Higher Uric Acid Levels in Critically Ill Patients Up AKI Risk
Odds of acute kidney injury increases by 29% with each 1 mg/dL increment in uric acid level at ICU admission.
CHICAGO—High plasma uric acid levels in critically ill patients independently predict an increased risk of incident acute kidney injury, according to study findings presented at the American Society of Nephrology's 2016 Kidney Week meeting.
In a prospective study of 115 patients admitted to intensive care units, investigators at Brigham and Women's Hospital in Boston led by Anand Srivastava, MD, MPH, found that the 29 patients who experienced AKI had significantly higher mean plasma uric acid levels than the 86 patients who did not (5.5 vs. 4.2 mg/dL). On multivariable analysis, each 1 mg/dL increment in uric acid at ICU admission was associated with 29% increased odds of incident AKI, after adjusting for age, sex, baseline estimated glomerular filtration rate (eGFR), and APACHE II score.
“Uric acid may lead to kidney injury via endothelial dysfunction, vasoconstriction, oxidative stress, and intra-tubular obstruction,” Dr Srivastava explained in an interview with Renal & Urology News. “Upon entry to the intensive care unit, higher uric acid levels are associated with an increased risk of acute kidney injury in critically ill patients. A randomized-placebo controlled trial of pharmacologic uric acid lowering should be considered to reduce the risk of acute kidney injury in critically ill patients.”
The investigators defined incident AKI using KDIGO (Kidney Disease: Improving Global Outcomes) criteria. The patients with and without AKI did not differ significantly with respect to racial and gender composition, age, and APACHE II score, but the AKI group had significantly lower mean eGFR (76.2 vs 92.4 mL/min/1.73 m2).
- Srivastava A, et al. Plasma uric acid and development of acute kidney injury in the critically ill. Presented as a poster at the 2016 Kidney Week meeting in Chicago, Nov. 15-20. Poster TH-PO649.