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Uric acid is a strong independent predictor of renal dysfunction in patients with rheumatoid arthritis

Dimitrios Daoussis¹, Vasileios Panoulas, Tracey Toms

¹Department of Rheumatology, Dudley Group of Hospitals NHS Trust, Russells Hall Hospital, Pensnett Road, Dudley, West Midlands, UK. jimdaoussis@hotmail.com

Arthritis Research & Therapy

|July 28, 2009

Insights

High uric acid (UA) levels are strongly linked to kidney dysfunction in rheumatoid arthritis (RA) patients. This association remains significant even after accounting for other health factors, suggesting UA

Area of Science:

Nephrology
Rheumatology
Metabolic Diseases

Background:

Emerging evidence suggests uric acid (UA) may directly contribute to kidney disease pathogenesis, independent of crystal deposition.
Previous research linked UA to hypertension and cardiovascular disease (CVD) in rheumatoid arthritis (RA) patients, alongside renal dysfunction.
This study aimed to explore the association between UA and renal dysfunction in RA patients, determining its independence from other risk factors.

Purpose of the Study:

To investigate the association between uric acid (UA) and renal dysfunction in patients with rheumatoid arthritis (RA).
To determine if this association is independent of comorbidities and risk factors for renal impairment.

Main Methods:

Assessed renal function using estimated glomerular filtration rate (eGFR) in 350 RA patients.
Collected data on risk factors for renal dysfunction, including age, blood pressure, cholesterol, triglycerides, RA duration, body mass index, and gender.
Employed linear regression to analyze the association between eGFR and UA, adjusting for potential confounders.

Main Results:

Uric acid (UA) showed the strongest association with reduced renal function (eGFR) in RA patients (r = -0.45, P < 0.001).
UA remained the primary correlate of eGFR after adjusting for age, blood pressure, lipids, RA duration, BMI, and gender.
Adjustments for medications, inflammation markers, and insulin resistance did not alter the significant association between UA and renal dysfunction.

Conclusions:

Uric acid is a significant correlate of renal dysfunction in patients with rheumatoid arthritis.
Elevated UA in RA patients may warrant screening for kidney dysfunction and timely management.
Further research is needed to elucidate the mechanisms and clinical implications of UA-related renal impairment in RA.

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Abstract

Introduction:

Recent evidence suggests that uric acid (UA), regardless of crystal deposition, may play a direct pathogenic role in renal disease. We have shown that UA is an independent predictor of hypertension and cardiovascular disease (CVD), and that CVD risk factors associate with renal dysfunction, in patients with rheumatoid arthritis (RA). In this study we investigated whether UA associates with renal dysfunction in patients with RA and whether such an association is independent or mediated through other comorbidities or risk factors for renal impairment.

Methods:

Renal function was assessed in 350 consecutive RA patients by estimated glomerular filtration rate (GFR) using the six-variable Modification of Diet in Renal Disease equation. Risk factors for renal dysfunction were recorded or measured in all participants. Linear regression was used to test the independence of the association between GFR and UA.

Results:

Univariable analysis revealed significant associations between GFR and age, systolic blood pressure, total cholesterol, triglycerides, RA duration and UA. UA had the most powerful association with renal dysfunction (r = -0.45, P < 0.001). A basic model was created, incorporating all of the above parameters along with body mass index and gender. UA ranked as the first correlate of GFR (P < 0.001) followed by age. Adjustments for the use of medications (diuretics, low-dose aspirin, cyclooxygenase II inhibitors and nonsteroidal anti-inflammatory drugs) and further adjustment for markers of inflammation and insulin resistance did not change the results.

Conclusions:

UA is a strong correlate of renal dysfunction in RA patients. Further studies are needed to address the exact causes and clinical implications of this new finding. RA patients with elevated UA may require screening for renal dysfunction and appropriate management.

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