title: Uric acid has a J-shaped association with cardiovascular and all-cause mortality in kidney transplant recipients.
abstract: The association between serum uric acid and kidney graft and recipient survival is uncertain. During 2000-2011, we measured serum uric acid at week 10 after transplantation. Of 2748 transplanted patients, 2200 (80.1%) attended this visit. After a median follow-up of 7.4 yr, 378 patients had died, 143 from a cardiovascular cause, and 185 patients lost their graft. The third quintile of uric acid levels (357-405 μM) had the lowest mortality risk and was used as reference group. In Cox proportional hazard models adjusting for graft and patient characteristics, the fifth quintile of uric acid levels (>474 μM) was independently associated with cardiovascular mortality (hazard ratio [HR] = 2.87 [1.55-5.32], p = 0.001) and all-cause mortality (HR = 1.57 [1.09-2.25], p = 0.02). Also, the lowest quintile of uric acid levels (<309 μM) showed a trend toward increased risk of cardiovascular mortality (HR = 1.79 [0.90-3.58], p = 0.10) and all-cause mortality (HR = 1.31 [0.89-1.93], p = 0.18). The increased risk at low uric acid levels was confined to diabetic recipients. Uric acid was not associated with death-censored graft loss. In conclusion, uric acid has a J-shaped association with cardiovascular and all-cause mortality in kidney transplant recipients.
authors.affiliation: Department of Transplant Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
authors.forename: Dag Olav
authors.initials: DO
authors.lastname: Dahle
authors.forename: Trond
authors.initials: T
authors.lastname: Jenssen
authors.forename: Hallvard
authors.initials: H
authors.lastname: Holdaas
authors.forename: Torbjørn
authors.initials: T
authors.lastname: Leivestad
authors.forename: Mari
authors.initials: M
authors.lastname: Vårdal
authors.forename: Geir
authors.initials: G
authors.lastname: Mjøen
authors.forename: Anna V
authors.initials: AV
authors.lastname: Reisaeter
authors.forename: Ingrid
authors.initials: I
authors.lastname: Toft
authors.forename: Anders
authors.initials: A
authors.lastname: Hartmann
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood*; D002318:Cardiovascular Diseases / Q000097:blood / Q000401:mortality*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000097:blood / Q000401:mortality*; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D007223:Infant; D007676:Kidney Failure, Chronic / Q000097:blood / Q000601:surgery; D007677:Kidney Function Tests; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate; D014527:Uric Acid / Q000097:blood*; D055815:Young Adult
chemical_list: D015415:Biomarkers; D014527:Uric Acid
keywords: kidney transplant recipients; mortality; uric acid