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Plasma Urate and Risk of a Hospital Stay with AKI: The Atherosclerosis Risk in Communities Study

Keiko I Greenberg1, Mara A McAdams-DeMarco2, Anna Köttgen3

  • 1Departments of Medicine and kgreenb4@jhmi.edu.

Clinical Journal of the American Society of Nephrology : CJASN
|February 27, 2015
PubMed

Insights

Higher plasma urate levels are linked to an increased risk of acute kidney injury (AKI). However, genetic analysis did not confirm urate as a direct cause of AKI, suggesting further research is needed.

Area of Science:

  • Nephrology
  • Cardiovascular Disease Epidemiology
  • Genetic Epidemiology

Background:

  • Elevated serum urate is a known risk factor for chronic kidney disease (CKD).
  • The association between serum urate and acute kidney injury (AKI) is less understood.
  • This study investigates the relationship between urate levels and hospitalized AKI risk.

Purpose of the Study:

  • To evaluate the association between plasma urate concentrations and the risk of hospitalized AKI.
  • To explore the potential causal role of urate in kidney injury using genetic data.
  • To examine interactions between urate, gout, and CKD in relation to AKI risk.

Main Methods:

  • A large population-based cohort (Atherosclerosis Risk in Communities study) with 11,011 participants followed for 12 years.
  • Cox regression analysis was used to assess the association between baseline plasma urate and AKI risk, adjusting for covariates.
  • Mendelian randomization with a genetic urate score was employed to infer causality.

Main Results:

  • Higher plasma urate (>5.0 mg/dl) was independently associated with an increased risk of hospitalized AKI (HR 1.16 per 1 mg/dl increase).
  • The urate-AKI association was significant only in participants without a history of gout (P=0.02).
  • No significant association was found between a genetic urate score and AKI risk, indicating a lack of causal evidence.

Conclusions:

  • Plasma urate levels above 5.0 mg/dl are independently associated with a higher risk of hospitalized AKI.
  • Genetic evidence does not support a causal role for urate in AKI.
  • Further research is warranted to determine if urate-lowering therapies can reduce AKI risk.
Abstract

Keywords:
acute renal failureclinical epidemiologyrisk factors

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