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Uric Acid and Acute Kidney Injury in the Critically Ill
Anand Srivastava1,2, Ragnar Palsson2, David E Leaf2
1Division of Nephrology and Hypertension, Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
Kidney Medicine
|August 1, 2020
Summary
Higher plasma uric acid levels do not independently predict acute kidney injury (AKI) or mortality in critically ill patients. This study found no significant association after adjusting for other factors.
Area of Science:
- Nephrology
- Critical Care Medicine
- Biochemistry
Background:
- Uric acid is excreted by the kidneys and can accumulate in cases of acute kidney injury (AKI).
- The relationship between elevated plasma uric acid levels and the development or complications of AKI remains unclear.
- Investigating plasma uric acid as a potential biomarker in critical illness is warranted.
Purpose of the Study:
- To determine if higher plasma uric acid levels are associated with an increased risk of incident AKI in critically ill patients.
- To investigate the association between plasma uric acid levels and 60-day mortality in critically ill patients with established AKI.
- To assess the independent predictive value of plasma uric acid for adverse outcomes in critical care settings.
Main Methods:
- Prospective observational cohort study involving two independent cohorts of critically ill patients.
- Cohort 1: 208 patients without AKI admitted to the intensive care unit (ICU).
- Cohort 2: 250 participants with AKI requiring renal replacement therapy (RRT) from the Acute Renal Failure Trial Network (ATN) Study.
- Plasma uric acid levels were measured upon ICU admission (Cohort 1) and before RRT initiation (Cohort 2).
- Logistic regression models were employed to analyze the association between plasma uric acid and outcomes, adjusting for relevant covariates.
Main Results:
- In the ICU cohort, higher plasma uric acid levels showed a non-significant association with incident AKI after multivariable adjustment (adjusted OR per doubling of uric acid, 1.50; 95% CI, 0.80-2.81).
- In the ATN Study cohort, there was no statistically significant association between plasma uric acid levels and 60-day mortality, even after multivariable adjustment (adjusted OR per doubling of uric acid, 1.15; 95% CI, 0.71-1.86).
- The initial observed associations were confounded by factors such as serum creatinine levels.
Conclusions:
- Plasma uric acid levels measured on ICU admission or prior to RRT initiation are not independently associated with adverse clinical outcomes in critically ill patients.
- The study highlights potential heterogeneity within ICU patient populations.
- Elevated uric acid is not a reliable independent predictor of AKI or mortality in this critically ill cohort.
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