a Department of Internal Medicine, School of Medicine , University of Ioannina , Ioannina , Greece.
b Department of Nephrology , University Hospital of Ioannina , Ioannina , Greece.
Curr Med Res Opin. 2018 Jul;34(7):1193-1199. doi: 10.1080/03007995.2017.1372157. Epub 2017 Sep 21.
Elevated uric acid (UA) is a recognized risk factor for chronic kidney disease (CKD). This study aimed to investigate whether this association exists in dyslipidemic patients receiving multifactorial treatment.
An observational study conducted in Greece including 1,269 dyslipidemic individuals followed-up in a lipid clinic for ≥3 years. Estimated glomerular filtration rate (eGFR) was calculated by CKD-EPI equation and CKD was defined as ≤60 mL/min/1.73 m. The correlation was assessed between UA levels and the CKD risk after adjusting for potential confounding factors, after defining the following UA quartiles: Q1: < 4, Q2: 4-5, Q3: 5-6, and Q4: > 6 mg/dL.
After excluding patients with baseline eGFR <60 mL/min/1.73 m, gout and those taking UA-lowering drugs, 1,095 individuals were eligible; of those, 91% and 69% were treated with statins and anti-hypertensive drugs, respectively. During their follow-up (6 years; IQR = 4-10), 11.9% of the subjects developed CKD, whereas the median annual eGFR decline was 0.69 mL/min/1.73 m (IQR = 0.45-2.33). Multivariate analysis showed that baseline UA levels (HR = 1.26; 95% CI = 1.09-1.45, p = .001), female gender (HR = 1.74; 95% CI = 1.14-2.65, p = .01), age (HR = 1.10; 95% CI = 1.07-1.12, p < .001), diabetes (HR = 1.67; 95% CI = 1.05-2.65, p = .03), cardiovascular disease (HR = 1.62; 95% CI = 1.02-2.58, p = .04), decreased baseline renal function (eGFR <90 mL/min/1.73 m) (HR = 2.38; 95% CI = 1.14-4.81, p = .02), and low-density lipoprotein cholesterol reduction (HR = 0.995; 95% CI = 0.991-0.998, p = .01) were associated with incident CKD. Additionally, patients with UA ≥6 mg/dL exhibited a higher risk of incident CKD compared with those in the lowest UA quartile (HR = 2.01; 95% CI = 1.11-3.65, p = .02).
Higher UA levels are correlated with a higher risk of incident CKD in dyslipidemic individuals taking multifactorial treatment.
尿酸（UA）升高是慢性肾脏病（CKD）的公认危险因素。本研究旨在探讨在接受多因素治疗的血脂异常患者中是否存在这种关联。
在希腊进行了一项观察性研究，纳入了 1269 名血脂异常患者，他们在血脂诊所接受随访≥3 年。通过 CKD-EPI 方程计算估算肾小球滤过率（eGFR），并将 eGFR≤60ml/min/1.73m 定义为 CKD。在调整潜在混杂因素后，评估 UA 水平与 CKD 风险之间的相关性，并根据 UA 四分位距定义以下 UA 四分位数：Q1：<4mg/dL，Q2：4-5mg/dL，Q3：5-6mg/dL，Q4：>6mg/dL。
排除基线 eGFR<60ml/min/1.73m、痛风和使用 UA 降低药物的患者后，1095 名患者符合条件；其中 91%和 69%分别接受了他汀类药物和抗高血压药物治疗。在他们的随访期间（6 年；IQR=4-10），11.9%的患者发生 CKD，而中位 eGFR 年下降为 0.69ml/min/1.73m（IQR=0.45-2.33）。多变量分析显示，基线 UA 水平（HR=1.26；95%CI=1.09-1.45，p=0.001）、女性（HR=1.74；95%CI=1.14-2.65，p=0.01）、年龄（HR=1.10；95%CI=1.07-1.12，p<0.001）、糖尿病（HR=1.67；95%CI=1.05-2.65，p=0.03）、心血管疾病（HR=1.62；95%CI=1.02-2.58，p=0.04）、基线肾功能下降（eGFR<90ml/min/1.73m）（HR=2.38；95%CI=1.14-4.81，p=0.02）和 LDL-C 降低（HR=0.995；95%CI=0.991-0.998，p=0.01）与新发 CKD 相关。此外，UA≥6mg/dL 的患者发生新发 CKD 的风险高于 UA 最低四分位的患者（HR=2.01；95%CI=1.11-3.65，p=0.02）。
在接受多因素治疗的血脂异常患者中，UA 水平升高与新发 CKD 的风险升高相关。
