In Reply to ‘Uric Acid, Cardiovascular Mortality, and Long-Term Outcomes in CKD’

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Turgut et al¹ make the point that renin-angiotensin system blockade and nonsteroidal anti-inflammatory drug (NSAID) use may have confounded the observed associations between uric acid levels and long-term outcomes in the Modification of Diet in Renal Disease (MDRD) Study cohort. The investigators focus on losartan in particular because it has uricosuric effects. The MDRD Study was conducted from 1989 to 1993 and predates the widespread use and availability of angiotensin receptor blockers. Of participants in the first, second, and third tertiles of uric acid level, 30%, 41%, and 38% reported angiotensin-converting enzyme–inhibitor use at baseline, respectively. Additional adjustment for angiotensin-converting enzyme–inhibitor use did not alter the observed associations (Table 1). Only 10% of the MDRD Study cohort reported NSAID use, including salicylic acid, at baseline, and there was no difference between uric acid tertiles. Adjustment for NSAID use did not modify results for any of the outcomes (data not shown).

Table 1. Relationship Between Tertiles of Uric Acid and All-Cause Mortality, Cardiovascular Disease Mortality, and Kidney Failure

	Tertile 1	Tertile 2	Tertile 3
Kidney failure	1.00(reference)	1.10(0.89-1.36)	1.11(0.89-1.39)
Cardiovascular mortality	1.00(reference)	0.91(0.58-1.42)	1.27(0.81-1.98)
All-cause mortality	1.00(reference)	1.21(0.86-1.72)	1.50(1.05-2.14)

Note: Values expressed as hazard ratio (95% confidence interval).

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Reference 

1. Turgut F, Kasapoglu B, Kanbay M. Uric acid and long-term outcomes in CKD. Am J Kidney Dis. 2009;54:582;(ltr)
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