Michelle C Odden1, Abdul-Razak Amadu2, Ellen Smit2, Lowell Lo3, Carmen A Peralta3. 1. 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. 2. School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR. 3. Division of Nephrology, Department of Medicine, University of California, San Francisco, CA.
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. STUDY DESIGN: Cross-sectional and longitudinal. SETTING & PARTICIPANTS: 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. PREDICTORS: 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). OUTCOMES: 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. LIMITATIONS: 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.
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. STUDY DESIGN: Cross-sectional and longitudinal. SETTING & PARTICIPANTS: 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. PREDICTORS: 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). OUTCOMES: 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. LIMITATIONS: 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: Michael A Schwarzschild; Eric A Macklin; Rachit Bakshi; Shamik Battacharyya; Robert Logan; Alberto J Espay; Albert Y Hung; Grace Bwala; Christopher G Goetz; David S Russell; John L Goudreau; Sotirios A Parashos; Marie H Saint-Hilaire; Alice Rudolph; Joshua M Hare; Gary C Curhan; Alberto Ascherio Journal: Neurology Date: 2019-09-04 Impact factor: 9.910
Authors: Richard J Johnson; George L Bakris; Claudio Borghi; Michel B Chonchol; David Feldman; Miguel A Lanaspa; Tony R Merriman; Orson W Moe; David B Mount; Laura Gabriella Sanchez Lozada; Eli Stahl; Daniel E Weiner; Glenn M Chertow Journal: Am J Kidney Dis Date: 2018-02-27 Impact factor: 8.860
Authors: Roy G Cutler; Simonetta Camandola; Kelli F Malott; Maria A Edelhauser; Mark P Mattson Journal: Curr Top Med Chem Date: 2015 Impact factor: 3.295
Authors: Jeffrey D Lebensburger; Gary R Cutter; Thomas H Howard; Paul Muntner; Daniel I Feig Journal: Pediatr Nephrol Date: 2017-04-05 Impact factor: 3.714