尿酸与肾功能和蛋白尿的关系：心脏健康尿酸合适水平研究（URRAH）项目。
Association of uric acid with kidney function and albuminuria: the Uric Acid Right for heArt Health (URRAH) Project.
机构信息
Department of Internal Medicine, University of Genoa and IRCCS Ospdedale Policlinico San Martino, Viale Benedetto XV, 6, 16132, Genoa, Italy.
Biomedical Department of Internal Medicine and Specialistics, University of Palermo, Palermo, Italy.
出版信息
J Nephrol. 2022 Jan;35(1):211-221. doi: 10.1007/s40620-021-00985-4. Epub 2021 Mar 23.
BACKGROUND
Hyperuricemia is commonly observed in patients with chronic kidney disease (CKD). However, a better understanding of the relationship among uric acid (UA) values, glomerular filtration rate (GFR) and albuminuria may shed light on the mechanisms underlying the excess of cardiovascular mortality associated with both chronic kidney disease and hyperuricemia and lead to better risk stratification. Our main goal was to study the relationships between serum uric acid and kidney disease measures (namely estimated GFR [eGFR] and albuminuria) in a large cohort of individuals at cardiovascular risk from the URic acid Right for heArt Health (URRAH) Project database.
METHODS
Clinical data of 26,971 individuals were analyzed. Factors associated with the presence of hyperuricemia defined on the basis of previously determined URRAH cutoffs for cardiovascular and all-cause mortality were evaluated through multivariate analysis. Chronic kidney disease was defined as eGFR < 60 ml/min per 1.73 m and/or abnormal urinary albumin excretion diagnosed as: (i) microalbuminuria if urinary albumin concentration was > 30 and ≤ 300 mg/L, or if urinary albumin-to-creatinine ratio (ACR) was > 3.4 mg/mmol and ≤ 34 mg/mmol; (ii) macroalbuminuria if urinary albumin concentration was > 300 mg/L, or if ACR was > 34 mg/mmol.
RESULTS
Mean age was 58 ± 15 years (51% males, 62% with hypertension and 12% with diabetes), mean eGFR was 81 ml/min per 1.73m2with a prevalence of eGFR < 60 and micro- or macroalbuminuria of 16, 15 and 4%, respectively. Serum uric acid showed a trend towards higher values along with decreasing renal function. Both the prevalence of gout and the frequency of allopurinol use increased significantly with the reduction of eGFR and the increase in albuminuria. Hyperuricemia was independently related to male gender, eGFR strata, and signs of insulin resistance such as body mass index (BMI) and triglycerides.
CONCLUSIONS
The lower the eGFR the higher the prevalence of hyperuricemia and gout. In subjects with eGFR < 60 ml/min the occurrence of hyperuricemia is about 10 times higher than in those with eGFR > 90 ml/min. The percentage of individuals treated with allopurinol was below 2% when GFR was above 60 ml/min, it increased to 20% in the presence of CKD 3b and rose further to 35% in individuals with macroalbuminuria.
背景
高尿酸血症在慢性肾脏病（CKD）患者中很常见。然而，更好地了解尿酸（UA）值、肾小球滤过率（GFR）和蛋白尿之间的关系，可以揭示与慢性肾脏病和高尿酸血症相关的心血管死亡率过高的潜在机制，并有助于更好地进行风险分层。我们的主要目标是在来自 URic acid Right for heArt Health（URRAH）项目数据库的心血管风险较大的人群中，研究血清尿酸与肾脏疾病指标（即估算肾小球滤过率[eGFR]和蛋白尿）之间的关系。
方法
分析了 26971 人的临床数据。通过多元分析评估了根据先前确定的 URRAH 心血管和全因死亡率切点定义的高尿酸血症存在的相关因素。慢性肾脏病定义为 eGFR<60 ml/min/1.73 m 和/或存在异常尿白蛋白排泄，诊断为：（i）如果尿白蛋白浓度>30 且≤300mg/L，或尿白蛋白/肌酐比值（ACR）>3.4mg/mmol 且≤34mg/mmol，则为微量白蛋白尿；（ii）如果尿白蛋白浓度>300mg/L，或 ACR>34mg/mmol，则为大量白蛋白尿。
结果
平均年龄为 58±15 岁（51%为男性，62%患有高血压，12%患有糖尿病），平均 eGFR 为 81ml/min/1.73 m2，eGFR<60 且微量或大量白蛋白尿的患病率分别为 16%、15%和 4%。血清尿酸值随着肾功能的降低而呈升高趋势。随着 eGFR 的降低和白蛋白尿的增加，痛风的患病率和别嘌呤醇的使用频率均显著增加。高尿酸血症与男性、eGFR 分层以及身体质量指数（BMI）和甘油三酯等胰岛素抵抗标志物独立相关。
结论
eGFR 越低，高尿酸血症和痛风的患病率越高。eGFR<60 ml/min 的患者中，高尿酸血症的发生率约为 eGFR>90 ml/min 的患者的 10 倍。当 GFR 高于 60ml/min 时，使用别嘌呤醇的患者比例低于 2%，在 CKD 3b 时增加到 20%，在存在大量白蛋白尿时进一步增加到 35%。
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