ORIGINAL ARTICLE
The role of uric acid in chronic kidney disease patients Yao-Peng Hsieh1, 2,3, 4, Chia-Chu Chang1,4, Yu Yang1,4, Yao-Ko Wen1 ,Ping-Fang Chiu1,4 , Chi-Chen Lin5
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Division of Nephrology, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan 2 Ph.D. program in Translational Medicine, College of Life Science, National Chung Hsing University, Taichung, Taiwan 3 Kaohsiung Medical University, Kaohsiung, Taiwan 4 School of Medicine, Chung Shan Medical University, Taichung, Taiwan 5 Institute of Biomedical Sciences, College of Life Science, National Chung Hsing University, Taichung, Taiwan
Corresponding author: Dr. Yao-Peng Hsieh Division of Nephrology, Internal Medicine, Changhua Christian Hospital 135 Nanxiao Street, Changhua City, 500 Taiwan, R.O.C. Tel: 886-4-7238595, ext. 3227 Fax: 886-4-7277982 e-mail: [email protected]
Word counts: 249 for abstract; 2939 for the body of manuscript This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/nep.12679 This article is protected by copyright. All rights reserved.
2
Key words: chronic kidney disease; hospitalization; kidney function; mortality; renal replacement therapy; uric acid. Running title: uric acid in chronic kidney disease patients
2
This article is protected by copyright. All rights reserved.
3
Acknowledgements: None. Support: There is absence of any support. Conflict of interest statement There is the absence of any interest to disclose.
3
This article is protected by copyright. All rights reserved.
4
Abstract Background: Chronic kidney disease (CKD) is always associated with hyperuricemia. However, the studies evaluating the clinical implications of hyperuricemia have shown conflicting results in these patients. Methods: A retrospective observational study was conducted in 2408 stage 3-5 CKD patients. Instead of one baseline uric acid (UA) level, the averaged level of the two consecutive measurements for each participant was used as the predictor for the outcomes of study, which included mortality, renal outcomes, and hospitalization risk. A multivariate Cox proportional hazards model and logistic regression model were performed to determine the independent risk factor. Results: The mean UA level was 0.46±0.106 mmol/L. Of the 2408 patients, there were 563 (23.3%) deaths, 143 (5.9%) cardiovascular deaths, 652 (27%) subjects commencing renal replacement therapy (RRT), 664 (27.5%) subjects with rapid renal progression, 1937 (58%) patients requiring hospitalization and 404 (16.7%) patients with CVD hospitalization during a mean follow-up of approximately 3.03 years. After multivariate adjustments, a 1-mg/dL increase in uric acid level was associated with a hazard ratio (HR) of 1.26 for RRT (p=0.002), an odds ratio (OR) of 1.27 for rapid renal progression (p=0.001), an HR of 1.19 for all-cause hospitalization (p
The role of uric acid in chronic kidney disease patients Yao-Peng Hsieh1, 2,3, 4, Chia-Chu Chang1,4, Yu Yang1,4, Yao-Ko Wen1 ,Ping-Fang Chiu1,4 , Chi-Chen Lin5
1
Division of Nephrology, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan 2 Ph.D. program in Translational Medicine, College of Life Science, National Chung Hsing University, Taichung, Taiwan 3 Kaohsiung Medical University, Kaohsiung, Taiwan 4 School of Medicine, Chung Shan Medical University, Taichung, Taiwan 5 Institute of Biomedical Sciences, College of Life Science, National Chung Hsing University, Taichung, Taiwan
Corresponding author: Dr. Yao-Peng Hsieh Division of Nephrology, Internal Medicine, Changhua Christian Hospital 135 Nanxiao Street, Changhua City, 500 Taiwan, R.O.C. Tel: 886-4-7238595, ext. 3227 Fax: 886-4-7277982 e-mail: [email protected]
Word counts: 249 for abstract; 2939 for the body of manuscript This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/nep.12679 This article is protected by copyright. All rights reserved.
2
Key words: chronic kidney disease; hospitalization; kidney function; mortality; renal replacement therapy; uric acid. Running title: uric acid in chronic kidney disease patients
2
This article is protected by copyright. All rights reserved.
3
Acknowledgements: None. Support: There is absence of any support. Conflict of interest statement There is the absence of any interest to disclose.
3
This article is protected by copyright. All rights reserved.
4
Abstract Background: Chronic kidney disease (CKD) is always associated with hyperuricemia. However, the studies evaluating the clinical implications of hyperuricemia have shown conflicting results in these patients. Methods: A retrospective observational study was conducted in 2408 stage 3-5 CKD patients. Instead of one baseline uric acid (UA) level, the averaged level of the two consecutive measurements for each participant was used as the predictor for the outcomes of study, which included mortality, renal outcomes, and hospitalization risk. A multivariate Cox proportional hazards model and logistic regression model were performed to determine the independent risk factor. Results: The mean UA level was 0.46±0.106 mmol/L. Of the 2408 patients, there were 563 (23.3%) deaths, 143 (5.9%) cardiovascular deaths, 652 (27%) subjects commencing renal replacement therapy (RRT), 664 (27.5%) subjects with rapid renal progression, 1937 (58%) patients requiring hospitalization and 404 (16.7%) patients with CVD hospitalization during a mean follow-up of approximately 3.03 years. After multivariate adjustments, a 1-mg/dL increase in uric acid level was associated with a hazard ratio (HR) of 1.26 for RRT (p=0.002), an odds ratio (OR) of 1.27 for rapid renal progression (p=0.001), an HR of 1.19 for all-cause hospitalization (p
