Kidney Failure, Death Tied With Elevated Uric Acid in CKD Patients

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In a study, CKD patients with high trajectories of serum uric acid had nearly triple the risk for ESRD and 4.5 times the risk for death.
In a study, CKD patients with high trajectories of serum uric acid had nearly triple the risk for ESRD and 4.5 times the risk for death.

Patients with chronic kidney disease (CKD) and elevate serum uric acid (SUA) trajectories appear to have greater risks for kidney failure and death, according to new study findings.

Chin-Chi Kuo, MD, and collaborators from China Medical University Hospital in Taiwan, assessed data from 5090 participants (aged 20–90 years) in their pre-ESRD registry 2003 to 2015. Using serial measurements of SUA and group-based trajectory modeling, the team described 4 uric acid trajectories: low, medium, medium-high, and high. A hyperuricemia cutoff of 7.5 mg/dL separated the low and medium patterns from the medium-high and high patterns.

Of the patients in the cohort, 948 progressed to end stage renal disease (ESRD) and 472 died at rates of 57.9 and 28.7 cases per 1000 person-years, respectively, according to results published in Nephrology Dialysis Transplantation. Compared with patients who had a low uric acid trajectory, individuals with moderate, moderate-high, and high trajectories had approximately 1.9-, 2.5-, and 2.8-fold greater risks of ESRD, respectively, and 1.4-, 2.0-, and 4.5-fold increased risk for all-cause mortality, respectively. The researchers adjusted for renal function, competing risks for death, and other confounders. Patients with CKD who did not take urate-lowering agents at baseline appeared more likely to progress to ESRD.

“In conclusion, the results of this study demonstrate the importance of SUA as a risk factor of all-cause mortality and progression to ESRD among CKD patients. Adequate experimental and empirical evidence is urgently required to assess whether SUA is an independent therapeutic target,” Dr Kuo and his colleagues wrote. When and how to optimize serum uric acid levels are unknown.

A 2017 study published online in the American Journal of Kidney Diseases also associated hyperuricemia with increased risks for renal failure and death in CKD patients.

In a systematic review and meta-analysis published previously in PLOS One, researchers concluded that uric acid-lowering therapy seemed to improve renal outcomes and reduce the risk for cardiovascular events.

Reference

Tsai CW, Chiu HT, Huang HC, Ting W, Yeh HC, and Kuo CC. Uric acid predicts adverse outcomes in chronic kidney disease: a novel insight from trajectory analyses. Nephrol Dial Transplant 2018;33:231–241. doi: 10.1093/ndt/gfx297

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