title: Uric acid levels, kidney function, and cardiovascular mortality in US adults: National Health and Nutrition Examination Survey (NHANES) 1988-1994 and 1999-2002.
abstract: BACKGROUND
  Chronic kidney disease (CKD) and hyperuricemia often coexist, and both conditions are increasing in prevalence in the United States. However, their shared role in cardiovascular risk remains highly debated.
  
  
  METHODS
  Cross-sectional and longitudinal.
  
  
  METHODS
  Participants in the National Health and Nutrition Examination Survey (NHANES) from 1988 to 2002 (n = 10,956); data were linked to mortality data from the National Death Index through December 31, 2006.
  
  
  METHODS
  Serum uric acid concentration, categorized as the sex-specific lowest (< 25th), middle (25th- < 75th), and highest (≥ 75th) percentiles; and kidney function assessed by estimated glomerular filtration rate (eGFR) based on the CKD-EPI (CKD Epidemiology Collaboration) creatinine-cystatin C equation and urinary albumin-creatinine ratio (ACR).
  
  
  RESULTS
  Cardiovascular death and all-cause mortality.
  
  
  RESULTS
  Uric acid levels were correlated with eGFR(cr-cys) (r = -0.29; P < 0.001) and were correlated only slightly with ACR (r = 0.04; P < 0.001). There were 2,203 deaths up until December 31, 2006, of which 981 were due to cardiovascular causes. Overall, there was a U-shaped association between uric acid levels and cardiovascular mortality in both women and men, although the lowest risk of cardiovascular mortality occurred at a lower level of uric acid for women compared with men. There was an association between the highest quartile of uric acid level and cardiovascular mortality even after adjustment for potential confounders (HR, 1.48; 95% CI, 1.13-1.96), although this association was attenuated after adjustment for ACR and eGFR(cr-cys) (HR, 1.25; 95% CI, 0.89-1.75). The pattern of association between uric acid levels and all-cause mortality was similar.
  
  
  CONCLUSIONS
  GFR not measured; mediating events were not observed.
  
  
  CONCLUSIONS
  High uric acid level is associated with cardiovascular and all-cause mortality, although this relationship was no longer statistically significant after accounting for kidney function.
authors.affiliation: School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR. Electronic address: michelle.odden@oregonstate.edu.
authors.forename: Michelle C
authors.initials: MC
authors.lastname: Odden
authors.affiliation: School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR.
authors.forename: Abdul-Razak
authors.initials: AR
authors.lastname: Amadu
authors.affiliation: School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR.
authors.forename: Ellen
authors.initials: E
authors.lastname: Smit
authors.affiliation: Division of Nephrology, Department of Medicine, University of California, San Francisco, CA.
authors.forename: Lowell
authors.initials: L
authors.lastname: Lo
authors.affiliation: Division of Nephrology, Department of Medicine, University of California, San Francisco, CA.
authors.forename: Carmen A
authors.initials: CA
authors.lastname: Peralta
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000097:blood / Q000401:mortality; D002423:Cause of Death; D015986:Confounding Factors, Epidemiologic; D003404:Creatinine / Q000097:blood; D055316:Cystatin C / Q000097:blood; D005260:Female; D006801:Humans; D033461:Hyperuricemia / Q000097:blood; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000453:epidemiology / Q000503:physiopathology; D012307:Risk Factors; D013223:Statistics as Topic; D014481:United States / Q000453:epidemiology; D014527:Uric Acid / Q000097:blood*
chemical_list: D055316:Cystatin C; D014527:Uric Acid; D003404:Creatinine
keywords: Uric acid; albuminuria; cardiovascular mortality; chronic kidney disease (CKD); hyperuricemia; kidney function; risk factor