Pediatrics, University of Rochester Medical Center, 601 Elmwood Avenue Box 777, Rochester, NY, USA.
Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Pediatr Nephrol. 2023 Feb;38(2):489-497. doi: 10.1007/s00467-022-05620-3. Epub 2022 Jun 1.
Elevated serum uric acid concentration is a risk factor for CKD progression. Its change over time and association with CKD etiology and concomitant changes in estimated glomerular filtration rate (eGFR) in children and adolescents are unknown.
Longitudinal study of 153 children/adolescents with glomerular (G) and 540 with non-glomerular (NG) etiology from the CKD in Children (CKiD) study. Baseline serum uric acid, change in uric acid and eGFR over time, CKD etiology, and comorbidities were monitored. Adjusted linear mixed-effects regression models quantified the relationship between within-person changes in uric acid and concurrent within-person changes in eGFR.
Participants with stable uric acid over follow-up had CKD progression which became worse for increased baseline uric acid (average annual percentage changes in eGFR were - 1.4%, - 7.7%, and - 14.7% in those with G CKD with baseline uric acid < 5.5 mg/dL, 5.5 - 7.5 mg/dL, and > 7.5 mg/dL, respectively; these changes were - 1.4%, - 4.1%, and - 8.6% in NG CKD). Each 1 mg/dL increase in uric acid over follow-up was independently associated with significant concomitant eGFR decreases of - 5.7% (95%CI - 8.4 to - 3.0%) (G) and - 5.1% (95%CI - 6.3 to - 4.0%) (NG) for those with baseline uric acid < 5.5 mg/dL and - 4.3% (95%CI - 6.8 to - 1.6%) (G) and - 3.3% (95%CI - 4.1 to - 2.6%) (NG) with baseline uric acid between 5.5 and 7.5 mg/dL.
Higher uric acid levels and increases in uric acid over time are risk factors for more severe progression of CKD in children and adolescents. A higher resolution version of the Graphical abstract is available as Supplementary information.
血清尿酸浓度升高是 CKD 进展的危险因素。但其随时间的变化以及与儿童和青少年 CKD 病因的关系，同时与估算肾小球滤过率（eGFR）的变化相关，目前尚不清楚。
对来自 CKD 儿童（CKiD）研究的 153 名肾小球（G）和 540 名非肾小球（NG）病因的儿童/青少年进行纵向研究。监测基线血清尿酸、随时间的尿酸变化和 eGFR，以及 CKD 病因和合并症。采用调整后的线性混合效应回归模型量化个体内尿酸变化与个体内 eGFR 变化之间的关系。
随访期间尿酸稳定的患者出现 CKD 进展，且基线尿酸升高的患者病情恶化（GCKD 中基线尿酸<5.5mg/dL、5.5-7.5mg/dL 和>7.5mg/dL 的患者，eGFR 年平均百分比变化分别为-1.4%、-7.7%和-14.7%；NGCKD 中分别为-1.4%、-4.1%和-8.6%）。随时间升高 1mg/dL 尿酸与 eGFR 显著降低相关，降幅分别为-5.7%（95%CI-8.4 至-3.0%）（G）和-5.1%（95%CI-6.3 至-4.0%）（NG），对于基线尿酸<5.5mg/dL 的患者；降幅分别为-4.3%（95%CI-6.8 至-1.6%）（G）和-3.3%（95%CI-4.1 至-2.6%）（NG），对于基线尿酸在 5.5-7.5mg/dL 之间的患者。
尿酸水平升高和随时间的尿酸升高是儿童和青少年 CKD 更严重进展的危险因素。一个分辨率更高的图文摘要版本可在补充信息中找到。
