Hung Yi-Hsin, Huang Chin-Chou, Lin Liang-Yu, Chen Jaw-Wen
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
Front Med (Lausanne). 2022 Jan 24;8:746886. doi: 10.3389/fmed.2021.746886. eCollection 2021.
Hyperuricemia is a risk factor for renal impairment. However, investigations focusing on patients with hypertension are limited and inconsistent. A single-center prospective cohort study of 411 Han Chinese non-diabetic hypertensive patients was conducted in Taiwan. The mean age of the participants was 62.0 ±14.4 years. The baseline estimated glomerular filtration rate and uric acid level were 86 mL/min/1.73 m and 6.2 mg/dL, respectively. All patients underwent serum biochemistry tests for creatinine levels every 3 months. Renal events were defined as >25% and >50% decline in estimated glomerular filtration rate. During an average follow-up period of 4.7 ± 2.9 years (median 4.0 years), a >25 and >50% decline in estimated glomerular filtration rate was noted in 52 and 11 patients, respectively. The multivariate Cox regression analysis revealed that a baseline uric acid level ≥8.0 mg/dL increased the risk of >25% decline (hazard ratio: 3.541; 95% confidence interval: 1.655-7.574, = 0.001) and >50% decline (hazard ratio: 6.995; 95% confidence interval: 1.309-37.385, = 0.023) in estimated glomerular filtration rate. Similarly, a baseline uric acid level ≥7.5 mg/dL was independently associated with >25% decline (hazard ratio: 2.789; 95% confidence interval: 1.399-5.560, = 0.004) and >50% decline (hazard ratio: 6.653; 95% confidence interval: 1.395-31.737, = 0.017). However, this was not demonstrated at baseline uric acid level ≥7.0 mg/dL. Our study suggests that hyperuricemia is an independent risk factor for the decline in renal function in patients with hypertension. Uric acid level ≥7.5 mg/dL may be considered as the optimal cutoff value for clinical practice in predicting the development of renal impairment.
高尿酸血症是肾功能损害的一个危险因素。然而，针对高血压患者的研究有限且结果不一致。在台湾进行了一项针对411名非糖尿病汉族高血压患者的单中心前瞻性队列研究。参与者的平均年龄为62.0±14.4岁。基线估计肾小球滤过率和尿酸水平分别为86 mL/min/1.73 m²和6.2 mg/dL。所有患者每3个月进行一次血清生化检查以检测肌酐水平。肾脏事件定义为估计肾小球滤过率下降>25%和>50%。在平均4.7±2.9年（中位数4.0年）的随访期内，分别有52例和11例患者的估计肾小球滤过率下降>25%和>50%。多因素Cox回归分析显示，基线尿酸水平≥8.0 mg/dL会增加估计肾小球滤过率下降>25%（风险比：3.541；95%置信区间：1.655 - 7.574，P = 0.001）和下降>50%（风险比：6.995；95%置信区间：1.309 - 37.385，P = 0.023）的风险。同样，基线尿酸水平≥7.5 mg/dL与估计肾小球滤过率下降>25%（风险比：2.789；95%置信区间：1.399 - 5.560，P = 0.004）和下降>50%（风险比：6.653；95%置信区间：1.395 - 31.737，P = 0.017）独立相关。然而，在基线尿酸水平≥7.0 mg/dL时未观察到这种情况。我们的研究表明，高尿酸血症是高血压患者肾功能下降的独立危险因素。尿酸水平≥7.5 mg/dL可被视为预测肾功能损害发生的临床实践最佳临界值。
