不同尿尿酸指标在慢性肾脏病患者中的疗效。
Efficacy of different urinary uric acid indicators in patients with chronic kidney disease.
机构信息
Department of Nephrology, Huadong Hospital affiliated to Fudan University, No. 221 West Yan'an Road, Shanghai, 200040, P.R. China.
Shanghai Key Laboratory of Clinical Geriatric Medicine, No. 221 West Yan'an Road, Shanghai, 200040, P.R. China.
出版信息
BMC Nephrol. 2020 Jul 22;21(1):290. doi: 10.1186/s12882-020-01953-z.
BACKGROUND
Mounting studies have shown that hyperuricemia is related to kidney diseases through multiple ways. However, the application of urinary uric acid indicators in patients with reduced renal function is not clear. In this study, we aim to determine the effects of renal function on various indicators reflecting uric acid levels in patients with chronic kidney disease (CKD).
METHODS
Anthropometric and biochemical examinations were performed in 625 patients with CKD recruited from Dept of Nephrology of Huadong hospital affiliated to Fudan University. Multiple regression analyses were used to study correlations of the estimated glomerular filtration rate (eGFR) with serum uric acid (SUA) and renal handling of uric acid. For further study, smooth curve plots and threshold effect analyses were applied to clarify associations between renal function and uric acid levels.
RESULTS
The nonlinear relationships were observed between eGFR and urinary uric acid indicators. The obvious inflection points were observed in smooth curve fitting of eGFR and fractional excretion of uric acid (FEur), excretion of uric acid per volume of glomerular filtration (EurGF). In subsequent analyses where levels of eGFR< 15 mL/min/1.73m were dichotomized (CKD5a/CKD5b), patients in the CKD5a showed higher levels of FEur and EurGF while lower levels of urinary uric acid excretion (UUA), clearance of uric acid (Cur) and glomerular filtration load of uric acid (FLur) compared with CKD5b group (all P < 0.05). And there was no significant difference of SUA levels between two groups. On the other hand, when eGFR< 109.9 ml/min/1.73 m and 89.1 ml/min/1.73 m, the resultant curves exhibited approximately linear associations of eGFR with Cur and FLur respectively.
CONCLUSION
FEur and EurGF showed significantly compensatory increases with decreased renal function. And extra-renal uric acid excretion may play a compensatory role in patients with severe renal impairment to maintain SUA levels. Moreover, Cur and FLur may be more reliable indicators of classification for hyperuricemia in CKD patients.
背景
越来越多的研究表明，高尿酸血症通过多种途径与肾脏疾病有关。然而，尿尿酸指标在肾功能降低的患者中的应用尚不清楚。本研究旨在确定肾功能对慢性肾脏病（CKD）患者反映尿酸水平的各种指标的影响。
方法
在复旦大学附属华东医院肾脏病科招募了 625 名 CKD 患者，进行人体测量和生化检查。采用多元回归分析研究估算肾小球滤过率（eGFR）与血清尿酸（SUA）和尿酸肾处理之间的相关性。为了进一步研究，应用平滑曲线和阈效应分析来阐明肾功能与尿酸水平之间的关系。
结果
eGFR 与尿尿酸指标之间存在非线性关系。在 eGFR 与尿酸分数排泄（FEur）、尿酸排泄量与肾小球滤过率（EurGF）的平滑曲线拟合中观察到明显的拐点。在随后将 eGFR<15 ml/min/1.73m 分为两部分（CKD5a/CKD5b）的分析中，与 CKD5b 组相比，CKD5a 组的 FEur 和 EurGF 水平较高，而尿尿酸排泄量（UUA）、尿酸清除率（Cur）和尿酸肾小球滤过负荷（FLur）水平较低（均 P<0.05）。两组间 SUA 水平无显著差异。另一方面，当 eGFR<109.9 ml/min/1.73 m 和 89.1 ml/min/1.73 m 时，所得曲线分别显示 eGFR 与 Cur 和 FLur 呈近似线性关系。
结论
FEur 和 EurGF 随着肾功能的降低而显著代偿性增加。在严重肾功能损害的患者中，肾脏外尿酸排泄可能发挥代偿作用，以维持 SUA 水平。此外，Cur 和 FLur 可能是 CKD 患者高尿酸血症分类的更可靠指标。
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