Serum uric acid levels exceeding 10 mg/dL predict kidney failure and death in patients with chronic kidney disease (CKD). Low uric acid levels less than 5 mg/dL predict death before kidney failure. The new study findings were published in Scientific Reports.
Using the French Chronic Kidney Disease-Renal Epidemiology and Information Network (CKD-REIN) cohort, Mathilde Prezelin-Reydit, MD, PhD, of the University Bordeaux in France, and colleagues examined longitudinal serum uric acid levels in 2781 patients with stage 3-5 CKD (66% men; median age 69 years) for a median 3.2 years. In an adjusted model, kidney failure risk rose along with current serum uric acid levels, with a plateau in risk from 6 to 10 mg/dL followed by a sharp increase above 11 mg/dL. Compared with a serum uric acid level of 5 mg/dL (reference), a level of 11 mg/dL was significantly associated with a 1.7-fold higher risk for kidney failure, whereas a level of 3 mg/dL was significantly associated with a 59% decreased risk.
The investigators observed a U-shaped relationship between current serum uric acid levels and death. Compared with the reference value, levels of 3 mg/dL and 11 mg/dL were significantly associated with a 1.8- and 2.3-fold increased risk for death, respectively. The lowest mortality risk was among patients with a current serum uric acid level of 6 mg/dL.
The investigators adjusted the models for CKD progression risk factors such as age, sex, primary kidney disease, hypertension, diabetes, cardiovascular disease, dyslipidemia, body mass index, albuminuria, CKD stage, medication adherence, and use of renin-angiotensin system inhibitors and urate-lowering therapy.
“Although the use of [urate-lowering therapy] to slow progression of CKD is not recommended, we believe that a [uric acid level] above 10 mg/dl may be considered as a strong risk marker for kidney failure and death, and thus should encourage nephrologists to be stricter in controlling cardiovascular and nephroprotective factors,” Dr Prezelin-Reydit’s team concluded.
Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Prezelin-Reydit M, Combe C, Fouque D, et al. Longitudinal uric acid has nonlinear association with kidney failure and mortality in chronic kidney disease. Sci Rep 13(1):3952. Published online March 9, 2023. doi:10.1038/s41598-023-30902-7