1
|
Li N, Yang X, Wu J, Wang Y, Wang Z, Mu H. Correlation between the increase in serum uric acid and the rapid decline in kidney function in adults with normal kidney function: a retrospective study in Urumqi, China. BMC Nephrol 2023; 24:103. [PMID: 37085795 PMCID: PMC10122314 DOI: 10.1186/s12882-023-03151-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 04/04/2023] [Indexed: 04/23/2023] Open
Abstract
BACKGROUND To examine the association between elevated serum uric acid (SUA) levels and the rapid decline in kidney function by conducting a retrospective cohort study on a physically healthy population in Urumqi, China. METHODS A cohort study of 2,802 physically healthy people with a normal estimated glomerular filtration rate (eGFR) was investigated from 2018 to 2021. The examination procedure included using questionnaires, taking physical measurements, and blood sampling. The rapid decline in kidney function was defined as eGFR > 5 mL·min-1 ·(1.73 m2 )-1 year. The relationship between elevated SUA levels and the rapid decline in kidney function was assessed. RESULTS When performing the three-year retrospective analysis, 688 (28.55%) cases experienced a rapid decline in kidney function, and 52 (1.9%) cases developed chronic kidney disease (CKD). They were divided into the stable group and the rapidly declining kidney function group according to eGFR > 15 mL·min-1·(1.73 m2 )-1. The comparison revealed a greater increase in uric acid in the rapidly declining kidney function group [0.30 (-0.29, 0.82) mg/dL vs. - 0.07(-0.54, 0.37) mg/dL, Z = - 8.822, P < 0.001]. The participants were further divided into four groups according to their uric acid levels in 2018 and 2021, which included the normal to normal (N-N) group, the normal to hyperuricemia (HUA) (N-H) group, the HUA to normal (H-N) group, and the persistently HUA (H-H) group. The decrease in eGFR was significantly higher in the N-H group than in the other three groups (χ2 = 20.580, P < 0.001). The results of the multifactorial logistic regression analysis showed that elevated uric acid was a risk factor for the rapid decline in kidney function (OR = 1.640, P < 0.001). CONCLUSION Elevated SUA levels were a risk factor for the rapid decline in kidney function in the Chinese health examination population. Higher SUA levels might predict the occurrence of progressive kidney impairment.
Collapse
Affiliation(s)
- Na Li
- Health Management Center, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Xiaoping Yang
- Health Management Center, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Jianrong Wu
- Health Management Center, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Yinghong Wang
- Health Management Center, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Zengliang Wang
- Health Management Center, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Huyati Mu
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
| |
Collapse
|
2
|
Fellström B, Helmersson-Karlqvist J, Lind L, Soveri I, Wu PH, Thulin M, Ärnlöv J, Larsson A. Associations Between Apolipoprotein A1, High-Density Lipoprotein Cholesterol, and Urinary Cytokine Levels in Elderly Males and Females. J Interferon Cytokine Res 2019; 40:71-74. [PMID: 31599692 DOI: 10.1089/jir.2019.0074] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
There exists a close relationship between cardiovascular diseases and chronic kidney disease. Apolipoprotein A1 and high-density lipoprotein (HDL) cholesterol are widely used as cardiovascular risk markers but they also have anti-inflammatory properties. The aim of this study was to investigate any associations between HDL levels and cytokine levels in urine. We randomly selected 90 urine samples from the Prospective Investigation of the Vasculature in Uppsala Seniors Study (41 males and 49 females). The samples were analyzed with 2 multiplex assays, Multiplex Inflammation I and Cardiovascular II kits (Olink Bioscience, Uppsala, Sweden). We analyzed the correlations between 158 cytokines in urine with apolipoprotein A1, HDL cholesterol, apolipoprotein B, and low-density lipoprotein cholesterol. There were strong correlations for apolipoprotein A1 and HDL cholesterol with individual cytokines. After adjustment for multiplicity testing, there were 33 significant correlations between apolipoprotein A1 and cytokine levels and 14 of these were also significantly correlated with HDL cholesterol. The strongest associations were observed for IL-1α, SPON2, RAGE, PAR-1, TRAIL-R2, IL-4RA, TNFRSF11A, and SCF. A total of 28 out of 33 correlations were negative, indicating a negative relationship between apolipoprotein A1 and urinary cytokines. The study shows a negative correlation between apolipoprotein A1 and HDL cholesterol and urinary cytokine levels. The finding is in agreement with the anti-inflammatory properties of HDL.
Collapse
Affiliation(s)
- Bengt Fellström
- Department of Medical Sciences, Uppsala University, Uppsala University Hospital, Uppsala, Sweden
| | | | - Lars Lind
- Department of Medical Sciences, Uppsala University, Uppsala University Hospital, Uppsala, Sweden
| | - Inga Soveri
- Department of Medical Sciences, Uppsala University, Uppsala University Hospital, Uppsala, Sweden
| | - Ping-Hsun Wu
- Department of Medical Sciences, Uppsala University, Uppsala University Hospital, Uppsala, Sweden
| | - Måns Thulin
- Institution of Statistics, Uppsala University, Uppsala, Sweden
| | - Johan Ärnlöv
- Department of School of Health and Social Studies, Dalarna University, Falun, Sweden.,Division of Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Anders Larsson
- Department of Medical Sciences, Uppsala University, Uppsala University Hospital, Uppsala, Sweden
| |
Collapse
|
3
|
Vlad CE, Foia L, Popescu R, Ivanov I, Luca MC, Delianu C, Toma V, Statescu C, Rezus C, Florea L. Apolipoproteins A and B and PCSK9: Nontraditional Cardiovascular Risk Factors in Chronic Kidney Disease and in End-Stage Renal Disease. J Diabetes Res 2019; 2019:6906278. [PMID: 31915710 PMCID: PMC6931031 DOI: 10.1155/2019/6906278] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 09/09/2019] [Accepted: 11/26/2019] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Nontraditional cardiovascular risk factors as apolipoprotein A (ApoA), apolipoprotein B (ApoB), and the proprotein convertase subtilisin/kexin type 9 (PCSK9) increase the prevalence of cardiovascular mortality in chronic kidney disease (CKD) or in end-stage renal disease (ESRD) through quantitative alterations. This review is aimed at establishing the biomarker (ApoA, ApoB, and PCSK9) level variations in uremic patients, to identify the studies showing the association between these biomarkers and the development of cardiovascular events and to depict the therapeutic options to reduce cardiovascular risk in CKD and ESRD patients. METHODS We searched the electronic database of PubMed, Scopus, EBSCO, and Cochrane CENTRAL for studies evaluating apolipoproteins and PCSK9 in CKD and ESRD. Randomized controlled trials, observational studies (including case-control, prospective or retrospective cohort), and reviews/meta-analysis were included if reference was made to those keys and cardiovascular outcomes in CKD/ESRD. RESULTS 18 studies met inclusion criteria. Serum ApoA-I has been significantly associated with the development of new cardiovascular event and with cardiovascular mortality in ESRD patients. ApoA-IV level was independently associated with maximum carotid intima-media thickness (cIMT) and was a predictor for sudden cardiac death. The ApoB/ApoA-I ratio represents a strong predictor for coronary artery calcifications, cardiovascular mortality, and myocardial infarction in CKD/ESRD. Plasma levels of PCSK9 were not associated with cardiovascular events in CKD patients. CONCLUSIONS Although the "dyslipidemic status" in CKD/ESRD is not clearly depicted, due to different research findings, ApoA-I, ApoA-IV, and ApoB/ApoA-I ratio could be predictors of cardiovascular risk. Serum PCSK9 levels were not associated with the cardiovascular events in patients with CKD/ESRD. Probably in the future, the treatment of dyslipidemia in CKD/ESRD will be aimed at discovering new effective therapies on the action of these biomarkers.
Collapse
Affiliation(s)
- Cristiana-Elena Vlad
- Department of Nephrology, “Dr. C. I. Parhon” Clinical Hospital Iasi, Iasi, Romania
- Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Liliana Foia
- Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Roxana Popescu
- Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Iuliu Ivanov
- Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | | | - Carmen Delianu
- Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Vasilica Toma
- Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | | | - Ciprian Rezus
- Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
- Department of Cardiology, “Sf. Spiridon” Clinical Hospital Iasi, Iasi, Romania
| | - Laura Florea
- Department of Nephrology, “Dr. C. I. Parhon” Clinical Hospital Iasi, Iasi, Romania
- Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
| |
Collapse
|
4
|
Plasma Nitration of High-Density and Low-Density Lipoproteins in Chronic Kidney Disease Patients Receiving Kidney Transplants. Mediators Inflamm 2015; 2015:352356. [PMID: 26648662 PMCID: PMC4662997 DOI: 10.1155/2015/352356] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 10/14/2015] [Accepted: 10/19/2015] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Functional abnormalities of high-density lipoprotein (HDL) could contribute to cardiovascular disease in chronic kidney disease patients. We measured a validated marker of HDL dysfunction, nitrated apolipoprotein A-I, in kidney transplant recipients to test the hypothesis that a functioning kidney transplant reduces serum nitrated apoA-I concentrations. METHODS Concentrations of nitrated apoA-I and apoB were measured using indirect sandwich ELISA assays on sera collected from each transplant subject before transplantation and at 1, 3, and 12 months after transplantation. Patients were excluded if they have history of diabetes, treatment with lipid-lowering medications or HIV protease inhibitors, prednisone dose > 15 mg/day, nephrotic range proteinuria, serum creatinine > 1.5 mg/dL, or active inflammatory disease. Sera from 18 transplanted patients were analyzed. Four subjects were excluded due to insufficient data. Twelve and eight patients had creatinine < 1.5 mg/dL at 3 and 12 months after transplantation, respectively. RESULTS. Nitrated apoA-I was significantly reduced at 12 months after transplantation (p = 0.039). The decrease in apoA-I nitration was associated with significant reduction in myeloperoxidase (MPO) activity (p = 0.047). In contrast to apoA-I, nitrated apoB was not affected after kidney transplantation. CONCLUSIONS Patients with well-functioning grafts had significant reduction in nitrated apoA-I 12 months after kidney transplantation. Further studies are needed in a large cohort to determine if nitrated apoA-I can be used as a valuable marker for cardiovascular risk stratification in chronic kidney disease.
Collapse
|
5
|
Lin CS, Chen SJ, Sung CC, Lin CL, Lin SH, Cheng SM, Wang IK, Huang WS, Kao CH. Hemodialysis Is Associated With Increased Peripheral Artery Occlusive Disease Risk Among Patients With End-Stage Renal Disease: A Nationwide Population-Based Cohort Study. Medicine (Baltimore) 2015; 94:e1164. [PMID: 26181560 PMCID: PMC4617093 DOI: 10.1097/md.0000000000001164] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
To investigate the effect of different dialysis modalities on the incidence of peripheral artery occlusive disease (PAOD) among patients with end-stage renal disease (ESRD) in a large population-based cohort study. The cohort study included 26,927 ESRD patients who underwent hemodialysis (17,737 patients, hemodialysis [HD] cohort) or peritoneal dialysis (PD, 9190 patients, PD cohort), and 107,588 matched controls between 2000 and 2010. A Cox proportional hazards model was to evaluate the risk of PAOD in the ESRD underwent HD or PD. Based on a mean follow-up period of 2.92, 3.64, and 4.91 years in the PD, HD, and control cohorts, respectively, the incidences of PAOD were 18.1% and 8.10% higher in the HD and PD cohorts, respectively, compared with the control cohort (log-rank test P < 0.001). The patients who underwent HD or PD exhibited a higher risk of PAOD compared with the control cohort regardless of age, sex, and presence or absence of comorbidities. In addition, the incidence of PAOD in the PD cohort and the propensity score-matched HD cohort were 12.4 and 20.7 per 1000 person-years, respectively, with a hazard ratio of 1.92 (95% confidence interval = 1.62-2.28) in HD patients, compared with the PD cohort. This nationwide population-based cohort study suggested a significantly increased risk of PAOD among ESRD patients. Moreover, the PD patients have a lower risk of developing PAOD compared with the HD cohort, indicating the beneficial roles of PD in reducing PAOD risk in ESRD patients.
Collapse
Affiliation(s)
- Chin-Sheng Lin
- From the Division of Cardiology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan (C-SL, S-MC); Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan (S-JC); Division of Nephrology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan (C-CS, S-HL); Management Office for Health Data, China Medical University Hospital (C-LL); College of Medicine, China Medical University (C-LL); Graduate Institute of Clinical Medical Science and School of Medicine (I-KW, C-HK); Department of Internal Medicine, College of Medicine, China Medical University (I-KW); Division of Kidney Disease, China Medical University Hospital, Taichung (I-KW); Department of Nuclear Medicine, Changhua Christian Hospital, Changhua (W-SH); and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan (C-HK)
| | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Kalantar-Zadeh K, Brown A, Chen JLT, Kamgar M, Lau WL, Moradi H, Rhee CM, Streja E, Kovesdy CP. Dietary restrictions in dialysis patients: is there anything left to eat? Semin Dial 2015; 28:159-68. [PMID: 25649719 PMCID: PMC4385746 DOI: 10.1111/sdi.12348] [Citation(s) in RCA: 131] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
A significant number of dietary restrictions are imposed traditionally and uniformly on maintenance dialysis patients, whereas there is very little data to support their benefits. Recent studies indicate that dietary restrictions of phosphorus may lead to worse survival and poorer nutritional status. Restricting dietary potassium may deprive dialysis patients of heart-healthy diets and lead to intake of more atherogenic diets. There is little data about the survival benefits of dietary sodium restriction, and limiting fluid intake may inherently lead to lower protein and calorie consumption, when in fact dialysis patients often need higher protein intake to prevent and correct protein-energy wasting. Restricting dietary carbohydrates in diabetic dialysis patients may not be beneficial in those with burnt-out diabetes. Dietary fat including omega-3 fatty acids may be important caloric sources and should not be restricted. Data to justify other dietary restrictions related to calcium, vitamins, and trace elements are scarce and often contradictory. The restriction of eating during hemodialysis treatment is likely another incorrect practice that may worsen hemodialysis induced hypoglycemia and nutritional derangements. We suggest careful relaxation of most dietary restrictions and adoption of a more balanced and individualized approach, thereby easing some of these overzealous restrictions that have not been proven to offer major advantages to patients and their outcomes and which may in fact worsen patients' quality of life and satisfaction. This manuscript critically reviews the current paradigms and practices of recommended dietary regimens in dialysis patients including those related to dietary protein, carbohydrate, fat, phosphorus, potassium, sodium, and calcium, and discusses the feasibility and implications of adherence to ardent dietary restrictions and future research.
Collapse
Affiliation(s)
- Kamyar Kalantar-Zadeh
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, Orange, California
- Long Beach Veterans Affairs Healthcare System, Long Beach, California
- Dept. Epidemiology, UCLA Fielding School of Public Health, University of California Los Angeles, Los Angeles, California
| | - Amanda Brown
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, Orange, California
- Long Beach Veterans Affairs Healthcare System, Long Beach, California
| | - Joline L. T. Chen
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, Orange, California
- Long Beach Veterans Affairs Healthcare System, Long Beach, California
| | | | - Wei-Ling Lau
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, Orange, California
| | - Hamid Moradi
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, Orange, California
- Long Beach Veterans Affairs Healthcare System, Long Beach, California
| | - Connie M. Rhee
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, Orange, California
| | - Elani Streja
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, Orange, California
- Long Beach Veterans Affairs Healthcare System, Long Beach, California
| | - Csaba P. Kovesdy
- Univ. of Tennessee Health Science Center, Memphis, Tennessee
- Memphis Veterans Affairs Healthcare System, Memphis, Tennessee
| |
Collapse
|
7
|
Ruskovska T, Bennett SJ, Brown CR, Dimitrov S, Kamcev N, Griffiths HR. Ankyrin is the major oxidised protein in erythrocyte membranes from end-stage renal disease patients on chronic haemodialysis and oxidation is decreased by dialysis and vitamin C supplementation. Free Radic Res 2014; 49:175-85. [DOI: 10.3109/10715762.2014.991725] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|