Early CKD: hyperuricemia tied to increased risk of renal failure, death

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Takeaway

  • Hyperuricemia is associated with an increased risk of renal failure and death in patients with earlier stages of chronic kidney disease (CKD).

Why this matters

  • Uric acid concentration may have more relevance for patients with preserved renal function.

Study design

  • Chronic Renal Insufficiency Cohort multicenter prospective study of 3885 patients with stage II-IV CKD.
  • Mean baseline estimated glomerular filtration rate (eGFR) was 44.3±15.0 mL/min/1.73 m2.
  • Funding: National Institute of Diabetes and Digestive and Kidney Diseases; National Heart, Lung, and Blood Institute.   

Key results

  • Over a median 7.9-year follow-up, 885 patients progressed to renal failure and 789 died.
  • Multivariate analysis showed that each standard deviation (SD) increase in baseline uric acid was tied to a 40% increased risk for renal failure in stage II/IIIa CKD (eGFR ≥45 mL/min/1.73 m2 [aHR, 1.40; 95% CI, 1.12-1.75]).
  • In CKD stage IIIb (eGFR 30-44 mL/min/1.73 m2), the risk was nominally higher but did not achieve statistical significance (aHR, 1.13; 95% CI, 0.99-1.29); no increased risk was observed in stage IV CKD.
  • Data showed a J-shaped curve (P=.007) between baseline uric acid and all-cause mortality after adjustment for demographic factors, comorbidities, medication, and laboratory findings (including eGFR).

Limitations

  • Observational data cannot prove causality.