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Longitudinal uric acid has nonlinear association with kidney failure and mortality in chronic kidney disease

Mathilde Prezelin-Reydit1,2,3, Christian Combe4,5, Denis Fouque6

  • 1INSERM, Bordeaux Population Health Research Center, UMR1219, Univ Bordeaux, Bordeaux, France. mathilde.reydit@maisondurein-aurad.fr.

Scientific Reports
|March 9, 2023
PubMed

Insights

In chronic kidney disease (CKD) patients, high uric acid (UA) above 10 mg/dl strongly predicts kidney failure and death. Low UA below 5 mg/dl is linked to death before kidney failure.

Area of Science:

  • Nephrology
  • Clinical Chemistry

Background:

  • Chronic kidney disease (CKD) affects millions globally.
  • The role of longitudinal uric acid (UA) levels in CKD progression and mortality requires further elucidation.

Purpose of the Study:

  • To investigate the shape of the relationship between longitudinal uric acid (UA) and the risk of kidney failure and death in CKD patients.
  • To identify specific uric acid thresholds associated with increased hazards in this population.

Main Methods:

  • Analysis of CKD stage 3-5 patients from the CKD-REIN cohort.
  • Utilized cause-specific multivariate Cox models with spline functions for current UA values (cUA).
  • Longitudinal data from a median of five UA measures per patient over a median follow-up of 3.2 years.

Main Results:

  • Kidney failure risk increased with higher cUA, showing a plateau between 6-10 mg/dl and a sharp rise above 11 mg/dl.
  • A U-shaped relationship was observed for the hazard of death, with elevated risks at both low (3 mg/dl) and high (11 mg/dl) UA levels compared to 5 mg/dl.
  • UA levels exceeding 10 mg/dl were identified as a significant risk marker for both kidney failure and death.

Conclusions:

  • In CKD patients, uric acid levels above 10 mg/dl are a strong predictor of kidney failure and mortality.
  • Uric acid levels below 5 mg/dl are associated with an increased risk of death, potentially preceding kidney failure.

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