Galán Isabel, Goicoechea Marian, Quiroga Borja, Macías Nicolás, Santos Alba, García de Vinuesa Maria Soledad, Verdalles Úrsula, Cedeño Santiago, Verde Eduardo, Pérez de José Ana, García Ana, Luño José
Hospital General Universitario Gregorio Marañón, Spain.
Hospital General Universitario Gregorio Marañón, Spain.
Nefrologia (Engl Ed). 2018 Jan-Feb;38(1):73-78. doi: 10.1016/j.nefro.2017.04.006. Epub 2017 Aug 30.
Hyperuricemia plays a major role in the development and progression of chronic kidney disease (CKD). Many large observational studies have indicated that increased serum uric acid level predicts the development and progression of CKD in some population, however this hypothesis has not been yet studied in patients with reduced renal mass.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Retrospective study with a cohort of 324 patients with reduced renal mass from an outpatient basis, followed during 60 (36-98) months. Demographics variables, cardiovascular factors, concomitant medications, albuminuria and uric acid levels were recorded yearly. The primary endpoint was the annual fall of estimated glomerular filtration rate (eGFR) by MDRD-4. The sample was divided into three successive groups (A1: patients with fall of eGFR lower than median, A2: greater than median, B: without fall of eGFR). Factors associated and predictors of kidney function decline were analyzed.
One hundred and seventy out of 324 patients suffered a fall of eGFR (group A), (median of fall -1.6ml/min/1.73m/year (-3.0, -0.7)). Male gender, albuminuria>100mg/day and higher pulse pressure were associated to progression in our cohort (group A). Hyperuricemia was more frequent among patients with higher kidney disease progression (group A2) (33% vs 49%, p=0.04) when comparing to lower progression (group A1). Adjusted Cox regression models showed that hyperuricemia, pulse pressure and albuminuria were independent predictors of kidney disease progression (HR 1.67 (1.06-2.63), p=0.023; 1.02 (1.01-1.03), p=0.001 and HR: 2.14 (1.26-3.64), p=0.005, respectively). Kidney disease progression was higher in patients with unilateral renal atrophy or agenesis than nephrectomy (log rank: 7.433, p=0.006).
Hyperuricemia is independently associated with kidney disease progression in patients with reduce functioning renal mass.
高尿酸血症在慢性肾脏病（CKD）的发生和发展中起主要作用。许多大型观察性研究表明，血清尿酸水平升高在某些人群中可预测CKD的发生和发展，然而，这一假设尚未在肾实质减少的患者中进行研究。
设计、研究地点、参与者及测量指标：一项回顾性研究，对324例门诊肾实质减少患者进行队列研究，随访60（36 - 98）个月。每年记录人口统计学变量、心血管因素、伴随用药、蛋白尿和尿酸水平。主要终点是采用MDRD - 4公式计算的估计肾小球滤过率（eGFR）的年度下降值。将样本分为三个连续组（A1：eGFR下降低于中位数的患者，A2：高于中位数的患者，B：eGFR未下降的患者）。分析与肾功能下降相关的因素和预测因素。
324例患者中有170例eGFR下降（A组），（下降中位数为-1.6ml/min/1.73m²/年（-3.0，-0.7））。在我们的队列（A组）中，男性、蛋白尿>100mg/天和较高脉压与疾病进展相关。与较低进展组（A1组）相比，高尿酸血症在较高疾病进展组（A2组）患者中更常见（33%对49%，p = 0.04）。校正后的Cox回归模型显示，高尿酸血症、脉压和蛋白尿是肾脏疾病进展的独立预测因素（HR分别为1.67（1.06 - 2.63），p = 0.023；1.02（1.01 - 1.03），p = 0.001和HR：2.14（1.26 - 3.64），p = 0.005）。单侧肾萎缩或肾发育不全患者的肾脏疾病进展高于肾切除术患者（对数秩检验：7.433，p = 0.006）。
高尿酸血症与肾实质功能降低患者的肾脏疾病进展独立相关。
