Chou Yu-Ching, Kuan Jen-Chun, Yang Tsan, Chou Wan-Yun, Hsieh Po-Chien, Bai Chyi-Huey, You San-Lin, Chen Chien-Hua, Wei Cheng-Yu, Sun Chien-An
School of Public Health, National Defense Medical Center, Taipei City, Taiwan, R.O.C..
J Nephrol. 2015 Aug;28(4):457-62. doi: 10.1007/s40620-014-0158-9. Epub 2014 Nov 20.
Cohort studies evaluating increased serum uric acid (SUA) level as a chronic kidney disease (CKD) risk factor have yielded variable results. We aimed to assess the association between the pattern of longitudinal changes in SUA and incident CKD [estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m(2)].
A population-based cohort study was conducted on 3,605 participants who were followed prospectively for a mean of 5.18 years. The longitudinal changes in SUA were categorized into three subgroups: persistently low, fluctuated (reduced or elevated), and persistently high. The primary outcome of interest was the development of CKD at a follow-up examination. Cox proportional hazards analysis was used to test the hypothesis.
After adjustment for potential confounders, participants with fluctuated SUA with progressively elevated level and persistently high SUA level had significantly higher risk of developing CKD compared to subjects with persistently low SUA level: adjusted hazard ratio (95% confidence interval) was 2.05 (1.24-3.38) vs. 1.90 (1.34-2.71). This longitudinal relationship was independent of sex, age, body mass index, and hypertension status.
Longitudinally elevated SUA independently predicts the risk of new-onset CKD.
队列研究评估血清尿酸（SUA）水平升高作为慢性肾脏病（CKD）危险因素的结果不一。我们旨在评估SUA纵向变化模式与新发CKD[估计肾小球滤过率（eGFR）<60 ml/min/1.73 m²]之间的关联。
对3605名参与者进行了一项基于人群的队列研究，前瞻性随访平均5.18年。SUA的纵向变化分为三个亚组：持续低水平、波动（降低或升高）和持续高水平。主要关注的结局是随访检查时CKD的发生。采用Cox比例风险分析来检验该假设。
在对潜在混杂因素进行调整后，与SUA持续低水平的受试者相比，SUA波动且水平逐渐升高以及SUA持续高水平的参与者发生CKD的风险显著更高：调整后的风险比（95%置信区间）为2.05（1.24 - 3.38），而1.90（1.34 - 2.71）。这种纵向关系独立于性别、年龄、体重指数和高血压状态。
SUA纵向升高独立预测新发CKD的风险。
