Kimio Watanabe1, Masaaki Nakayama1,2, Tae Yamamoto3, Gen Yamada4, Hiroshi Sato5, Mariko Miyazaki6,7, Sadayoshi Ito7,8. 1. Division of Kidney Center, St Luke's International Hospital, Tokyo, Japan. 2. Research Division of Chronic Kidney Disease and Dialysis Treatment, Tohoku University Hospital, Sendai, Japan. 3. Division of Kidney Center, Sendai City Hospital, Sendai, Japan. 4. Division of Nephrology and Endocrinology, Osaki Citizen Hospital, Osaki, Japan. 5. Division of Internal Medicine, JR Sendai Hospital, Sendai, Japan. 6. Division of Blood Purification, Tohoku University Hospital, Sendai, Japan. 7. Division of Nephrology, Hypertension and Endocrinology, Tohoku University, Sendai, Japan. 8. Katta General Public Hospital, Shiroishi, Japan.
Abstract
BACKGROUND: Hyperuricemia is highly prevalent in chronic kidney disease (CKD) patients, but the evidence for a relationship between uric acid (UA) and clinical outcomes in CKD patients is limited and inconsistent. We hypothesized that UA has a different impact on clinical outcomes according to the underlying disease causing CKD. METHODS: This study prospectively investigated the associations between UA and renal and non-renal outcomes according to the underlying disease causing CKD in 2,797 Japanese patients under the care of nephrologists. The patients were categorized into four groups: primary renal disease (n = 1306), hypertensive nephropathy (n = 467), diabetic nephropathy (n = 275), and other nephropathy (n = 749). The renal outcome was defined as end-stage renal disease (ESRD), and the non-renal outcome was defined as a composite endpoint of cardiovascular events (CVEs) and all-cause mortality. RESULTS: During a median 4.8-year follow-up, 359 (12.8%) patients reached the renal outcome, and 260 (9.3%) reached the non-renal outcome. In the all-patient analysis, hyperuricemia was not associated with the risks for renal and non-renal outcomes, but in primary renal disease (PRD) and hypertensive renal disease (HTN) patients, hyperuricemia was significantly associated with non-renal outcomes. Per 1 mg/dl higher UA level, multivariable adjusted hazard ratio was 1.248 (95% CI: 1.003 to 1.553) for PRD, and 1.250 (1.035 to 1.510) for HTN. Allopurinol did not reduce the risks for renal and non-renal outcomes, both in all patients and in the subgroup analysis. CONCLUSIONS: The effect of hyperuricemia on clinical outcomes in CKD patients varies according to the underlying disease causing CKD. Hyperuricemia is an independent risk factor for non-renal outcomes in primary renal disease and hypertensive renal disease patients. Allopurinol did not decrease the risks for renal and non-renal outcomes.
BACKGROUND:Hyperuricemia is highly prevalent in chronic kidney disease (CKD) patients, but the evidence for a relationship between uric acid (UA) and clinical outcomes in CKDpatients is limited and inconsistent. We hypothesized that UA has a different impact on clinical outcomes according to the underlying disease causing CKD. METHODS: This study prospectively investigated the associations between UA and renal and non-renal outcomes according to the underlying disease causing CKD in 2,797 Japanese patients under the care of nephrologists. The patients were categorized into four groups: primary renal disease (n = 1306), hypertensive nephropathy (n = 467), diabetic nephropathy (n = 275), and other nephropathy (n = 749). The renal outcome was defined as end-stage renal disease (ESRD), and the non-renal outcome was defined as a composite endpoint of cardiovascular events (CVEs) and all-cause mortality. RESULTS: During a median 4.8-year follow-up, 359 (12.8%) patients reached the renal outcome, and 260 (9.3%) reached the non-renal outcome. In the all-patient analysis, hyperuricemia was not associated with the risks for renal and non-renal outcomes, but in primary renal disease (PRD) and hypertensive renal disease (HTN) patients, hyperuricemia was significantly associated with non-renal outcomes. Per 1 mg/dl higher UA level, multivariable adjusted hazard ratio was 1.248 (95% CI: 1.003 to 1.553) for PRD, and 1.250 (1.035 to 1.510) for HTN. Allopurinol did not reduce the risks for renal and non-renal outcomes, both in all patients and in the subgroup analysis. CONCLUSIONS: The effect of hyperuricemia on clinical outcomes in CKDpatients varies according to the underlying disease causing CKD. Hyperuricemia is an independent risk factor for non-renal outcomes in primary renal disease and hypertensive renal diseasepatients. Allopurinol did not decrease the risks for renal and non-renal outcomes.
Authors: Jiaojiao Jing; Jan T Kielstein; Ulla T Schultheiss; Thomas Sitter; Stephanie I Titze; Elke S Schaeffner; Mara McAdams-DeMarco; Florian Kronenberg; Kai-Uwe Eckardt; Anna Köttgen Journal: Nephrol Dial Transplant Date: 2014-11-13 Impact factor: 5.992
Authors: Marian Goicoechea; Soledad García de Vinuesa; Ursula Verdalles; Caridad Ruiz-Caro; Jara Ampuero; Abraham Rincón; David Arroyo; José Luño Journal: Clin J Am Soc Nephrol Date: 2010-06-10 Impact factor: 8.237
Authors: M Mazzali; J Hughes; Y G Kim; J A Jefferson; D H Kang; K L Gordon; H Y Lan; S Kivlighn; R J Johnson Journal: Hypertension Date: 2001-11 Impact factor: 10.190
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: Takahiko Nakagawa; Richard J Johnson; Ana Andres-Hernando; Carlos Roncal-Jimenez; Laura G Sanchez-Lozada; Dean R Tolan; Miguel A Lanaspa Journal: J Am Soc Nephrol Date: 2020-04-06 Impact factor: 10.121
Authors: Michiel J Bos; Peter J Koudstaal; Albert Hofman; Jacqueline C M Witteman; Monique M B Breteler Journal: Stroke Date: 2006-05-04 Impact factor: 7.914
Authors: Bhadran Bose; Sunil V Badve; Swapnil S Hiremath; Neil Boudville; Fiona G Brown; Alan Cass; Janak R de Zoysa; Robert G Fassett; Randall Faull; David C Harris; Carmel M Hawley; John Kanellis; Suetonia C Palmer; Vlado Perkovic; Elaine M Pascoe; Gopala K Rangan; Robert J Walker; Giles Walters; David W Johnson Journal: Nephrol Dial Transplant Date: 2013-09-15 Impact factor: 5.992