U-Shaped Link Observed Between Uric Acid and Heart Risks in Children with Kidney Disease: Study

A new study published in the journal of Pediatric Nephrology revealed an U-shaped relationship between serum uric acid levels and cardiovascular risk in children with chronic kidney disease (CKD). The research provides new insights into how uric acid behaves as both a potential marker and modifiable factor in pediatric kidney and heart health.

The study analyzed baseline data from 338 children diagnosed with CKD, with a median age of 9.8 years. Their average estimated glomerular filtration rate (eGFR) was 63.5 mL/min/1.73 m², which indicated mild to moderate impairment. The median serum uric acid level was 5.8 mg/dL.

This research found that certain demographic and clinical factors had strong associations with uric acid levels. Specifically, male sex, older age, and lower eGFR values were linked to elevated uric acid concentrations. In children whose CKD had progressed to stage III or higher, those whose disease stemmed from glomerulopathy also tended to have higher uric acid levels. These results suggest that worsening kidney function and disease type significantly influence how uric acid accumulates in young patients.

However, the most striking finding emerged from the analysis of cardiovascular disease (CVD) risk factors. The data showed that uric acid levels did not linearly increase the risk of heart-related complications such as hypertension or left ventricular hypertrophy. Instead, the relationship formed a U-shaped curve: both low and high uric acid levels were linked to higher rates of these CVD indicators, while the lowest risk occurred within a moderate range (between 5.5 and 7.5 mg/dL).

A detailed look at the regression analysis confirmed that children with uric acid levels outside this optimal range had greater odds of developing high blood pressure or LVH, even after adjusting for confounding factors such as age, sex, and kidney function. This suggests that maintaining uric acid within a balanced range may be key to managing cardiovascular risks in pediatric CKD patients.

This research emphasized that monitoring uric acid could serve as an accessible biomarker for assessing both kidney and cardiovascular health in young CKD patients. Moreover, therapeutic strategies aimed at optimizing uric acid levels might offer protective benefits against heart complications.

Overall, this study highlights that in children with CKD, moderate uric acid levels appear to strike a protective balance, which reinforces the need for individualized management approaches in pediatric nephrology.

Reference:

Cho, M. H., Kang, H. G., Ahn, Y. H., Kim, S. H., Park, E., Lee, J. H., Jung, J., Cho, M. H., Baek, H. S., Shin, J. I., Lee, K. H., Han, K. H., Cho, H., Song, J. Y., Kim, J. H., & Yang, E. M. (2025). Factors influencing serum uric acid levels and their impact on cardiovascular risk in patients with pediatric chronic kidney disease. Pediatric Nephrology (Berlin, Germany). https://doi.org/10.1007/s00467-025-06961-5