title: Uric acid level has a U-shaped association with loss of kidney function in healthy people: a prospective cohort study.
abstract: BACKGROUND
  The relationship between hyperuricemia and chronic kidney disease (CKD) has been found in various observational studies. Although hypouricemia is associated with cardiovascular events, it has not been established as a risk factor for CKD. We investigated the relationship between serum uric acid level and the loss of kidney function and incident CKD in healthy people.
  
  
  METHODS
  Healthy people were enrolled in this community-based prospective cohort study, the Saitama Cardiometabolic Disease and Organ Impairment Study, Japan. The analysis was conducted on 4188 subjects followed up for at least 3 years, 3102 for 6 years and 1052 for 9 years. Their data including glomerular filtration rate (eGFR) decline were examined every three years. The outcome event was incident CKD or the decrease in eGFR by more than 25% in three years. Multivariate statistical models were adjusted for the baseline characteristics.
  
  
  RESULTS
  The following data was obtained: mean ± SD age, male, 39.6 ± 10.4 years, female 38.4 ± 10.8 years; eGFR, male, 81.9 ± 16.4 ml/min/1.73 m2, female, 82.1 ± 17.5 ml/min/1.73 m2; serum uric acid level, male, 5.8 ± 1.2 mg/dl, female, 4.1 ± 0.9 mg/dl. Both low and high serum uric acid levels were associated with the outcome and eGFR decline in males (multivariate logistic additional additive models, linear p = 0.0001, spline p = 0.043; generalized additive models, linear p = 0.0001, spline p = 0.012). In subjects with low serum uric acid levels (male, <5 mg/dl; female, <3.6 mg/dl), multivariate linear mixed models showed that low serum uric acid levels were associated with eGFR decline in a time-dependent manner (male, p = 0.0001; female, p = 0.045).
  
  
  CONCLUSIONS
  This study showed that low as well as high levels of uric acid are associated with the loss of kidney function. Hypouricemia is a candidate predictor of kidney function decline in healthy people.
authors: Department of Nephrology, Tokyo Kyosai Hospital, Meguro, Tokyo, Japan; Center for life science and bioethics, Tokyo Medical and Dental University, Bunkyo, Tokyo, Japan.
authors: Eiichiro
authors: E
authors: Kanda
authors: Saitama Citizens Medical Center, Saitama, Saitama, Japan.
authors: Toshitaka
authors: T
authors: Muneyuki
authors: Department of Nephrology, Tokyo Medical University, Shinjuku, Tokyo, Japan.
authors: Yoshihiko
authors: Y
authors: Kanno
authors: Saitama Health Promotion Corporation, Hikigun, Saitama, Japan.
authors: Kaname
authors: K
authors: Suwa
authors: Division of Clinical Nutrition, Department of Medical Dietetics, Faculty of Pharmaceutical Sciences, Josai University, Sakado, Saitama, Japan.
authors: Kei
authors: K
authors: Nakajima
mesh_terms: D000328:Adult; D015444:Exercise; D005260:Female; D005919:Glomerular Filtration Rate; D064368:Healthy Volunteers; D006801:Humans; D033461:Hyperuricemia; D007668:Kidney / Q000502:physiology* / Q000503:physiopathology*; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000453:epidemiology; D012307:Risk Factors; D014527:Uric Acid / Q000097:blood*
chemical_list: D014527:Uric Acid