Relationship of Uric Acid With Progression of Kidney Disease
Background
Uric acid levels are increased in patients with kidney dysfunction. We tested the hypothesis that uric acid may be associated with kidney disease progression.
Study Design
Cohort study.
Setting & Participants
5,808 participants of the Cardiovascular Health Study.
Predictor
Uric acid levels.
Outcomes & Measurements
Kidney disease progression was defined as a decrease in estimated glomerular filtration rate (GFR) of 3 mL/min/1.73 m2 per year or greater (≥0.05 mL/s) and as incident chronic kidney disease (CKD). Measures of kidney function were estimated GFR using the Modification of Diet in Renal Disease Study equation.
Results
Higher quintiles of uric acid levels were associated with greater prevalences of estimated GFR less than 60 mL/min/1.73 m2 (<1.00 mL/s) of 7%, 14%, 12%, 25%, and 42% for quintiles 1 (≤4.41 mg/dL [≤262 μmol/L]), 2 (4.41 to 5.20 mg/dL [262 to 309 μmol/L]), 3 (5.21 to 5.90 mg/dL [310 to 351 μmol/L]), 4 (5.91 to 6.90 mg/dL [352 to 410 μmol/L]), and 5 (>6.90 mg/dL [>410 μmol/L]), respectively. In comparison, there was only a modest, but significant, association between quintiles of uric acid levels and progression of kidney function decrease, with adjusted odds ratios of 1.0, 0.88 (95% confidence interval [CI], 0.64 to 1.21), 1.23 (95% CI, 0.87 to 1.75), 1.47 (95% CI, 1.04 to 2.07), and 1.49 (95% CI, 1.00 to 2.22) for quintiles 1 through 5, respectively. No significant association was found between uric acid level and incident CKD (adjusted odds ratio, 1.00; 95% CI, 0.89 to 1.14).
Limitations
Measurements of albuminuria were not available.
Conclusions
Uric acid levels are associated strongly with prevalent CKD. In comparison, greater uric acid levels had a significant, but much weaker, association with progression of kidney disease.
Index Words: Uric acid, kidney function, chronic kidney disease
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Originally published online as doi:10.1053/j.ajkd.2007.05.013 on June 28, 2007.
Because an author of this manuscript is an editor for AJKD, the peer-review and decision-making processes were handled entirely by an outside editor, Michel Jadoul, MD, Cliniques Universitaires Saint Luc, who served as acting Editor-in-Chief. Details of the journal’s procedures for potential editor conflicts are given in the Editorial Policies section of the AJKD Website.
PII: S0272-6386(07)00832-3
doi:10.1053/j.ajkd.2007.05.013
© 2007 National Kidney Foundation, Inc. Published by Elsevier Inc All rights reserved.
