Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan.
Sci Rep. 2020 Oct 16;10(1):17585. doi: 10.1038/s41598-020-74747-w.
The relationship between serum uric acid (SUA) and cardiovascular (CV) mortality in patients with chronic kidney disease (CKD) has been described as either a J- or U-shaped function. However, its effect in non-diabetic CKD (and varying severities of CKD) remains unclear. We analyzed the database of the National Health and Nutrition Examination Survey, USA, from the years 1999 to 2010. We then grouped the subjects into 4 categories according to their SUA levels: (a) < 5 mg/dl, (b) 5-7 mg/dl, (c) 7-9 mg/dl and (d) ≥ 9 mg/dl. For mortality comparison purposes (CV related, cancer related and all-cause mortality), we set the SUA group of 5-7 mg/dl as the reference. We also separated this population into moderate (stage 3) and severe (stages 4 and 5) CKD. A total of 1860 participants were included in this study. Results showed that the group with the lowest SUA levels (< 5 mg/dl), were the least male gender (19.25%), had the lowest body mass index (26.41(95% CI = 25.66-27.16) kg/m), highest systolic blood pressure (139.02 (95% CI 135.72-142.32) mmHg), highest high-density cholesterol (59.55 (95% CI 57.37-61.74) mg/dl), lowest blood glucose (95.46 (95% CI 93.16-97.76) mg/dl), highest total cholesterol (210.31 (95% CI 203.36-217.25) mg/dl), lowest serum albumin (4.09 (95% CI 4.04-4.14) g/dl), highest estimated glomerular filtration rate (eGFR) (47.91 (95% CI 45.45-50.49) ml/min/1.732m), least history of hypertension (54.4%), and least total energy intake (1643.7 (95% CI 1536.13-1751.27) kcal/day). In the group with SUA ≥ 9 mg/dl, patients had higher all-cause mortality (HR = 2.15) whatever their baseline CVD status. In non-DM CKD patients with a CVD history, the group with SUA ≥ 9 mg/dl had the highest all-cause mortality (HR = 5.39), CVD mortality (HR = 8.18) and CVD or cancer (HR = 8.25) related mortality. In non-DM patients with severe CKD (eGFR < 30 ml/min/1.732m), the group with SUA < 5 had a significantly increased all-cause mortality. On the contrary, in non-DM patients with moderate CKD (eGFR = 30-60 ml/min/1.832m), the group with SUA ≥ 9 had a significantly increased all-cause mortality. In moderate non-DM CKD, SUA ≥ 9 mg/dl is associated with higher all-cause mortality. However, once progressing to severe non-DM CKD, SUA < 5 mg/dl is associated with higher all-cause mortality (even though it has the least risk factors for metabolic syndrome).
血清尿酸（SUA）与慢性肾脏病（CKD）患者心血管（CV）死亡率之间的关系被描述为 J 形或 U 形函数。然而，其在非糖尿病 CKD（以及不同严重程度的 CKD）中的作用仍不清楚。我们分析了美国国家健康和营养检查调查（NHANES）数据库，时间范围为 1999 年至 2010 年。然后，我们根据 SUA 水平将受试者分为 4 组：（a）<5 mg/dl，（b）5-7 mg/dl，（c）7-9 mg/dl 和（d）≥9 mg/dl。为了进行死亡率比较（与 CV 相关、与癌症相关和全因死亡率），我们将 SUA 组 5-7 mg/dl 设为参考。我们还将这一人群分为中度（第 3 阶段）和重度（第 4 阶段和第 5 阶段）CKD。共有 1860 名参与者纳入本研究。结果表明，SUA 水平最低（<5 mg/dl）的组，男性比例最低（19.25%），身体质量指数（BMI）最低（26.41（95% CI 25.66-27.16）kg/m），收缩压最高（139.02（95% CI 135.72-142.32）mmHg），高密度胆固醇最高（59.55（95% CI 57.37-61.74）mg/dl），血糖最低（95.46（95% CI 93.16-97.76）mg/dl），总胆固醇最高（210.31（95% CI 203.36-217.25）mg/dl），血清白蛋白最低（4.09（95% CI 4.04-4.14）g/dl），估算肾小球滤过率（eGFR）最高（47.91（95% CI 45.45-50.49）ml/min/1.732m），高血压病史最少（54.4%），总能量摄入最少（1643.7（95% CI 1536.13-1751.27）kcal/天）。在 SUA≥9 mg/dl 的组中，无论基线 CVD 状况如何，所有原因的死亡率都更高（HR=2.15）。在有 CVD 病史的非糖尿病 CKD 患者中，SUA≥9 mg/dl 的组全因死亡率（HR=5.39）、CVD 死亡率（HR=8.18）和 CVD 或癌症（HR=8.25）相关死亡率最高。在非糖尿病严重 CKD（eGFR<30 ml/min/1.732m）患者中，SUA<5 的组全因死亡率显著增加。相反，在非糖尿病中度 CKD（eGFR=30-60 ml/min/1.832m）患者中，SUA≥9 的组全因死亡率显著增加。在中度非糖尿病 CKD 中，SUA≥9 mg/dl 与全因死亡率增加相关。然而，一旦进展为严重非糖尿病 CKD，SUA<5 mg/dl 与全因死亡率增加相关（尽管它有最低的代谢综合征风险因素）。
