Association of hyperuricemia with renal outcomes, cardiovascular disease, and mortality.
OBJECTIVE
Hyperuricemia is an independent risk factor for mortality, cardiovascular disease, and renal disease in general population. However, the relationship between hyperuricemia with clinical outcomes in CKD remains controversial.


METHODS
The study investigated the association between uric acid with all-cause mortality, cardiovascular events, renal replacement therapy, and rapid renal progression (the slope of estimated GFR was less than -6 ml/min per 1.73 m(2)/y) in 3303 stages 3-5 CKD patients that were in the integrated CKD care system in one medical center and one regional hospital in southern Taiwan.


RESULTS
In all subjects, the mean uric acid level was 7.9 ± 2.0 mg/dl. During a median 2.8-year follow-up, there were 471 (14.3%) deaths, 545 (16.5%) cardiovascular events, 1080 (32.3%) participants commencing renal replacement therapy, and 841 (25.5%) participants with rapid renal progression. Hyperuricemia increased risks for all-cause mortality and cardiovascular events (the adjusted hazard ratios for quartile four versus quartile one of uric acid [95% confidence interval] were 1.85 [1.40-2.44] and 1.42 [1.08-1.86], respectively) but not risks for renal replacement therapy (0.96 [0.79-1.16]) and rapid renal progression (1.30 [0.98-1.73]).


CONCLUSIONS
In stages 3-5 CKD, hyperuricemia is a risk factor for all-cause mortality and cardiovascular events but not renal replacement therapy and rapid renal progression.
Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Taiwan.
Wan-Chun
WC
Liu
Chi-Chih
CC
Hung
Szu-Chia
SC
Chen
Shih-Meng
SM
Yeh
Ming-Yen
MY
Lin
Yi-Wen
YW
Chiu
Mei-Chuan
MC
Kuo
Jer-Ming
JM
Chang
Shang-Jyh
SJ
Hwang
Hung-Chun
HC
Chen
D000368:Aged; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000097:blood / Q000401:mortality*; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D006773:Hospitals, Municipal; D006785:Hospitals, University; D006801:Humans; D033461:Hyperuricemia / Q000097:blood / Q000401:mortality*; D007668:Kidney / Q000503:physiopathology; D007674:Kidney Diseases / Q000097:blood / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011379:Prognosis; D016016:Proportional Hazards Models; D017582:Renal Replacement Therapy; D018570:Risk Assessment; D012307:Risk Factors; D013624:Taiwan; D013997:Time Factors; D014527:Uric Acid / Q000097:blood*
D015415:Biomarkers; D014527:Uric Acid