Relationship between serum uric acid level and abnormal renal function in adults

doi:10.11958/20220663

Abstract

Abstract:

Objective To explore the relationship between serum uric acid (SUA) levels and renal function decline in adults. Methods A total of 12 138 normal physical examination subjects were selected as research subjects. General data of subjects were collected by questionnaire, and serum creatinine (Scr), SUA and fasting blood glucose were measured. Subjects were divided into two groups based on estimated glomerular filtration rate (eGFR): the abnormal renal function group (1 607 cases) and the normal renal function group (10 531 cases). Men and women of subjects were divided into the hyperuricemia group and the normal uric acid group according to 420 μmol/L and 360 μmol/L uric acid levels, respectively. The normal uric acid group was then divided into four sub-groups according to SUA quartile. Trends in the proportion of patients with abnormal renal dysfunction with SUA levels were analyzed in different genders. Logistic regression was used to analyze the influence of SUA level and renal function in subgroups with different gender, age, education level, exercise, hypertension and diabetes. Results In men and women, with the increase of SUA level, the proportion of SUA quartile groups and hyperuricemia patients in the renal dysfunction group showed an increasing trend (Z _male =6.411; Z _female =23.800, P<0.01). Logistic regression results showed that compared with the first quartile group, the second, third, and fourth quartile groups and hyperuricemia group were all risk factors of renal dysfunction (P<0.05). There was a significant dose-response relationship between SUA and renal dysfunction in both men and women (P _{for trend}<0.01). The relationship was statistically significant across subgroups of age, education, physical activity, hypertension and diabetes. Conclusion Elevated SUA are related with an increased risk of renal dysfunction in a dose-response relationship.

Key words: uric acid, hyperuricemia, glomerular filtration rate, renal insufficiency, sex factors

CLC Number:

R181.3+8

Figures/Tables 6

References 25

[1]	COUSER W G, REMUZZI G, MENDIS S, et al. The contribution of chronic kidney disease to the global burden of major noncommunicable diseases[J]. Kidney Int, 2011, 80(12):1258-1270. doi:10.1038/ki.2011.368.
[2]	MALLAT S G, AL KATTAR S, TANIOS B Y, et al. Hyperuricemia,hypertension,and chronic kidney disease:An Emerging Association[J]. Curr Hypertens Rep, 2016, 18(10):74. doi:10.1007/s11906-016-0684-z.
[3]	OH T R, CHOI H S, KIM C S, et al. Hyperuricemia has increased the risk of progression of chronic kidney disease:Propensity score matching analysis from the KNOW-CKD study[J]. Sci Rep, 2019, 9(1):6681. doi:10.1038/s41598-019-43241-3.
[4]	STURM G, KOLLERITS B, NEYER U, et al. Uric acid as a risk factor for progression of non-diabetic chronic kidney disease? The mild to moderate kidney disease(MMKD)study[J]. Exp Gerontol, 2008, 43(4):347-352. doi:10.1016/j.exger.2008.01.006.
[5]	AKIZUKI S. Serum uric acid levels among thirty-four thousand people in Japan[J]. Ann Rheum Dis, 1982, 41(3):272-274. doi:10.1136/ard.41.3.272.
[6]	NAGASAWA Y, YAMAMOTO R, SHOJI T, et al. Serum uric acid level predicts progression of IgA nephropathy in females but not in males[J]. PLoS One, 2016, 11(8):e0160828. doi:10.1371/journal.pone.0160828.
[7]	HUANG Y P, ZHENG T, ZHANG D H, et al. Community-based study on elderly CKD subjects and the associated risk factors[J]. Ren Fail, 2016, 38(10):1672-1676. doi:10.1080/0886022X.2016.1229987.
[8]	LEE S, SHIMADA H, LEE S, et al. Association between sedentary time and kidney function in community-dwelling elderly Japanese people[J]. Geriatr Gerontol Int, 2017, 17(5):730-736. doi:10.1111/ggi.12779.
[9]	KRITTANAWONG C, TUNHASIRIWET A, WANG Z, et al. Association between short and long sleep durations and cardiovascular outcomes:A systematic review and meta-analysis[J]. Eur Heart J Acute Cardiovasc Care, 2019, 8(8):762-770. doi:10.1177/2048872617741733.
[10]	WANG J, XIE P, HUANG J M, et al. The new Asian modified CKD-EPI equation leads to more accurate GFR estimation in Chinese patients with CKD[J]. Int Urol Nephrol, 2016, 48(12):2077-2081. doi:10.1007/s11255-016-1386-9.
[11]	INKER L A, ASTOR B C, FOX C H, et al. KDOQI US commentary on the 2012 KDIGO clinical practice guideline for the evaluation and management of CKD[J]. Am J Kidney Dis, 2014, 63(5):713-735. doi:10.1053/j.ajkd.2014.01.416.
[12]	中国医师协会肾脏内科医师分会. 中国肾脏疾病高尿酸血症诊治的实践指南(2017版)[J]. 中华医学杂志, 2017, 97(25):1927-1936.
	Annual Conference of Chinese Nephrologist Association. Practice guidelines for the diagnosis and management of hyperuricemia in kidney disease in China (2017 Edition)[J]. Natl Med J China, 2017, 97(25):1927-1936. doi:10.3760/cma.j.issn.0376-2491.2017.25.003.
[13]	HU C, WU X. Treatment of asymptomatic hyperuricemia complicated by renal damage:a controversial issue[J]. Int Urol Nephrol, 2019, 51(12):2227-2233. doi:10.1007/s11255-019-02256-5.
[14]	KIELSTEIN J T, PONTREMOLI R, BURNIER M. Management of hyperuricemia in patients with chronic kidney disease:A focus on renal protection[J]. Curr Hypertens Rep, 2020, 22(12):102. doi:10.1007/s11906-020-01116-3.
[15]	OBERMAYR R P, TEMML C, GUTJAHR G, et al. Elevated uric acid increases the risk for kidney disease[J]. J Am Soc Nephrol, 2008, 19(12):2407-2413. doi:10.1681/ASN.2008010080.
[16]	HANAI K, TAUCHI E, NISHIWAKI Y, et al. Effects of uric acid on kidney function decline differ depending on baseline kidney function in type 2 diabetic patients[J]. Nephrol Dial Transplant, 2019, 34(8):1328-1335. doi:10.1093/ndt/gfy138.
[17]	JOO H J, KIM G R, CHOI D W, et al. Uric acid level and kidney function: a cross-sectional study of the Korean national health and nutrition examination survey(2016-2017)[J]. Sci Rep,2020, 10(1):21672. doi:10.1038/s41598-020-77702-x.
[18]	AHOLA A J, SANDHOLM N, FORSBLOM C, et al. The serum uric acid concentration is not causally linked to diabetic nephropathy in type 1 diabetes[J]. Kidney Int, 2017, 91(5):1178-1185. doi:10.1016/j.kint.2016.11.025.
[19]	KRITMETAPAK K, CHAROENSRI S, THAOPANYA R, et al. Elevated serum uric acid is associated with rapid decline in kidney function:A 10-year follow-up study[J]. Int J Gen Med, 2020, 13:945-953. doi:10.2147/IJGM.S277957.
[20]	MWASONGWE S E, FÜLÖP T, KATZ R, et al. Relation of uric acid level to rapid kidney function decline and development of kidney disease:The Jackson Heart Study[J]. J Clin Hypertens(Greenwich), 2018, 20(4):775-783. doi:10.1111/jch.13239.
[21]	XUE C, YE X D, LI W, et al. Prevalence of chronic kidney disease in Jing adults in China: a village-based study[J]. Clin Nephrol, 2013, 79(1):50-56. doi:10.5414/CN107511.
[22]	TAKIUE Y, HOSOYAMADA M, KIMURA M, et al. The effect of female hormones upon urate transport systems in the mouse kidney[J]. Nucleosides Nucleotides Nucleic Acids, 2011, 30(2):113-119. doi:10.1080/15257770.2010.551645.
[23]	ZHANG L, WANG F, WANG L, et al. Prevalence of chronic kidney disease in China:A cross-sectional survey[J]. Lancet, 2012, 379(9818):815-822. doi:10.1016/S0140-6736(12)60033-6.
[24]	黄琼, 董陈娣, 张鼎君, 等. 睡眠情况对慢性肾脏病患者肾功能影响的系统评价[J]. 海南医学院学报, 2019, 25(5):351-357.
	HUANG Q, DONG C D, ZHANG D J, et al. The Effects of sleep status on renal function in patients with chronic kidney disease:a sys- tematic review[J]. Journal of Hainan Medical University, 2019, 25(5):351-357. doi:10.13210/j.cnki.jhmu.20181213.001.
[25]	MARTENS R, VAN DER BERG J D, STEHOUWER C, et al. Amount and pattern of physical activity and sedentary behavior are associated with kidney function and kidney damage:The Maastricht Study[J]. PLoS One, 2018, 13(4):e0195306. doi:10.1371/journal.pone.0195306.

组别	锻炼	每天静坐时长（<4 h/4~6 h/>6 h）	睡眠时长（<6 h/6~9 h/>9 h）	高血压	2型糖尿病	肥胖
肾功能正常组	3 127（66.17）	659/1 401/2 669	607/3 679/440	1 697（35.91）	497（10.52）	1 022（21.63）
肾功能异常组	524（66.83）	120/211/453	96/603/85	447（57.02）	115（14.67）	173（22.07）
χ²	0.107	2.887	1.920	125.151^＊＊	15.808^＊＊	0.053

组别	锻炼	每天静坐时长（<4 h/4~6 h/>6 h）	睡眠时长（<6 h/6~9 h/>9 h）	高血压	2型糖尿病	肥胖
肾功能正常组	3 127（66.17）	659/1 401/2 669	607/3 679/440	1 697（35.91）	497（10.52）	1 022（21.63）
肾功能异常组	524（66.83）	120/211/453	96/603/85	447（57.02）	115（14.67）	173（22.07）
χ²	0.107	2.887	1.920	125.151^＊＊	15.808^＊＊	0.053

组别			n	年龄（<65 岁/≥65岁）			婚姻状况（未婚/已婚）		职业（非脑力劳动/脑力劳动）		文化程度（大专以下/大专及以上）				吸烟			饮酒
肾功能正常组			5 805	5 472/333			907/4 898		5 415/390		413/5 392				113（1.95）			218（3.76）
肾功能异常组			823	481/342			30/793		799/24		153/670				28（3.40）			25（3.04）
χ²				1 007.128^＊＊			84.231^＊＊		17.151^＊＊		120.078^＊＊				6.653^＊			0.858
组别	锻炼				每天静坐时长（<4 h/4~6 h/>6 h）					睡眠时长（<6 h/6~9 h/>9 h）			高血压			2型糖尿病			肥胖
肾功能正常组	3 370（58.05）				871/1 610/3 324					871/1 610/3 324			940（16.19）			252（4.34）			365（6.29）
肾功能异常组	492（59.78）				115/242/466					102/601/466			379（46.05）			95（11.54）			95（11.54）
χ²	0.815				1.286					4.708			401.265^＊＊			73.915^＊＊			30.017^＊＊
组别		血脂异常				冠心病		SUA水平
组别		血脂异常				冠心病		Q1		Q2		Q3		Q4			高尿酸血症
肾功能正常组		930（16.02）				98（1.69）		1 494（25.74）		1 412（24.32）		1 411（24.31）		1 210（20.84）			278（4.79）
肾功能异常组		372（45.20）				82（9.96）		54（6.56）		104（12.64）		134（16.28）		301（36.57）			230（27.95）
χ²		262.172^＊＊				183.716^＊＊		759.003^＊＊

组别			n	年龄（<65 岁/≥65岁）			婚姻状况（未婚/已婚）		职业（非脑力劳动/脑力劳动）		文化程度（大专以下/大专及以上）				吸烟			饮酒
肾功能正常组			5 805	5 472/333			907/4 898		5 415/390		413/5 392				113（1.95）			218（3.76）
肾功能异常组			823	481/342			30/793		799/24		153/670				28（3.40）			25（3.04）
χ²				1 007.128^＊＊			84.231^＊＊		17.151^＊＊		120.078^＊＊				6.653^＊			0.858
组别	锻炼				每天静坐时长（<4 h/4~6 h/>6 h）					睡眠时长（<6 h/6~9 h/>9 h）			高血压			2型糖尿病			肥胖
肾功能正常组	3 370（58.05）				871/1 610/3 324					871/1 610/3 324			940（16.19）			252（4.34）			365（6.29）
肾功能异常组	492（59.78）				115/242/466					102/601/466			379（46.05）			95（11.54）			95（11.54）
χ²	0.815				1.286					4.708			401.265^＊＊			73.915^＊＊			30.017^＊＊
组别		血脂异常				冠心病		SUA水平
组别		血脂异常				冠心病		Q1		Q2		Q3		Q4			高尿酸血症
肾功能正常组		930（16.02）				98（1.69）		1 494（25.74）		1 412（24.32）		1 411（24.31）		1 210（20.84）			278（4.79）
肾功能异常组		372（45.20）				82（9.96）		54（6.56）		104（12.64）		134（16.28）		301（36.57）			230（27.95）
χ²		262.172^＊＊				183.716^＊＊		759.003^＊＊

变量	β	SE	Wald χ²	P	OR（95%CI）
模型1
SUA水平
Q2	0.354	0.219	2.621	0.105	1.425（0.928~2.188）
Q3	0.400	0.205	3.791	0.052	1.492（0.997~2.232）
Q4	0.691	0.199	12.103	0.001	1.996（1.352~2.947）
高尿酸血症	0.949	0.201	22.222	<0.001	2.584（1.741~3.834）
模型2
SUA水平
Q2	0.370	0.151	5.978	0.014	1.447（1.076~1.947）
Q3	0.736	0.147	25.140	<0.001	2.088（1.566~2.784）
Q4	0.864	0.145	35.665	<0.001	2.373（1.787~3.152）
高尿酸血症	1.315	0.140	88.398	<0.001	3.724（2.831~4.898）
年龄	2.234	0.098	518.610	<0.001	9.335（7.702~11.314）
婚姻	1.587	0.260	37.137	<0.001	4.891（2.936~8.149）
模型3
SUA水平
Q2	0.387	0.152	6.503	0.011	1.473（1.094~1.983）
Q3	0.744	0.147	25.513	<0.001	2.105（1.577~2.810）
Q4	0.880	0.145	36.699	<0.001	2.411（1.813~3.205）
高尿酸血症	1.344	0.141	91.164	<0.001	3.836（2.911~5.055）
年龄	2.227	0.100	500.417	<0.001	9.276（7.631~11.275）
婚姻	1.623	0.262	38.502	<0.001	5.069（3.036~8.463）
饮酒	-0.319	0.096	11.136	0.001	0.727（0.602~0.876）
模型4
SUA水平
Q2	0.365	0.152	5.726	0.017	1.440（1.068~1.941）
Q3	0.728	0.148	24.079	<0.001	2.070（1.548~2.769）
Q4	0.862	0.147	34.527	<0.001	2.367（1.776~3.155）
高尿酸血症	1.310	0.144	83.029	<0.001	3.707（2.797~4.915）
年龄	2.098	0.106	389.194	<0.001	8.149（6.616~10.038）
婚姻	1.587	0.262	36.699	<0.001	4.889（2.926~8.169）
饮酒	-0.338	0.096	12.320	<0.001	0.714（0.591~0.862）
高血压	0.313	0.092	11.587	0.001	1.368（1.142~1.638）