在一项时变分析中，尿酸与肾移植存活率高度相关。

Uric acid is highly associated with kidney allograft survival in a time-varying analysis.

作者信息

Weng S-C, Shu K-H, Tarng D-C, Cheng Chi-H, Chen Cheng-H, Yu T-M, Chuang Y-W, Huang S-T, Wu M-J

机构信息

Center for Geriatrics and Gerontology, Taichung Veterans General Hospital, Taichung, Taiwan; Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.

Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan.

出版信息

Transplant Proc. 2014;46(2):505-10. doi: 10.1016/j.transproceed.2013.09.038.

DOI:10.1016/j.transproceed.2013.09.038

PMID:24656000

Abstract

BACKGROUND

Hyperuricemia may be associated with the development of new cardiovascular events and graft loss in renal transplant recipients. This study was conducted to clarify whether hyperuricemia is a persistently independent predictor of long-term graft survival and patient outcome.

METHODS

Renal allograft recipients (n = 880) who underwent transplantation from December 1999 to March 2013 were included. Participants were divided into 2 groups: a hyperuricemic group (n = 389) and a normouricemic group (n = 491). The mean serum uric acid (UA) level was obtained by averaging all measurements, once per month for 3 months, before the study began. Clinical and laboratory data were collected. We investigated the role of hyperuricemia in the primary endpoint of graft failure by using time-varying analysis and Kaplan-Meier plots. All-cause mortality in renal transplant recipients was also surveyed.

RESULTS

During a mean follow-up of 43.3 ± 26.3 months, the major predisposing factors in the 389 patients with hyperuricemia were male predominance (62.98%), high entry serum UA (7.70; range 6.70-8.80 mg/dL), more hypertension (92.29%), previous hemodialysis mode (29.56%), hepatitis C infection (24.42%), more frequent use of UA-lowering agents (43.44%), and use of more drugs for inducing high serum UA (17.74%). After 12 months, the hyperuricemic group had persistently high serum UA (7.66 ± 2.00 vs 6.17 ± 1.60 mg/dL, P < .001) and poor renal function (serum creatinine 2.96 ± 3.20 vs 1.61 ± 1.96 mg/dL, P < .001) compared with the normouricemic group. Survival analysis showed the hyperuricemic group had poorer graft survival (60.47%) than the normouricemic group (75.82%, P = .0069) after 13-year follow-up. However, there was no difference in all-cause mortality between the 2 groups.

CONCLUSION

Persistently high serum UA seems to be implicated in elevation of serum creatinine, which could increase the risk for allograft dysfunction.

摘要

背景

高尿酸血症可能与肾移植受者新发心血管事件及移植肾失功有关。本研究旨在明确高尿酸血症是否为长期移植肾存活及患者预后的持续独立预测因素。

方法

纳入1999年12月至2013年3月接受移植的肾移植受者（n = 880）。参与者分为两组：高尿酸血症组（n = 389）和正常尿酸血症组（n = 491）。在研究开始前，通过对3个月内每月一次的所有测量值求平均来获得平均血清尿酸（UA）水平。收集临床和实验室数据。我们使用时间变化分析和Kaplan-Meier曲线研究高尿酸血症在移植肾失功主要终点中的作用。还调查了肾移植受者的全因死亡率。

结果

在平均43.3±26.3个月的随访期间，389例高尿酸血症患者的主要易感因素为男性占优势（62.98%）、入院时血清UA水平高（7.70；范围6.70 - 8.80 mg/dL）、高血压更多（占比92.29%）、既往血液透析模式（占比29.56%）、丙型肝炎感染（占比24.42%）、更频繁使用降尿酸药物（占比43.44%）以及使用更多导致血清UA升高的药物（占比17.74%）。12个月后，与正常尿酸血症组相比，高尿酸血症组血清UA持续升高（7.66±2.00 vs 6.17±1.60 mg/dL，P <.001）且肾功能较差（血清肌酐2.96±3.20 vs 1.61±1.96 mg/dL，P <.001）。生存分析显示，13年随访后，高尿酸血症组的移植肾存活率（60.47%）低于正常尿酸血症组（75.82%，P =.0069）。然而，两组的全因死亡率无差异。