title: Hyperuricemia after orthotopic liver transplantation: divergent associations with progression of renal disease, incident end-stage renal disease, and mortality.
abstract: Although hyperuricemia is common after orthotopic liver transplantation (OLT), its relationship to mortality, progressive kidney disease, or the development of end stage renal disease (ESRD) is not well-described.
  
  
  
  Data from 304 patients undergoing OLT between 1996 and 2010 were used to assess the association of mean serum uric acid (UA) level in the 3-months post-OLT with mortality, doubling of creatinine, and ESRD incidence. Post-OLT survival to event outcomes according to UA level and eGFR was assessed using the Kaplan Meier method and multivariate Cox proportional hazards models.
  
  
  
  Mean UA level among the 204 patients with an eGFR level ≥60 ml/min/1.73 m2was 6.4 mg/dl compared to 7.9 mg/dl among the 100 patients with eGFR <60 (p < 0.0001). During a median of 4.6 years of follow-up, mortality rate, doubling of creatinine, and ESRD incidence were 48.9, 278.2, and 20.7 per 1000 person-years, respectively. In the first 5 years of follow-up, elevated UA was associated with mortality (Hazard Ratio, HR = 1.7; p = 0.045). However, among those with eGFR ≥ 60, UA level did not predict mortality (HR = 1.0; p = 0.95), and among those with eGFR < 60, elevated UA was a strong predictor of mortality (HR = 3.7[1.1, 12.0]; p = 0.03). UA was not associated with ESRD, but was associated with doubling of creatinine among diabetics (HR = 2.2[1.1, 4.3]; p = 0.025).
  
  
  
  In this post-OLT cohort, hyperuricemia independently predicted mortality, particularly among patients with eGFR < 60, and predicted doubling of creatinine among diabetics.
authors.affiliation: Department of Community Medicine and Behavioural Sciences, Kuwait University Faculty of Medicine, Kuwait City, Kuwait.|Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Longenecker
authors.affiliation: Department of Medicine, University of Wisconsin School of Medicine, Madison, WI, USA.
authors.forename: Sana
authors.initials: S
authors.lastname: Waheed
authors.affiliation: Department of Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: Ghassan
authors.initials: G
authors.lastname: Bandak
authors.affiliation: Lakelands Nephrology, PA, Greenwood, SC, USA.
authors.forename: Christine A
authors.initials: CA
authors.lastname: Murakami
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Blaithin A
authors.initials: BA
authors.lastname: McMahon
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Allan C
authors.initials: AC
authors.lastname: Gelber
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. matta1@jhmi.edu.
authors.forename: Mohamed G
authors.initials: MG
authors.lastname: Atta
mesh_terms: D000328:Adult; D003404:Creatinine / Q000378:metabolism; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D033461:Hyperuricemia / Q000453:epidemiology* / Q000378:metabolism; D015994:Incidence; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000378:metabolism; D017093:Liver Failure / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009026:Mortality; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology / Q000378:metabolism; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D014527:Uric Acid / Q000378:metabolism
chemical_list: D014527:Uric Acid; D003404:Creatinine
keywords: Clinical epidemiology; Liver transplantation; Uric acid; eGFR