Longitudinal trajectories of obesity and eGFR decline jointly predict incident hyperuricemia: A multi-center...

The joint effects of longitudinal changes in body mass index (BMI) and estimated glomerular filtration rate (eGFR), on hyperuricemia risk remain unclear. We aimed to investigate this relationship and identify high-risk trajectories for hyperuricemia prediction.

In this prospective community-based cohort (2018-2023), we enrolled 5329 Chinese adults ≥18 years with serial measurements of BMI, eGFR, and serum urate. Restricted cubic splines (RCS) nested in the Cox regression framework were applied to assess dose-response relationships between BMI, eGFR and hyperuricemia risk. Group-based trajectory modeling identified distinct BMI/eGFR patterns, with multivariable-adjusted Bayesian Cox proportional hazards models quantifying their associations with incident hyperuricemia. Over an average follow-up period of 3.25 years, 489 individuals developed hyperuricemia, resulting in an incidence rate of 15.05 per 100 person-years. Each unit increase in BMI during follow-up was associated with a 21 % (95 % CI: 14 %-30 %) increased risk for hyperuricemia. Similarly, each 10-unit decrease in eGFR correlated with a 12 % (95 % CI: 5 %-19 %) elevation in hyperuricemia risk. The RCS curves indicated linear associations between changes in BMI and eGFR and hyperuricemia risk (all p values < 0.001). The low eGFR trajectory showed a marginal HR of 1.52 (95 % CI: 1.02-2.37). The HRs for the high BMI trajectory group was 3.89 (95 % CI: 2.35-6.38). Notably, the influence of eGFR variability was more pronounced in men, while that of BMI was stronger in women.

Longitudinal patterns of rising BMI and declining eGFR synergistically predict hyperuricemia development, with clinically relevant sexual difference.