Hernan Rincon-Choles1, Stacey E Jolly2, Susana Arrigain3, Victoria Konig3, Jesse D Schold3, Georges Nakhoul1, Sankar D Navaneethan4,5, Joseph V Nally1, Michael B Rothberg2,6. 1. Department of Nephrology, Cleveland Clinic Foundation, Cleveland, Ohio, USA. 2. Department of Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA. 3. Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio, USA. 4. Baylor College of Medicine, Houston, Texas, USA. 5. Houston Veterans Affairs Medical Center, Houston, Texas, USA. 6. Cleveland Clinic Foundation Center for Value-Based Care Research, Cleveland, Ohio, USA.
Abstract
BACKGROUND: Hyperuricemia is associated with the progression of chronic kidney disease (CKD), but it is not known whether the relationship is causal. We examined the association of hyperuricemia and uric acid lowering therapy (UALT) with progression of CKD in patients with CKD 3 and 4 in the Cleveland Clinic CKD registry. METHODS: We included 1,676 patients with CKD stages 3 and 4 from Ohio, who had measured their uric acid (UA) levels a year prior to the recording of the second eGFR <60 mL/min/1.73 m2, and follow-up eGFR, between 2005 and 2009. Our primary composite outcome included a 50% drop in eGFR or progression to ESRD. Secondary outcomes included the rate of decline in eGFR, all-cause mortality, progression to ESRD, and a composite measure of progression to ESRD or death. We assessed the association between UA, UALT, and outcomes using Cox models and competing risks regression models. RESULTS: In multivariable models, higher UA was associated with the composite endpoint, but it reached statistical significance only in the 4th quartile (≥8.9 mg/dL). Receipt of UALT was significantly associated with increased risk of the composite outcome. Neither UA nor UALT (considered a time-dependent covariate) was significantly associated with mortality. The inference was similar for UA as high vs. low, quartiles, or continuous. Similarly, neither high UA nor UALT were significantly associated with ESRD, the composite of ESRD and mortality, or eGFR decline. CONCLUSIONS: Hyperuricemia is associated with increased risk of progression to ESRD in patients with CKD stages 3 and 4, but UALT does not ameliorate the risk, suggesting that the relationship is not causal.
BACKGROUND:Hyperuricemia is associated with the progression of chronic kidney disease (CKD), but it is not known whether the relationship is causal. We examined the association of hyperuricemia and uric acid lowering therapy (UALT) with progression of CKD in patients with CKD 3 and 4 in the Cleveland Clinic CKD registry. METHODS: We included 1,676 patients with CKD stages 3 and 4 from Ohio, who had measured their uric acid (UA) levels a year prior to the recording of the second eGFR <60 mL/min/1.73 m2, and follow-up eGFR, between 2005 and 2009. Our primary composite outcome included a 50% drop in eGFR or progression to ESRD. Secondary outcomes included the rate of decline in eGFR, all-cause mortality, progression to ESRD, and a composite measure of progression to ESRD or death. We assessed the association between UA, UALT, and outcomes using Cox models and competing risks regression models. RESULTS: In multivariable models, higher UA was associated with the composite endpoint, but it reached statistical significance only in the 4th quartile (≥8.9 mg/dL). Receipt of UALT was significantly associated with increased risk of the composite outcome. Neither UA nor UALT (considered a time-dependent covariate) was significantly associated with mortality. The inference was similar for UA as high vs. low, quartiles, or continuous. Similarly, neither high UA nor UALT were significantly associated with ESRD, the composite of ESRD and mortality, or eGFR decline. CONCLUSIONS:Hyperuricemia is associated with increased risk of progression to ESRD in patients with CKD stages 3 and 4, but UALT does not ameliorate the risk, suggesting that the relationship is not causal.
Authors: Mahmoud G El Sebaei; Reham A El-Shafei; Mohamed A El-Adl; Amany Farag; Abdelfattah H Eladl Journal: Vet Res Commun Date: 2021-11-30 Impact factor: 2.459
Authors: Federica Piani; Fumihiko Sasai; Petter Bjornstad; Claudio Borghi; Ashio Yoshimura; Laura G Sanchez-Lozada; Carlos Roncal-Jimenez; Gabriela E Garcia; Ana Andres Hernando; Gabriel Cara Fuentes; Bernardo Rodriguez-Iturbe; Miguel A Lanaspa; Richard J Johnson Journal: J Bras Nefrol Date: 2021 Oct-Dec