High Uric Acid Raises Death Risk in CKD
Patients with chronic kidney disease who have hyperuricemia have a 3-fold higher risk of all-cause mortality.
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SAN DIEGO—Hyperuricemia is independently associated with an increased risk of death among patients with chronic kidney disease (CKD), investigators concluded in a presentation at the American Society of Nephrology's Kidney Week 2018 meeting.
In a study of 42,253 patients with CKD in a multi-center cohort, Yong Chul Kim, MD, and colleagues from Seoul National University in Korea, found that hyperuricemia—uric acid level 6.8 mg/dL or above—was associated with a significant 3-fold increased risk of all-cause mortality after adjusting for confounders such as age, hypertension, diabetes, and estimated glomerular filtration rate (eGFR).
Hyperuricemia, however, was independently associated with a significant 46% lower risk of kidney failure. Hyperuricemia in patients with an eGFR below 30 mL/min/1.73 m2 was associated with a significant 81% decreased risk of death.
The mean uric acid level for the entire cohort was 5.4 mg/dL. During a median 1 year of follow-up, renal failure developed in 3,556 patients (8.4%) and 5094 (12%) died.
The new study adds to the findings from previous studies showing a link between elevated uric acid and kidney failure or death among CKD patients. In a 2018 paper published in Nephrology Dialysis Transplantation, Ching-Wei Tsai, MD, and colleagues reported on a study of 5090 CKD patients showing that an elevated serum uric acid trajectory in these patients was associated with increased risk of kidney failure and all-cause mortality.
In addition, a previous study published in 2018 in the American Journal of Kidney Diseases by Anand Srivastava, MD, MPH, and collaborators found that higher uric acid levels were independently associated with an increased risk of kidney failure in earlier stages of CKD (eGFR of 45 mL/min/1.73 m2 or above). The study found a J-shaped relationship with all-cause mortality. In a separate study of 838 patients with stages 3 to 4 CKD published in 2009 in the same journal, Magdalena Madero, MD, and colleagues demonstrated that patients in the highest tertile of uric acid level had a 57% increased risk of all-cause mortality compared with those in the lowest tertile. The study found no association between uric acid levels and renal failure.
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Kim YC, An JN, Kim DK, et al. The impact of hyperuricemia on kidney failure and mortality in a multi-center CKD cohort: An instrumental variable analysis. Presented at the American Society of Nephrology's 2018 Kidney Week meeting in San Diego, Oct. 23-28. Abstract FR-PO179.
Tsai CW, Chiu HT, Huang HC, et al. Uric acid predicts adverse outcomes in chronic kidney disease: a novel insight from trajectory analyses. Nephrol Dial Transplant. 2018;33:231-241.