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The Bidirectional Relationship between Chronic Kidney Disease and Hyperuricemia: Evidence from a Population-Based
Zhibin Ma1, Xiao Wang1, Jia Zhang1
1Department of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, Lanzhou 730000, China.
Insights
This study reveals a two-way link between chronic kidney disease (CKD) and hyperuricemia (HUA). Both conditions increase the risk of developing the other, highlighting their interconnectedness in kidney health.
Area of Science:
- Nephrology
- Metabolic Diseases
- Epidemiology
Background:
- The relationship between chronic kidney disease (CKD) and hyperuricemia (HUA) is complex and not fully understood.
- Previous research has not definitively established the directionality of the association between CKD and HUA.
Purpose of the Study:
- To investigate the bidirectional association between chronic kidney disease (CKD) and hyperuricemia (HUA).
- To determine if CKD increases the risk of HUA and if HUA increases the risk of CKD.
Main Methods:
- Three analyses were conducted involving over 25,000 participants.
- Cox proportional hazards regression models were used to assess incident HUA and new-onset CKD.
- Cross-lag models were employed to further explore the bidirectional relationship between serum uric acid (sUA) and estimated glomerular filtration rate (eGFR).
Main Results:
- Individuals with CKD had a significantly higher risk of developing HUA (HR = 1.58).
- Lower eGFR levels were associated with an increased risk of HUA.
- Individuals with HUA had a higher risk of developing CKD (HR = 1.28).
- The fourth quintile of sUA was associated with an increased risk of CKD (HR = 1.24).
- A significant bidirectional relationship was found between sUA and eGFR.
Conclusions:
- Chronic kidney disease (CKD) and hyperuricemia (HUA) are closely associated.
- A bidirectional relationship exists between serum uric acid (sUA) and estimated glomerular filtration rate (eGFR).
Background:
Although several studies have examined the association between chronic kidney disease (CKD) and hyperuricemia (HUA), the direction of the association remains unclear. We aimed to investigate whether there was a bidirectional association between them.
Methods:
The present study was conducted in three analyses. Analysis I included 25,433 participants free of HUA at baseline to evaluate the associations between CKD and estimated glomerular filtration rate (eGFR) with incident HUA. Analysis II had 28,422 participants free of CKD at baseline to analyze the relationships between HUA and serum uric acid (sUA) with new-onset CKD. Cox proportional hazards regression models were applied to evaluate the association involved in Analysis I and II. Analysis III included 31,028 participants with complete data and further dissected the bidirectional association between sUA and eGFR using cross-lag models.
Results:
New-onset HUA and CKD were observed in the first round of the follow-up study among 1597 and 1212 participants, respectively. A significantly higher risk of HUA was observed in individuals with CKD compared to individuals without CKD (HR = 1.58, 95% CI: 1.28-1.95). The adjusted HRs (95% CIs) of HUA were 3.56 (2.50-5.05) for the participants in the group of eGFR less than 60 mL·min-1·1.73 m-2, 1.61 (1.42-1.83) for those in the group of eGFR between 60 and 90 mL·min-1·1.73 m-2, and 1.74 (1.42-2.14) for those in the group of eGFR more than 120 mL·min-1·1.73 m-2, compared with the group of eGFR between 90 and 120 mL·min-1·1.73 m-2. A higher risk of CKD was also observed in individuals with HUA compared to individuals without HUA (HR = 1.28, 95% CI: 1.12-1.47). Compared with the first quintile of sUA, the adjusted HR (95% CI) of CKD was 1.24 (1.01-1.51) for the participants in the fourth quantile. There was a bidirectional relationship between sUA and eGFR, with the path coefficients (ρ1 = -0.024, p < 0.001) from baseline eGFR to follow-up sUA and the path coefficients (ρ2 = -0.015, p = 0.002) from baseline sUA to follow-up eGFR.
Conclusions:
The present study indicated that CKD and HUA were closely associated, and there was a bidirectional relationship between sUA and eGFR.
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