Wakasugi Minako, Kazama Junichiro James, Narita Ichiei, Konta Tsuneo, Fujimoto Shouichi, Iseki Kunitoshi, Moriyama Toshiki, Yamagata Kunihiro, Tsuruya Kazuhiko, Asahi Koichi, Kimura Kenjiro, Kondo Masahide, Kurahashi Issei, Ohashi Yasuo, Watanabe Tsuyoshi
Center for Inter-Organ Communication Research, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
Am J Nephrol. 2015;41(2):138-46. doi: 10.1159/000381106. Epub 2015 Mar 18.
Hypouricemia, conventionally defined as a serum uric acid level of ≤2 mg/dl, is considered a biochemical disorder with no clinical significance. However, individuals with renal hypouricemia have a high risk of urolithiasis and exercise-induced acute kidney injury, both of which are risk factors for reduced kidney function.
To test the hypothesis that individuals with hypouricemia would be at a higher risk of reduced kidney function, we conducted a population-based cross-sectional study using data from the Specific Health Checkups and Guidance System in Japan. Logistic analysis was used to examine the relationship between hypouricemia and reduced kidney function, defined as estimated glomerular filtration rate <60 ml/min/1.73 m(2).
Among 90,710 men (mean age, 63.8 years) and 136,935 women (63.7 years), 193 (0.2%) and 540 (0.4%) were identified as having hypouricemia, respectively. The prevalence of hypouricemia decreased with age in women (p for trend <0.001), but not in men (p for trend = 0.24). Hypouricemia was associated with reduced kidney function in men (odds ratio, 1.83; 95% confidence interval, 1.23-2.74), but not in women (0.61; 0.43-0.86), relative to the reference category (i.e., serum uric acid levels of 4.1-5.0 mg/dl) after adjusting for age, drinking, smoking, diabetes, hypertension, hypercholesterolemia, obesity, and history of renal failure. Sensitivity analyses stratified by diabetic status yielded similar results.
This study is the first to provide evidence that hypouricemia is associated with reduced kidney function in men. Further research will be needed to determine the long-term prognosis of individuals with hypouricemia.
传统上，低尿酸血症被定义为血清尿酸水平≤2mg/dl，被认为是一种无临床意义的生化紊乱。然而，肾性低尿酸血症患者有患尿路结石和运动诱发急性肾损伤的高风险，这两者都是肾功能下降的危险因素。
为了检验低尿酸血症患者肾功能下降风险更高这一假设，我们利用日本特定健康检查与指导系统的数据进行了一项基于人群的横断面研究。采用逻辑分析来研究低尿酸血症与肾功能下降之间的关系，肾功能下降定义为估计肾小球滤过率<60ml/min/1.73m²。
在90710名男性（平均年龄63.8岁）和136935名女性（63.7岁）中，分别有193名（0.2%）和540名（0.4%）被确定为患有低尿酸血症。女性低尿酸血症患病率随年龄下降（趋势p<0.001），但男性无此现象（趋势p = 0.24）。在调整年龄、饮酒、吸烟、糖尿病、高血压、高胆固醇血症、肥胖和肾衰竭病史后，相对于参考类别（即血清尿酸水平为4.1 - 5.0mg/dl），男性低尿酸血症与肾功能下降相关（优势比，1.83；95%置信区间，1.23 - 2.74），而女性则无关联（0.61；0.43 - 0.86）。按糖尿病状态分层的敏感性分析得出了相似结果。
本研究首次提供证据表明，低尿酸血症与男性肾功能下降有关。需要进一步研究以确定低尿酸血症患者的长期预后。
