Maintenance of normal serum uric acid levels may improve health outcomes among CKD patients

Hyperuricemia is prevalent in individuals with chronic kidney disease. Elevated serum uric acid concentrations have been considered an independent risk factor for the onset of chronic kidney disease. However, the relationship between serum uric acid concentrations and long-term health outcomes among patients with chronic kidney disease remains unclear.

Researchers performed a prospective cohort study with nationally representative sample samples to investigate the relationship between serum uric acid concentrations and mortality risk among patients with chronic kidney disease. The weighted restricted cubic spline analyses combined with the multivariate-adjusted Cox proportional hazard models were used to examine a non-linear relationship multivariate-adjusted on all-cause, cardiovascular disease, and cancer mortality.

Results

The 6642 patients participating in National Health and Nutrition Examination Survey 1999–2018 were enrolled. During 656 885 person-months of follow-up time, 2619 all-cause deaths were recorded, including 1030 cardiovascular disease deaths and 458 cancer deaths. Our study presented J-shaped non-linear relationships between serum uric acid concentrations and all-cause and cardiovascular disease mortality with inflection points at 311.65 μmol/L and 392.34 μmol/L, respectively. When serum uric acid concentration was higher than those inflection points, every increase of 50 μmol/L serum uric acid was associated with 11.7% and 17.0% greater multivariable-adjusted hazard ratios of all-cause and cardiovascular disease mortality, respectively. In addition, a negative linear correlation with cancer mortality was detected.

These findings suggested that maintaining appropriate serum uric acid concentrations may improve long-term health outcomes among chronic kidney disease patients. The corresponding inflection points of J-shaped non-linear relationships were 311.65 and 392.34 μmol/L for all-cause and cardiovascular disease mortality. Further clinical trials are required to investigate uric acid lowering targets.

Reference:

Shijie Wu, Wen Xue, Hanqing Yu, Hanjie Yu, Zhaoqiang Shi, Ling Wang, Ai Peng, Serum uric acid levels and health outcomes in CKD: a prospective cohort study, Nephrology Dialysis Transplantation, 2023;, gfad201, https://doi.org/10.1093/ndt/gfad201

Keywords:

Maintenance, normal, serum, uric acid, levels, may, improve, health, outcomes, among, CKD, patients, Nephrology Dialysis Transplantation, Shijie Wu, Wen Xue, Hanqing Yu, Hanjie Yu, Zhaoqiang Shi, Ling Wang, Ai Peng, Serum uric acid