Warm ischemia time and elevated serum uric acid are associated with metabolic syndrome after liver transplantation with donation after cardiac death

AIM To describe the prevalence of posttransplant metabolic syndrome(PTMS) after donation after cardiac death(DCD) liver transplantation(LT) and the pre-and postoperative risk factors.METHODS One hundred and forty-seven subjects who underwent DCD LT from January 2012 to February 2016 were enrolled in this study. The demographics and the clinical characteristics of pre-and post-transplantation were collected for both recipients and donors. PTMS was defined according to the 2004 Adult Treatment Panel-Ⅲ criteria. All subjects were followed monthly for the initial 6 mo after discharge, and then, every 3 mo for 2 years. The subjects were followed every 6 mo or as required after 2 years post-LT.RESULTS The prevalence of PTMS after DCD donor orthotopic LT was 20/147(13.6%). Recipient's body mass index(P = 0.024), warm ischemia time(WIT)(P = 0.045), and posttransplant hyperuricemia(P = 0.001) were significantly associated with PTMS. The change in serum uric acid levels in PTMS patients was significantly higher than that in non-PTMS patients(P 0.001). After the 1 s t mo, the level of serum uric acid of PTMS patients rose continually over a period, while it was unaltered in non-PTMS patients. After transplantation, the level of serum uric acid in PTMS patients was not associated with renal function.CONCLUSION PTMS could occur at early stage after DCD LT with growing morbidity with the passage of time. WIT and post-LT hyperuricemia are associated with the prevalence of PTMS. An increased serum uric acid level is highly associated with PTMS and could act as a serum marker in this disease.     

Gender differences in the association between elevated serum uric acid, not diuretic-induced, and cardiovascular disease in untreated hypertension patients

background Studies have been inconsistent regarding whether hyperuricemia, either diuretic- or non diuretic-induced, is an independent risk factor for cardiovascular events. The study investigated the association of cardiovascular disease with diuretic- and non diuretic-induced elevated serum uric acid. MethodsA community-based cross-section study was conducted in 5,235 treated and untreated hypertensive patients aged 40-75 years. Conventional risk factors, serum uric acid and the presence of cardiovascular disease were determined. Hyperuricemia was defined as serum uric acid levels ≥420 μmol/L in men or ≥360 μmol/L in women. ResultsHyperuricemia was more common in men than in women (21.5 % vs. 10.2 %, P < 0.001). After adjustment for age and other conventional risk factors, hyperuricemia was associated with metabolic syndrome, decreased creatinine clearance, and use of diuretics in both genders, as well as age in women and alcohol consumption in men. The presence of coronary artery disease or stroke increased significantly with the increase of quartiles of serum uric acid (8.0 %, 11.0 %, 13.4 %, and 16.8 %, respectively, P < 0.01), and the highest serum uric acid quartile was associated with a 1.8-fold risk for cardiovascular disease (OR: 1.83, 95 % CI: 1.24-2.71) in untreated women. But this association was not observed in untreated men as well as in treated patients using diuretics in both genders. Conclusions Hyperuricemia is markedly associated with metabolic syndrome, decreased creatinine clearance, use of diuretics besides alcohol consumption in men and age in women. Elevated serum uric acid, but not that diuretic-induced, may be associated with increased the risk of cardiovascular disease in untreated hypertensive women.     

健康体检人群血尿酸与非酒精性脂肪肝的相关性研究

目的 观察非酒精性脂肪性肝病(NAFLD)在不同血尿酸水平人群中的分布,以探讨血尿酸与NAFLD的相关性.方法 以本院体检中心5 230名健康体检者为研究对象,测量其身高、体重、血压,空腹取血行肝肾功能、血脂、血糖、肝炎相关指标检查,同时行心电图、腹部超声、胸部X线等检查.NAFLD诊断依据2006年中华肝脏病学会和酒精性肝病学组所规定的NAFLD诊断标准.结果 除高血糖人群外,随血尿酸水平增高,男性和女性超重或肥胖、高血压、血脂异常以及代谢综合征(MS)检出率均逐步升高(P＜0.05或P＜0.01).除男性MS人群外,无论有无超重或肥胖、高血糖、高血压、血脂紊乱,NAFLD检出率均随血尿酸增高明显升高,尤其当血尿酸＞333 μmol/L(男)或＞233 μmol/L(女)时(P＜0.05或P＜0.01),但女性高血糖和血脂紊乱人群,最低尿酸水平组人群NAFLD的检出率亦较高(P＜0.05).对无任何MS相关组分的人群研究发现,在相同血尿酸水平下,男性NAFLD检出率明显高于女性(P＜0.01),女性NAFLD检出率在血尿酸＞233 μmol/L时迅速升高(P＜0.01);无论男女NAFLD检出率均随血尿酸增高而增高(P＜0.05);logistic回归分析显示,性别、体重指数、血糖、甘油三酯、低密度脂蛋白胆固醇、尿酸分级是NAFLD的高危因素,OR值分别为2.500、1.344、1.292、1.279、1.244和1.256.结论 高尿酸血症是NAFLD的高危因素,与NAFLD的发病密切相关.

Abstract：

Objective To evaluate the relationship between hyperuricemia and nonalcoholic fatty liver disease(NAFLD) by observing the prevalence of NAFLD among healthy individuals with different levels of serum uric acid.Methods The data of 5 230 persons from medical centers for health examination were analyzed,such as height,weight,blood pressure,blood lipids,blood sugar, hepatitis-related markers, and abdominal color Doppler ultrasound examination were conducted in the fasting state.The diagnosis of NAFLD was made according to the diagnostic criteria adopted by China Institute of Liver Disease and Alcoholic Liver Disease Group.Results The incidences of overweight or obesity, hypertension,hyperlipidemia, and metabolic syndrome were raised with serum uric acid greater than 333 μmol/L in male and＞233 μmol/L in female subjects(P＜0.05 or P＜0.01). Excluding the metabolic syndrome in male subjects, the incidence of NAFLD was increased with serum uric acid,＞333 μmol/L in males or ＞233 μmol/L in females(P＜0.05 or P＜0.01). In further studies with subjects without any metabolic syndrome, the detection rate of NAFLD was higher in males than in females at the same serum uric acid level(P＜0.01). Logistic regression analysis showed that sex, body mass index, blood glucose, and triglyceride, low-density lipoprotein cholesterol, uric acid grading were risk factors of NAFLD(OR 1.344, 2.500, 1.292, 1.279, 1.244, 1.256 respectively).Conclusion A high serum uric acid level is associated with an increased risk of NAFLD.     

Elevated serum uric acid level as a predictor for cardiovascu-lar and all-cause mortality in Chinese patients with high cardiovascular risk

Objective To assess the predictive value of serum uric acid levels for cardiovascular and all-cause mortality in a large prospective population based study.Methods The study was based on 3648 participants in Shanghai and Beijing,who were inpatients with high cardiovascular(CV) risk at baseLine (2004.7 to 2005.1),and blood was taken.Follow-up for death from cardiovascular disease and any cause was complete until January 1,2006.Results The mean follow-up was 1 years.There were 303 deaths during follow-up,of which 121 were cardiovascular.Crude mortality rates were 8.3 % for all patients,6.8% for female patients (116/1715),and 9.7% (187/1933) for male patients.Among men,patients in the lower and higher uric acid groups had increased cardiac and overall mortality risks compared with patients in the normal uric acid groups.Similar relation was found in women but not statistically significant.After adjusting for other conventional risk factors (age,diabetes,hypertension,diuretic use and smoking),baseline uric acid level was still associated with increased risk for death from cardiovascular disease (P=0.005),or death from all causes (P=0.014) Conclusion Our data suggest that abnormal serum uric acid levels are independently and significantly associated with risk of cardiovascular and all-cause mortality.(J Geriatr Cardiol 2008;5:15-20)     

原发性高尿酸血症患者发生痛风的前瞻性研究

目的 明确原发性高尿酸血症(HUA)患者发生痛风的危险因素.方法 对2004年山东沿海流行病学调查和本院健康体格检查高尿酸血症患者随访3年,主要观察指标为是否发生痛风,评估膳食因素对痛风发生的影响和患者血生化指标变化.结果 536例HUA患者,102例发生痛风,发生率为19%.年龄(OR=1.046,P＜0.05)、血尿酸(OR=1.021,P＜0.05)、空腹血糖(OR=1.021,P＜0.05)、甘油三酯(OR=1.008,P＜0.05)、蟹贝类摄入量(OR=5.992,P＜0.05)和啤酒摄入量(OR=1.012,P＜0.05)是HUA患者发生痛风的危险因素.结论 HUA患者蟹贝类、啤酒等过量摄入造成血尿酸波动是发生痛风的主要危险因素.调整糖脂代谢紊乱、减少高嘌呤食物摄入、控制血尿酸水平是减少痛风发作的重要措施.

Abstract：

Objective To determinate the risk factors of gout in patients with hyperuricemia.Methods Patients detected with hyperuricemia both in epidemiological survey of Shandong coastal areas in 2004 and in health examination of our hospital were followed up for three years to observe the incidence of gout, relationship of diet and gout, and changes of biochemical indicators.Results During 3 years, 102 patients (19%) out of 536 patients with hyperuricemia developed gout. Age(OR=1.046, P＜0.05), serum uric acid(OR=1.021, P＜0.05), fasting plasma glucose(OR=1.021, P＜0.05), triglyceride(OR=1.008, P＜0.05), tony crab intake ( OR=5.992, P＜0.05),and beer intake(OR=1.012, P＜0.05) were the risk factors of gout attack in patients with hyperuricemia.Conclusions Excess intake of tony crab and beer resulting in fluctuation of serum uric acid is the main risk factor of gout in patients with hyperuricemia. Correcting metabolic disorder of glucose and lipid, reducing the intake of high-purine food, and controlling the level of serum uric acid are the measures to reduce gout attack.     

Influence of serum uric acid level and change in hyperuricemia status on the progression of renal impairment in patients with type 2 diabetes mellitus and its gender differences

<正>Objective To explore the impact of serum uric acid(SUA) level and change in hyperuricemia(HUA) status on the progression of renal impairment in patients with type 2 diabetes mellitus(T2DM) and its gender differences.Methods 645 patients with T2DM were selected in The Third Xiangya Hospital of Central South University from January 2009 to December 2017.According to the level of eGFR at the last follow-up,T2DM patients were divided into progressive group[eGFR <60 ml/(min·1.73 m²     

A community-based epidemiological study of elevated serum alanine aminotransferase levels in Kinmen, Taiwan

AIM: To explore any gender-related differences in prevalence of and condition-associated factors related to an elevated serum alanine aminotransferase (ALT) level amongst residents of Kinmen, Taiwan. METHODS: A total of 11 898 of a potential 20 112 regional residents aged 30 years or more completed a related questionnaire that was carried out by the Yang-Ming Crusade between 1991 and 1994 inclusively, with blood samples being collected by public nurses. The overall questionnaire response rate was 59.3% (52.4% for males and 66.0% for females). RESULTS: The prevalence of an elevated serum ALT level for this sub-population was found to be 7.2%, the prevalence revealing a statistically significant decrease with increasing population age (P<0.0001). Males exhibited a greater prevalence of elevated serum ALT level than did females (9.4% vs 5.3%, P<0.0001). Using multiple logistic regression analysis, in addition to male gender, a younger age, greater waist circumference, presence of type-2 diabetes and hyperuricemia were the significant factors associated with an elevated serum ALT level for both males and females. Gender-related differences as regards associated factors were also revealed. For males, obesity was significantly related to an elevated serum ALT level (OR = 1.28, 95%CI: 1.00-1.66) but this was not so for females (OR = 1.09, 95%CI: 0.84-1.42). Hypertriglyceridemia (OR = 1.80, 95%CI: 1.36-2.39) and hyperuricemia (OR = 1.61, 95%CI: 1.03-2.52) were significantly related to elevated serum ALT levels only for females. CONCLUSION: Several gender-related differences were noted pertaining to the prevalence of and relationship between obesity, hypertriglyceridemia and hyperuricemia and elevated serum ALT level in the present study.     

广西城市社区居民高尿酸血症流行病学调查及其与慢性肾脏病的关系

目的 通过社区人群筛查了解广西城市原住民中高尿酸血症(HUA)的患病率及其与慢性肾脏病(CKD)的关系,并探讨影响HUA肾损害的风险因素.方法 选择桂林市城区原住居民集中的象山社区,对18～75岁居民(n=6 273)采取横断面进行筛查.收集空腹血及晨尿进行血糖、肾功能、血脂、胰岛素和尿蛋白等检测,同时进行问卷调查和体格检查.结果 社区居民中HUA总患病率为23.5%,其中男性HUA患病率显著高于女性(28.4%对19.7%,P＜0.01).社区居民中CKD患病率为21.6%,其中男性居民CKD患病率较女性显著增高(24.9%对19.0%,P＜0.01).在HUA人群中CKD检出率显著高于尿酸正常人群(30.4%对18.9%,P＜0.01).男性HUA人群CKD检出率显著高于同性别正常血尿酸人群(34.3%对21.2%,P＜0.01),也显著高于女性HUA人群(25.9%,P＜0.01).Logistic回归分析发现,CKD仅与收缩压、低密度脂蛋白胆固醇和血糖水平独立相关(P＜0.01).结论 广西城市社区居民中HUA患病率显著增加,与CKD患病率增高有关,且血尿酸轻度增高即增加CKD患病率.

Abstract：

Objective To detect the prevalence of hyperuricemia and its relationship to chronic kidney disease(CKD) in the residents of Guangxi, and to discuss the risk factors for the hyperuricemia associated renal damage. Methods The residents aged 18-75 years old(n=6 273) in Xiangshan community,Guilin, were screened by means of cross-sectional study. Blood pressure was measured at 8:00-9:00.Fasting blood and urine samples were collected to determine blood glucose, lipid, insulin, creatinine, and urine albumin. Results The prevalence of hyperuricemia in the community residents was 23.5% in all cohort, being significantly higher in male residents than in female(28.4% vs 19.7%,P＜0.01). The prevalence of CKD was 21.6% in all cohort, and was 24.9% in males and 19.0% in females(P＜0.01). The prevalence of CKD was 30.4% and 18.9% respectively in residents with and without hyperuricemia(P＜0.01).The prevalence of CKD in males with hyperuricemia(34.3%) was significantly higher than in males without hyperuricemia(21.2%) and females with hyperuricemia(25.9%, all P＜0.01). CKD was only positively related to low-density lipoprotein cholesterol, blood glucose, and systolic blood pressure shown by logistic regression analysis. Conclusions The prevalence of hyperuricemia markedly increases in the urban residents, which contribute to the raised prevalence of CKD. Slightly elevated blood uric acid level is associated with raised prevalence of CKD.     

The relationship of body mass index and hyperuricemia in hypertensive adults over 80 years

Background Hyperuricemia (HUA) and hypertension are associated with the increasing risk and mortality of cardiovascular disease (CVD) . However,the relationship between body mass index (BMI) and HUA in hypertensive adults over 80 years remains uncertain. Methods Observational trial was designed and 308 patients who were newly diagnosed as essential hypertension without anti-hypertensive therapy were enrolled into our study. According to the cut-off value of serum UA,participants were stratified into normal (420 μmol/L for men and 360 μmol/L for women) and increased UA groups (≥420 μmol/L for men and ≥360 μmol/L for women) . Serum UA level,blood pressure and other baseline characteristics were compared,logistic regression analysis and receiver operating characteristic curve (ROC) were performed. Results The mean (SD) serum uric level was 382.2 (108.7) μmol/L and the prevalence of hyperuricemia was 45% among men and 50% among women.BMI was significantly higher (22.6 vs. 24.0 kg/m~2,P=0.003) and FBG was lower (5.13 vs. 4.98 mmol/L,P=0.025) in increased UA group among aged women,and BMI and FBG were found the independent determinants for UA increase in female subjects according to logistic regression analysis,and the odd ratio were 1.154 (95% interval confidence 1.058-1.259,P=0.001) and 0.646 (95% interval confidence 0.44-0.949,P=0.026),respectively.Moreover,evaluation of receiver operating characteristic curve (ROC) showed that area under the curve for BMI to predict UA increase was 0.627+0.039,P=0.001 in women. However,the results mentioned above were only found in elderly women,not in men. Conclusions Our study indicates that aged women have higher prevalence of HUA than men,and that BMI is independently associated with serum uric acid level for hypertensive women but not for men over 80 years old. Therefore,BMI is a useful predictor of serum uric acid level in elderly women with hypertension.     

运用高分辨率熔解曲线技术检测痛风患者SLC22A12基因intron5(+4668C/T)多态性

Objective To investigate a new single nucleotid polymorphism (SNP) intron5(+4668C/T) in SLC22A12 in primary gout patients and the association between clinical characteristics and genotypes. Methods One hundred and one primary gout patients and 186 healthy subjects were recruited into this study. Blood pressure, body mass index (BMI) was recorded. Serum uric acid, glucose, lipid and creatinine were detected. DNA was extracted from peripheral blood to amplify the fragment located in intron 5. The genotypes of SLC22A12 can be detected with high-resolution melting (HRM) assay, followed by sequencing analysis. Chi-square test was used for statistical analysis. Results ① A new SNP in intron 5 of SLC22A12 was identi-fied successfully by HRM, which was defined as intron 5 (+4668C/T). CC, CT and TT genotypes were unam-biguously distinguished with HRM technology, which was fully concordant with sequencing. ②The genotypes of CC, CT and TT in male and female groups were 28.1%, 33.7%, 38.2% and 20.0%, 47.1%, 32.9%, respectively.③ However, no significant differences of genotype distribution were found concerning BMI, blood pressure, creatinine, total cholesterol and triglyceride in both male group and female group. But the serum uric acid levels in the CC genotype were significantly higher than those with the CT+TT genotypes. ④ The genotype frequencies of CC and CT+TT in high uric acid group were remarkably different from those in low uric acid group (21.2%, 78.8%,; 35.0%, 65.0%; P<0.05). Conclusion A new SNP has been successfully discovered with HRM technology with simplicity, rapidity and accuracy. T allele of intron 5 (+4668C/T) may be a genetic protective factor for hyperuricemia among Chinese population.     

Hyperuricemia and gout in Taiwan: results from the Nutritional and Health Survey in Taiwan (1993-96)

OBJECTIVE: To evaluate the prevalence of hyperuricemia in Taiwan. METHODS: A multi-stage stratified sampling scheme was used in Nutrition and Health Survey, which was conducted in Taiwan between 1993 and 96. Complete biochemical and questionnaire data for 2754 males and 2953 females aged 4 years and older were included in the analysis. The colorimetric enzymatic method was used to measure plasma uric acid in fasting blood samples. Information on self-reported, physician-diagnosed gout was also obtained. RESULTS: The uric acid values of males were found to reach a peak between the ages of 13 and 18 and decrease slightly after 18. The uric acid values of females were stable before the age of 18, decreasing slightly between 19 and 44 years, and increasing in the mid to older age groups (> or = 45 years). Twenty-six percent of adult males (> or = 19 years) and 22% of older males (> or = 45 years) either had hyperuricemia (serum uric acid > 458.0 microM or 7.7 mg/dl) or were taking medication for it. Seventeen percent of adult females and 23% of older females either had hyperuricemia (serum uric acid > 392.57 microM or 6.6 mg/dl) or were taking medication for it. Both adult males and females in mountainous areas, who were primarily aboriginal, had the highest prevalence of hyperuricemia (> 50%) among the 7 survey areas. Mean body mass index (BMI), alcohol consumption, and prevalence of gout were among the highest in mountainous people compared to all included in the study. Multivariate analysis showed that mountainous area, age and BMI are important factors associated with hyperuricemia in males, whereas mountainous area, Class II townships, and BMI are the factors associated with hyperuricemia in females. CONCLUSIONS: We found a high prevalence of hyperuricemia in Han Chinese in Taiwan despite a lack both of obesity and high alcohol consumption. Mountainous people (mainly aborigines) in Taiwan have an even higher prevalence of hyperuricemia, which cannot be completely explained by obesity and alcohol consumption. Genetic components and other environmental factors may have contributed to this pattern of hyperuricemia.     

Uric Acid as a Marker for Renal Dysfunction in Hypertensive Women on Diuretic and Nondiuretic Therapy

Hyperuricemia is a common finding in hypertensive patients, especially among those who are on diuretic therapy. However, its clinical relevance regarding cardiovascular and chronic kidney disease (CKD) has not clearly been established. The authors assessed whether, in a population of 385 hypertensive women categorized according to diuretic therapy, the stratification in quartiles by uric acid levels would identify a gradient of changes in renal function and in risk factors for cardiovascular disease. The following were evaluated: serum uric acid, glycemia, total and fractional cholesterol, triglycerides, apolipoprotein (Apo) B, Apo A-I, and C-reactive protein. Renal function was assessed by serum creatinine, albuminuria, and estimated glomerular filtration rate (eGFR) by the Modification of Diet in Renal Disease equation, whereas cardiovascular risk was estimated through the Framingham score. A total of 246 women were on diuretic therapy; 139 were taking other antihypertensive medications. There was a reduction in eGFR parallel to the increase in uric acid levels, regardless of diuretic use and without a concomitant increase in albuminuria. In both groups, higher uric acid levels translated into an increase in metabolic syndrome components, in markers of insulin resistance, triglyceride/high-density lipoprotein levels, and Apo B/Apo A-I ratios, as well as in Framingham scores. Hyperuricemia was associated with an increase in inflammatory markers only in patients on diuretic therapy. In a binary logistic regression, hyperuricemia (uric acid >6.0 mg/dL) was independently associated with CKD (eGFR <60 mL/min/1.73 m²) (odds ratio, 2.63; 95% confidence interval, 1.61–4.3; P <.001). In hypertensive women, the presence of hyperuricemia indicated a substantial degree of kidney dysfunction as well as a greater cardiovascular risk profile.     

Hyperuricemia and albuminuria in patients with type 2 diabetes mellitus

INTRODUCTION. Hyperuricemia is an independent risk factor for kidney dysfunction in diabetic patients. On the other hand, albuminuria is considered as the proxy of early stages of diabetic nephropathy. We investigated the correlation between hyperuricemia and albuminuria in patients with diabetes mellitus. MATERIALS AND METHODS. In a cross-sectional study of 1275 patients (555 men and 720 women) with type 2 diabetes mellitus, serum uric acid and urinary albumin-creatinine ratio were determined. Other metabolic parameters including lipid profile, hemoglobin A1c, glomerular filtration rate, body mass index, blood pressure, blood glucose were assessed, as well. RESULTS. The mean age of the patients was 52.45 ± 10.11 years old. Serum uric acid levels for normoalbuminuric, microalbuminuric, and macroalbuminuric patients were 4.49 ± 1.22 mg/dL, 4.84 ± 1.52 mg/dL, and 6.15 ± 1.68 mg/dL, respectively. Among patients with clinical metabolic syndrome, 233 (27.5%) were in the forth upper quartile of uric acid level (> 5.3 mg/dL), but in diabetic patients without this syndrome, only 80 (18.7%) were in this group. There was a significant relationship between hyperuricemia and serum triglyceride, fasting blood glucose, hemoglobin A1c, glomerular filtration rate, and serum creatinine levels (P < .001). No significant correlation was found between hyperuricemia and cholesterol levels, age, duration of diabetes mellitus, and body mass index. Serum uric acid level correlated positively with urinary albumin-creatinine ratio (P = .04). CONCLUSIONS. We showed that higher serum uric acid concentrations were associated with a greater probability of albuminuria in patients with type 2 diabetes mellitus.     

Serum Uric Acid and Risk of CKD in Type 2 Diabetes

Background and objective

Serum uric acid may predict the onset and progression of kidney disease, but it is unclear whether uric acid is an independent risk factor for diabetic nephropathy. Our aim was to study the relationship between uric acid levels and the development of CKD components in patients with type 2 diabetes.

Design, setting, participants, & measurements

Longitudinal study of a cohort of patients with type 2 diabetes from the database of the Italian Association of Clinical Diabetologists network. From a total of 62,830 patients attending the diabetes centers between January 1, 2004, and June 30, 2008, we considered those with baseline eGFR values ≥60 ml/min per 1.73 m² and normal albumin excretion (n=20,142). Urinary albumin excretion, GFR, and serum uric acid were available in 13,964 patients. We assessed the association of serum uric acid quintiles with onset of CKD components by multinomial logistic regression model adjusting for potential confounders. We calculated the relative risk ratios (RRRs) for eGFR <60 ml/min per 1.73 m², albuminuria, and their combination at 4 years.

Results

At 4-year follow-up, 1109 (7.9%) patients developed GFR <60 ml/min per 1.73 m² with normoalbuminuria, 1968 (14.1%) had albuminuria with eGFR ≥60 ml/min per 1.73 m², and 286 (2.0%) had albuminuria with eGFR <60 ml/min per 1.73 m². The incidence of eGFR <60 ml/min per 1.73 m² increased in parallel with uric acid quintiles: Compared with the lowest quintile, RRRs were 1.46 (95% confidence interval [CI], 1.14 to 1.88; P=0.003), 1.44 (95% CI, 1.11 to 1.87; P=0.006), 1.95 (95% CI, 1.48 to 2.58; P<0.001), and 2.61 (95% CI, 1.98 to 3.42; P<0.001) for second, third, fourth, and fifth quintiles, respectively. Serum uric acid was significantly associated with albuminuria only in presence of eGFR <60 ml/min per 1.73 m².

Conclusions

Mild hyperuricemia is strongly associated with the risk of CKD in patients with type 2 diabetes.     

The impact of serum uric acid level on arterial stiffness and carotid atherosclerosis: The Korean Multi-Rural Communities Cohort study

Objective

Serum uric acid level has been found to be associated with a risk factor for cardiovascular diseases. However, the topic has not been explored in the general population, especially in Korea. This study was designed to determine whether serum uric acid is associated with carotid atherosclerosis and arterial stiffness in the Korean Multi-Rural Communities Cohort study.

Methods

A total of 5568 participants from the Korean Multi-Rural Communities Cohort were evaluated for the risk of hyperuricemia in cardiovascular atherosclerosis. Important surrogates for cardiovascular atherosclerosis such as intima–media thickness (IMT) and brachial-ankle pulse wave velocity (baPWV) were assessed. We evaluated the association between these atherosclerosis indices and serum uric acid level or hyperuricemia through multivariate-adjusted logistic and linear regression analyses.

Results

There was a significant difference of carotid IMT and baPWV between males and females (p < 0.0001, respectively). Both male and female subjects with hyperuricemia showed higher baPWV than subjects without hyperuricemia (p = 0.0004 for males; p = 0.001 for females). Serum uric acid level was positively correlated with baPWV in males (β = 0.0006, p < 0.0001) and in females (β = 0.0001, p = 0.04), whereas no association between serum uric acid and carotid IMT was found in either gender. A linear relationship of baPWV with increasing serum uric acid level was observed in males (p = 0.0005) and in females (p = 0.004).

Conclusion

Serum uric acid level could be considered an important risk factor for arterial stiffness in Korean population, whereas carotid IMT is not associated with serum uric acid in either gender when using data from the Korean Multi-Rural Communities Cohort study.     

Serum uric acid levels and long-term outcomes in chronic kidney disease

Hyperuricemia is common in chronic kidney disease (CKD), but data regarding the relationship between serum uric acid levels and the long-term outcomes of CKD patients have been limited. The present study evaluated the associations between baseline serum uric acid levels with mortality and end-stage renal disease (ESRD). The subjects of this study were 551 stage 2–4 CKD patients. Cox proportional hazards models were used to evaluate the relationship between serum uric acid tertiles and all-cause mortality, cardiovascular disease (CVD) mortality, 50 % reduction in estimated glomerular filtration rate (eGFR), and development of ESRD, initially without adjustment, and then after adjusting for several groups of covariates. The mean age of the study subjects was 58.5 years, 59.3 % were men, and 10.0 % had diabetes. The mean eGFR was 42.02 ± 18.52 ml/min/1.73 m². In all subjects, the mean serum uric acid level was 6.57 ± 1.35 mg/dl, and 52.2 % of study subjects were on hypouricemic therapy (allopurinol; 48.3 %) at baseline. Thirty-one patients (6.1 %) died during a follow-up period of approximately 6 years. There was no significant association between serum uric acid level and all-cause mortality, CVD mortality, development of ESRD and 50 % reduction in eGFR in the unadjusted Cox models. In the adjusted models, hyperuricemia was found to be associated with all-cause mortality and CVD mortality after adjustment with CVD risk factors, kidney disease factors, and allopurinol, but not associated with development of ESRD and 50 % reduction in eGFR. The results of this study showed that hyperuricemia but not serum uric acid levels were associated with all-cause mortality, CVD mortality after adjustments with CVD risk factors, kidney disease factors, and allopurinol in stage 2–4 CKD patients.     

Diuretics and hyperuricemia in the elderly

Serum uric acid (SUA) was studied in a rural population of 420 males and 592 females aged 65 years or more. The mean SUA concentration was 0.313 mmol/l in males and 0.316 mmol/l in females. In males, 47 (11.2%) and in females 60 (10.1%) had a SUA level of 0.42 mmol/l or more. Both the mean serum values and the frequency of hyperuricemia were higher than 11 years earlier in another, similar study. The SUA concentration was 0.361 mmol/l in the 435 individuals using diuretics and 0.281 mmol/l in the remaining 578. Of the 107 hyperuricemic individuals, 82% used diuretics, and only 2 out of those 20 where the SUA level was 0.50 mmol/l or more did not use diuretics. Apart from diuretics, only the serum creatinine concentration, the Body Mass Index, body weight and the hematocrit level were significantly associated with hyperuricemia in both sexes.     

老年人群慢性肾脏疾病流行病学研究

目的 了解我国老年人群慢性肾脏疾病(CKD)的患病率及其影响因素.方法 对2004年1月至2007年1月长期在北京医院老年病房进行健康查体及疾病治疗、病历资料完整的老年人进行回顾性调查.分别记录受检者年龄、身高、体质量、血压、血尿、蛋白尿、血红蛋白、血肌酐、血尿素、血脂、血尿酸、乙肝表面抗原、影像学检查结果 以及既往诊断疾病情况,采用公式法估算肾小球滤过率,并对影响蛋白尿及CKD的危险因素进行二分类Logistic回归分析.结果 1082例老年人中,蛋白尿检出率为4.9%,肾功能下降为47.2%,CKD检出率为48.4%;多因素Logistic回归分析表明,糖尿病(OR=2.257)和镜下血尿(OR=5.324)是老年人发生蛋白尿的危险因素(P<0.05),高血压(OR=1.459)、冠心病(OR=3.290)、慢性阻塞性肺病(OR=2.094)、恶性肿瘤(OR=2.072)、高尿酸血症(OR=1.928)、贫血(OR=8.122)、血尿(OR=1.604)是发生CKD的危险因素(P<0.05).结论 初步估计我国特殊老年人群的CKD患病率为48.4%,相关危险因素有糖尿病、高血压、高尿酸血症、贫血等,与发达国家水平相似.     

Hyperuricemia as an Independent Risk Factor of Chronic Kidney Disease in Middle-Aged and Elderly Population

IntroductionHyperuricemia in the general population remains controversial, in terms of it being considered a risk factor for chronic kidney disease (CKD). Within this context, we evaluated the effects of hyperuricemia on renal function in older Taiwanese adults.MethodsFrom January 2002 to December 2006, we conducted a community-based medical screening program involving 31,331 subjects older than 40 years. According to the National Kidney Foundation guidelines, stage 3 to 5 patients with CKD were included for analysis. Age, body mass index, systolic blood pressure, fasting plasma glucose, triglyceride, cholesterol and proteinuria were considered potential confounders.ResultsParticipants with hyperuricemia tended to have higher systolic blood pressure, sugar levels, body mass index, and cholesterol and triglyceride levels but lower estimated glomerular filtration rate (eGFR) levels; eGFR negatively correlated with serum uric acid level. By using multiple logistic regression models before and after adjusting for any confounding factors, we noted that participants with hyperuricemia had a 4.036-fold (odds ratios = 4.036) and 3.649-fold (odds ratios = 3.649) increased risk for CKD, respectively, compared with the control group. We used multiple linear regression analysis to examine the association of serum uric acid level and eGFR at different stages of CKD; significance was found only in participants with stage 3 CKD and not in participants with stages 4 or 5.ConclusionsHyperuricemia is an independent risk factor for CKD in middle-aged and elderly Taiwanese adults. Thus, an effective screening program that identifies people with hyperuricemia is warranted.