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J-shaped mortality relationship for uric acid in CKD
Mohamed E Suliman1, Richard J Johnson, Elvia García-López
1Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden.
Summary
High and low serum uric acid levels increase mortality risk in chronic kidney disease (CKD) patients. The lowest mortality risk was observed in patients with moderate uric acid levels, indicating a J-shaped association.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Clinical Chemistry
Background:
- Hyperuricemia is prevalent in chronic kidney disease (CKD) patients.
- The association between hyperuricemia and cardiovascular mortality in CKD is not well-established.
Purpose of the Study:
- To investigate the relationship between serum uric acid levels and all-cause mortality in patients with advanced CKD.
- To explore the association of uric acid with comorbidities in this population.
Main Methods:
- A cohort of 294 incident CKD stage 5 patients starting renal replacement therapy was studied.
- Patients were stratified into three groups based on serum uric acid levels: low, middle, and high quintiles.
- Survival analysis was performed over a mean follow-up of 27 months, with adjustments for multiple clinical factors.
Main Results:
- A J-shaped association was observed between serum uric acid levels and all-cause mortality.
- Both high and low serum uric acid levels were associated with increased mortality risk compared to moderate levels.
- Uric acid levels correlated with markers of dyslipidemia, inflammation, and calcium/phosphate metabolism.
Conclusions:
- Serum uric acid levels exhibit a J-shaped relationship with all-cause mortality in CKD stage 5 patients.
- Moderate serum uric acid levels are associated with the lowest mortality risk.
- Uric acid is linked to key CKD comorbidities including metabolic disturbances and inflammation.
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