Ye Meiyu, Hu Kang, Jin Juan, Wu Diandian, Hu Peiying, He Qiang
Department of Nephrology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, No. 158 Shangtang Road, Hangzhou, 310014, Zhejiang Province, People's Republic of China.
The Second Clinical Medical College, Zhejiang Chinese Medical University, No. 548 Binwen Road, Hangzhou, 310053, Zhejiang Province, People's Republic of China.
BMC Nephrol. 2018 Jul 31;19(1):190. doi: 10.1186/s12882-018-0982-6.
Investigations on the role of the time-mean serum uric acid (SUA) value in determining the risk of chronic kidney disease (CKD) are limited. We investigated whether the time-mean SUA value indicates the risk of CKD, and explored associations of the baseline and time-mean SUA levels with kidney function decline and incident CKD in a healthy population.
We initiated an inhabitant-based cohort study between January 2011 and December 2016. All participants completed a yearly medical check-up at the Zhejiang Province People's Hospital and had baseline estimated glomerular filtration rates (eGFR) > 60 ml/min/1.73m. The SUA level and eGFR were assessed every year in the follow-up period. A multivariate adjusted binary logistic regression analysis and Cox proportional hazards models were used to evaluate the risk of newly-developed CKD among different stratified groups.
During the 6-year follow-up period, 227 (4.4%) participants developed CKD. In multivariable-adjusted analyses, the odds ratio (OR) for new-onset CKD increased, with higher time-mean SUA levels than at baseline (OR: 1.00 [reference], 2.709 [95% confidence interval: 1.836-5.293], 3.754 [1.898-7.428], and 7.462 [3.694-15.073]). After adjustment for potential cofounders, a multivariate Cox proportional hazard model showed that a higher SUA increased the risk of developing CKD (the adjusted hazard ratios of the highest and lowest quartiles for the baseline and time-mean SUA levels were 1.689 [1.058-2.696] and 6.320 [3.285-12.159], respectively).
An increased time-mean and single SUA value were independently associated with an increased likelihood of eGFR decline and development of new-onset CKD in the general population.
关于时间平均血清尿酸（SUA）值在确定慢性肾脏病（CKD）风险中的作用的研究有限。我们调查了时间平均SUA值是否表明CKD风险，并在健康人群中探讨了基线和时间平均SUA水平与肾功能下降和新发CKD的关联。
我们在2011年1月至2016年12月期间开展了一项基于居民的队列研究。所有参与者在浙江省人民医院完成年度体检，且基线估计肾小球滤过率（eGFR）>60ml/min/1.73m²。在随访期间每年评估SUA水平和eGFR。采用多变量调整二元逻辑回归分析和Cox比例风险模型评估不同分层组中新发CKD的风险。
在6年随访期内，227名（4.4%）参与者发生了CKD。在多变量调整分析中，新发CKD的比值比（OR）随着时间平均SUA水平高于基线水平而增加（OR：1.00[参考值]，2.709[95%置信区间：1.836 - 5.293]，3.754[1.898 - 7.428]，以及7.462[3.694 - 15.073]）。在对潜在混杂因素进行调整后，多变量Cox比例风险模型显示较高的SUA增加了发生CKD的风险（基线和时间平均SUA水平最高和最低四分位数的调整后风险比分别为1.689[1.058 - 2.696]和6.320[3.285 - 12.159]）。
时间平均SUA值和单次SUA值升高均与普通人群中eGFR下降和新发CKD可能性增加独立相关。
