Department of Clinical Epidemiology, Leiden University Medical Center, Albinusdreef 2, Leiden 2333 ZA, The Netherlands.
BMC Nephrol. 2014 Jun 16;15:91. doi: 10.1186/1471-2369-15-91.
In patients with chronic kidney disease (CKD) hyperuricemia is common. Evidence that hyperuricemia might also play a causal role in vascular disease, hypertension and progression of CKD is accumulating. Therefore, we studied the association between baseline uric acid (UA) levels and the rate of decline in renal function and time until start of dialysis in pre-dialysis patients.
Data from the PREPARE-2 study were used. The PREPARE-2 study is an observational prospective cohort study including incident pre-dialysis patients with CKD stages IV-V in the years between 2004 and 2011. Patients were followed for a median of 14.9 months until start of dialysis, kidney transplantation, death, or censoring. Main outcomes were the change in the rate of decline in renal function (measured as estimated glomerular filtration rate (eGFR)) estimated using linear mixed models, and time until start of dialysis estimated using Cox proportional hazards models.
In this analysis 131 patients were included with a baseline UA level (mean (standard deviation (SD)) of 8.0 (1.79) mg/dl) and a mean decline in renal function of -1.61 (95% confidence interval (CI), -2.01; -1.22) ml/min/1.73 m2/year. The change in decline in GFR associated with a unit increase in UA at baseline was -0.14 (95% CI -0.61;0.33, p=0.55) ml/min/1.73 m2/year. Adjusted for demography, comorbidities, diet, body mass index (BMI), blood pressure, lipids, proteinuria, diuretic and/or allopurinol usage the change in decline in eGFR did not change. The hazard ratio (HR) for starting dialysis for each mg/dl increase in UA at baseline was 1.08 (95% CI, 0.94;1.24, p=0.27). After adjustment for the same confounders the HR became significant at 1.26 (95% CI, 1.06;1.49, p=0.01), indicating an earlier start of dialysis with higher levels of UA.
Although high UA levels are not associated with an accelerated decline in renal function, a high serum UA level in incident pre-dialysis patient is a risk factor for an earlier start of dialysis.
在慢性肾脏病（CKD）患者中，高尿酸血症很常见。越来越多的证据表明，高尿酸血症可能在血管疾病、高血压和 CKD 进展中也起因果作用。因此，我们研究了基线尿酸（UA）水平与透析前患者肾功能下降速度和开始透析时间之间的关系。
使用 PREPARE-2 研究的数据。PREPARE-2 研究是一项观察性前瞻性队列研究，包括 2004 年至 2011 年间发生的 CKD 四至五期的透析前患者。患者中位随访 14.9 个月，直至开始透析、肾移植、死亡或删失。主要结局是使用线性混合模型估计的肾功能下降速度（估计肾小球滤过率（eGFR））的变化，以及使用 Cox 比例风险模型估计的开始透析时间。
在这项分析中，纳入了 131 例患者，基线 UA 水平（均值（标准差（SD））为 8.0（1.79）mg/dl）和肾功能下降速度的平均值为-1.61（95%置信区间（CI），-2.01；-1.22）ml/min/1.73 m2/年。基线 UA 水平每增加一个单位，GFR 下降的变化与-0.14（95%CI，-0.61；0.33，p=0.55）ml/min/1.73 m2/年相关。调整人口统计学、合并症、饮食、体重指数（BMI）、血压、血脂、蛋白尿、利尿剂和/或别嘌醇使用后，eGFR 下降的变化没有改变。基线 UA 每增加 1mg/dl，开始透析的风险比（HR）为 1.08（95%CI，0.94；1.24，p=0.27）。在调整相同混杂因素后，HR 变得显著，为 1.26（95%CI，1.06；1.49，p=0.01），表明 UA 水平较高的患者开始透析的时间更早。
虽然高 UA 水平与肾功能下降速度加快无关，但透析前新发患者的血清 UA 水平较高是开始透析较早的一个危险因素。
