Serum Uric Acid and Risk for Acute Kidney Injury Following Contrast.
Contrast-induced acute kidney injury (CI-AKI) is a common cause of hospital-acquired acute kidney injury (AKI). We evaluated the evidence that uric acid (UA) plays a pathogenic role in CI-AKI. Ten studies were eligible for inclusion for meta-analysis. Hyperuricemia predicted risk for cases with AKI in prospective cohort studies. Higher levels of serum UA (SUA), as defined by the authors, were associated with a 2-fold increased risk to develop AKI (pooled odds ratio 2.03; 95% confidence interval [CI] 1.48-2.78). Significant heterogeneity was found in cohort studies ( P = .001, I2= 85.7%). In 2 clinical trials, lowering of SUA with saline hydration was significantly associated with reduced risk for AKI compared with saline hydration alone or saline hydration with N-acetyl cysteine. An analysis of 2 randomized controlled trials found that allopurinol with saline hydration had a significant protective effect on renal function (assessed by serum creatinine values) compared with hydration alone (mean difference: -0.52 mg/dL; 95% CI: -0.81 to -0.22). Hyperuricemia independently predicts CI-AKI. Two clinical trials suggest lowering SUA may prevent CI-AKI. The mechanism by which UA induces CI-AKI is likely related to acute uricosuria.
1 Division of Nephrology, Department of Medicine, Koc University School of Medicine, Istanbul, Turkey.
Mehmet
M
Kanbay
2 Department of Nephrology, Sakarya Training and Research Hospital, Sakarya, Turkey.
Yalcin
Y
Solak
3 Division of Nephrology, Department of Medicine, Konya Numune State Hospital, Konya, Turkey.
Baris
B
Afsar
4 Nephrology Department, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania.|5 ERBP, Ghent University Hospital, Ghent, Belgium.
Ionut
I
Nistor
6 Department of Cardiology, Koc University Hospital, Istanbul, Turkey.
Gamze
G
Aslan
1 Division of Nephrology, Department of Medicine, Koc University School of Medicine, Istanbul, Turkey.
Ozlem Hilal
OH
Çağlayan
1 Division of Nephrology, Department of Medicine, Koc University School of Medicine, Istanbul, Turkey.
Asli
A
Aykanat
4 Nephrology Department, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania.
Mihaela-Dora
MD
Donciu
7 Division of Renal Diseases and Hypertension, University of Colorado, Denver, CO, USA.
Miguel A
MA
Lanaspa
8 Division of Nephrology, Hypertension, and Transplantation, University of Florida, Gainesville, FL, USA.
Ahsan A
AA
Ejaz
7 Division of Renal Diseases and Hypertension, University of Colorado, Denver, CO, USA.
Richard J
RJ
Johnson
4 Nephrology Department, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania.
Adrian
A
Covic
D058186:Acute Kidney Injury / Q000097:blood* / Q000139:chemically induced* / Q000453:epidemiology; D015415:Biomarkers / Q000097:blood*; D002986:Clinical Trials as Topic; D003287:Contrast Media / Q000009:adverse effects; D006801:Humans; D012307:Risk Factors; D014527:Uric Acid / Q000097:blood*
D015415:Biomarkers; D003287:Contrast Media; D014527:Uric Acid
acute kidney injury; allopurinol; contrast nephropathy; uric acid