title: Hyperuricemia and Progression of CKD in Children and Adolescents: The Chronic Kidney Disease in Children (CKiD) Cohort Study.
abstract: BACKGROUND
  Hyperuricemia is associated with essential hypertension in children. No previous studies have evaluated the effect of hyperuricemia on progression of chronic kidney disease (CKD) in children.
  
  
  METHODS
  Prospective observational cohort study.
  
  
  METHODS
  Children and adolescents (n=678 cross-sectional; n=627 longitudinal) with a median age of 12.3 (IQR, 8.6-15.6) years enrolled at 52 North American sites of the CKiD (CKD in Children) Study.
  
  
  METHODS
  Serum uric acid level (<5.5, 5.5-7.5, and >7.5mg/dL).
  
  
  RESULTS
  Composite end point of either >30% decline in glomerular filtration rate (GFR) or initiation of renal replacement therapy.
  
  
  METHODS
  Age, sex, race, blood pressure status, GFR, CKD cause, urine protein-creatinine ratio (<0.5, 0.5-<2.0, and ≥2.0mg/mg), age- and sex-specific body mass index > 95th percentile, use of diuretics, and serum uric acid level.
  
  
  RESULTS
  Older age, male sex, lower GFR, and body mass index > 95th percentile were associated with higher uric acid levels. 162, 294, and 171 participants had initial uric acid levels < 5.5, 5.5 to 7.5, or >7.5 mg/dL, respectively. We observed 225 instances of the composite end point over 5 years. In a multivariable parametric time-to-event analysis, compared with participants with initial uric acid levels < 5.5mg/dL, those with uric acid levels of 5.5 to 7.5 or >7.5mg/dL had 17% shorter (relative time, 0.83; 95% CI, 0.62-1.11) or 38% shorter (relative time, 0.62; 95% CI, 0.45-0.85) times to event, respectively. Hypertension, lower GFR, glomerular CKD cause, and elevated urine protein-creatinine ratio were also associated with faster times to the composite end point.
  
  
  CONCLUSIONS
  The study lacked sufficient data to examine how use of specific medications might influence serum uric acid levels and CKD progression.
  
  
  CONCLUSIONS
  Hyperuricemia is a previously undescribed independent risk factor for faster progression of CKD in children and adolescents. It is possible that treatment of children and adolescents with CKD with urate-lowering therapy could slow disease progression.
authors.affiliation: University of Rochester Medical Center, Rochester, NY.
authors.forename: Kyle E
authors.initials: KE
authors.lastname: Rodenbach
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors.forename: Michael F
authors.initials: MF
authors.lastname: Schneider
authors.affiliation: Children's Hospital of Philadelphia, Philadelphia, PA.
authors.forename: Susan L
authors.initials: SL
authors.lastname: Furth
authors.affiliation: National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD.
authors.forename: Marva M
authors.initials: MM
authors.lastname: Moxey-Mims
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors.forename: Mark M
authors.initials: MM
authors.lastname: Mitsnefes
authors.affiliation: Levine Children's Hospital, Charlotte, NC.
authors.forename: Donald J
authors.initials: DJ
authors.lastname: Weaver
authors.affiliation: Children's Mercy Hospital, Kansas City, MO.
authors.forename: Bradley A
authors.initials: BA
authors.lastname: Warady
authors.affiliation: University of Rochester Medical Center, Rochester, NY. Electronic address: george_schwartz@urmc.rochester.edu.
authors.forename: George J
authors.initials: GJ
authors.lastname: Schwartz
mesh_terms: D000293:Adolescent; D002648:Child; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D018450:Disease Progression; D005260:Female; D006801:Humans; D033461:Hyperuricemia / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology*; D008137:Longitudinal Studies; D008297:Male; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology*; D014527:Uric Acid / Q000097:blood
chemical_list: D014527:Uric Acid
keywords: CKD progression; CKiD (Chronic Kidney Disease in Children); Uric acid; adolescents; children; chronic kidney disease (CKD); disease trajectory; end-stage renal disease (ESRD); glomerular filtration rate (GFR); hyperuricemia; pediatric kidney disease; renal function decline; renal replacement therapy (RRT); risk factor; urate