiency Cohort (CRIC) between June 2003 and September 2008 and followed up through March 2013.
Predictor: Baseline uric acid concentrations.
Outcomes: Kidney failure (initiation of dialysis therapy or transplantation) and all-cause mortality.
During a median follow-up of 7.9 years, 885 participants progressed to kidney failure and 789 participants died.
After adjustment for demographic, cardiovascular, and kidney-specific covariates, higher uric acid concentrations were independently associated with risk for kidney failure in participants with estimated glomerular filtration rates (eGFRs) ≥ 45 (adjusted HR 1.4, p<0.05), but not in those with eGFRs < 30.
There was a nominally higher HR in participants with eGFRs of 30-45 (adjusted HR, 1.13; 95% CI, 0.99-1.29), but this did not reach statistical significance.
The relationship between uric acid concentration and all-cause mortality was J-shaped (P = 0.007).
Limitations: Potential residual confounding through unavailable confounders; lack of follow-up measurements to adjust for changes in uric acid concentrations over time.
Uric acid concentration is an independent risk factor for kidney failure in earlier stages of CKD and has a J-shaped relationship with all-cause mortality in CKD.
Adequately powered randomized placebo-controlled trials in CKD are needed to test whether urate lowering may prove to be an effective approach to prevent complications and progression of CKD.