Barnini Cecilia, Russo Elisa, Leoncini Giovanna, Ghinatti Maria Carla, Macciò Lucia, Piaggio Michela, Viazzi Francesca, Pontremoli Roberto
Department of Internal Medicine IV, Nephrology and Hypertension, Medical University Innsbruck, 6020 Innsbruck, Tirol, Austria.
Department of Internal Medicine and Medical Specialties (DiMI), University of Genoa, 16132 Genoa, Italy.
Metabolites. 2025 Jan 2;15(1):11. doi: 10.3390/metabo15010011.
Chronic kidney disease (CKD) is a prevalent global health concern affecting approximately 850 million people worldwide, with a significant and rising mortality rate. CKD often coexists with hyperuricemia (HSUA), which is also increasingly common due to its association with hypertension, obesity, and diabetes. The interplay between hyperuricemia and CKD is complex; while in vitro studies and animal models support a role for uric acid mediating glomerular and tubule-interstitial damage, and HSUA has been shown to predict the onset and progression of CKD, the expectations of renal protection by the use of urate lowering treatment (ULT) are inconsistent. A significant challenge in managing asymptomatic HSUA in CKD patients lies in determining the appropriate SUA threshold values. Recent research, including the URRAH project, has sought to identify SUA cut-offs predictive of cardiovascular mortality, but these thresholds may vary depending on the severity of CKD. This variability complicates the establishment of universal guidelines for treating asymptomatic HSUA, leading to a lack of specific recommendations in clinical practice. In conclusion, while hyperuricemia is recognized as a prognostic factor for CKD and cardiovascular risk, more research is needed to refine the threshold values for SUA and to identify which patients may benefit from ULT. Stratification based on glomerular filtration rate may be necessary to tailor the treatments and improve outcomes in this population.
慢性肾脏病（CKD）是一个普遍存在的全球健康问题，全球约有8.5亿人受其影响，死亡率显著且呈上升趋势。CKD常与高尿酸血症（HSUA）并存，由于其与高血压、肥胖和糖尿病的关联，HSUA也日益常见。高尿酸血症与CKD之间的相互作用很复杂；虽然体外研究和动物模型支持尿酸在介导肾小球和肾小管间质损伤中起作用，并且HSUA已被证明可预测CKD的发生和进展，但使用降尿酸治疗（ULT）对肾脏保护的预期并不一致。在CKD患者中管理无症状HSUA的一个重大挑战在于确定合适的血尿酸（SUA）阈值。包括URRAH项目在内的近期研究试图确定预测心血管死亡率的SUA临界值，但这些阈值可能因CKD的严重程度而异。这种变异性使得制定治疗无症状HSUA的通用指南变得复杂，导致临床实践中缺乏具体建议。总之，虽然高尿酸血症被认为是CKD和心血管风险的一个预后因素，但需要更多研究来完善SUA阈值，并确定哪些患者可能从ULT中获益。基于肾小球滤过率进行分层可能有必要，以便在此人群中调整治疗方案并改善治疗效果。
