Division of Nephrology, Department of Medicine, University of Iowa, Iowa City, IA.
Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC.
Am J Kidney Dis. 2017 Dec;70(6):762-769. doi: 10.1053/j.ajkd.2017.06.013. Epub 2017 Aug 9.
Elevated uric acid concentration is associated with higher rates of cardiovascular (CV) morbidity and mortality in the general population. It is not known whether hyperuricemia increases the risk for CV death or transplant failure in kidney transplant recipients.
Post hoc cohort analysis of the FAVORIT Study, a randomized controlled trial that examined the effect of homocysteine-lowering vitamins on CV disease in kidney transplantation.
SETTING & PARTICIPANTS: Adult recipients of kidney transplants in the United States, Canada, or Brazil participating in the FAVORIT Study, with hyperhomocysteinemia, stable kidney function, and no known history of CV disease.
Uric acid concentration.
The primary end point was a composite of CV events. Secondary end points were all-cause mortality and transplant failure. Risk factors included in statistical models were age, sex, race, country, treatment assignment, smoking history, body mass index, presence of diabetes mellitus, history of CV disease, blood pressure, estimated glomerular filtration rate (eGFR), donor type, transplant vintage, lipid concentrations, albumin-creatinine ratio, and uric acid concentration. Cox proportional hazards models were fit to examine the association of uric acid concentration with study end points after risk adjustment.
3,512 of 4,110 FAVORIT participants with baseline uric acid concentrations were studied. Median follow-up was 3.9 (IQR, 3.0-5.3) years. 503 patients had a primary CV event, 401 died, and 287 had transplant failure. In unadjusted analyses, uric acid concentration was significantly related to each outcome. Uric acid concentration was also strongly associated with eGFR. The relationship between uric acid concentration and study end points was no longer significant in fully adjusted multivariable models (P=0.5 for CV events; P=0.09 for death, and P=0.1 for transplant failure).
Unknown use of uric acid-lowering agents among study participants.
Following kidney transplantation, uric acid concentrations are not independently associated with CV events, mortality, or transplant failure. The strong association between uric acid concentrations with traditional risk factors and eGFR is a possible explanation.
在普通人群中，尿酸浓度升高与更高的心血管（CV）发病率和死亡率相关。尚不清楚高尿酸血症是否会增加肾移植受者的 CV 死亡或移植失败风险。
FAVORIT 研究的事后队列分析，这是一项随机对照试验，研究了降低同型半胱氨酸的维生素对肾移植中 CV 疾病的影响。
在美国、加拿大或巴西接受肾移植的成年人，具有高同型半胱氨酸血症、稳定的肾功能和无已知 CV 病史。
尿酸浓度。
3512 例 FAVORIT 参与者中有基线尿酸浓度，中位随访时间为 3.9 年（IQR，3.0-5.3）。503 例患者发生主要 CV 事件，401 例死亡，287 例移植失败。在未调整的分析中，尿酸浓度与每种结果显著相关。尿酸浓度与 eGFR 也有很强的相关性。在完全调整的多变量模型中，尿酸浓度与研究终点之间的关系不再显著（CV 事件的 P=0.5；死亡的 P=0.09；移植失败的 P=0.1）。
研究参与者中未知的尿酸降低剂的使用情况。
肾移植后，尿酸浓度与 CV 事件、死亡率或移植失败无关。尿酸浓度与传统危险因素和 eGFR 之间的强烈关联可能是一个解释。
