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Vareldzis R, Perez A, Reisin E. Hyperuricemia: An Intriguing Connection to Metabolic Syndrome, Diabetes, Kidney Disease, and Hypertension. Curr Hypertens Rep 2024; 26:237-245. [PMID: 38270791 DOI: 10.1007/s11906-024-01295-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2024] [Indexed: 01/26/2024]
Abstract
PURPOSE OF THE REVIEW Our review explores the epidemiology, physiology, and clinical data surrounding the connection between hyperuricemia and metabolic syndrome, chronic kidney disease, and hypertension. RECENT FINDINGS Compelling physiologic mechanisms have been proposed to explain a causal relationship between hyperuricemia and metabolic syndrome, chronic kidney disease, and hypertension but clinical studies have given mixed results in terms of whether intervening with hyperuricemia using urate-lowering therapy has any beneficial effects for patients with these conditions. Despite the large amount of research already put into this topic, more randomized placebo-controlled trials are needed to more firmly establish whether a cause-effect relationship exists and whether lowering uric acid levels in patients with these conditions is beneficial.
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Affiliation(s)
- Ramzi Vareldzis
- Section of Nephrology and Hypertension, Louisiana State University Health Science Center, New Orleans, LA, USA
| | - Annalisa Perez
- Section of Nephrology and Hypertension, Louisiana State University Health Science Center, New Orleans, LA, USA
| | - Efrain Reisin
- Section of Nephrology and Hypertension, Louisiana State University Health Science Center, New Orleans, LA, USA.
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Wu S, Wang H, Pan D, Guo J, Zhang F, Ning Y, Gu Y, Guo L. Association between hyperuricemia and diabetic nephropathy: insights from the national health and nutrition examination survey 2007-2016 and mendelian randomization analysis. Int Urol Nephrol 2024:10.1007/s11255-024-04094-6. [PMID: 38809295 DOI: 10.1007/s11255-024-04094-6] [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: 03/26/2024] [Accepted: 05/23/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND This study aimed to investigate the role of uric acid (UA) in diabetic nephropathy (DN) from epidemiological and genetic perspectives. METHODS We used data from the 2007-2016 National Health and Nutrition Examination Survey to evaluate the relationship between UA and DN risk using weighted multivariate-adjusted logistic regression. Subsequently, a two-sample Mendelian randomization study was conducted using genome-wide association study summary statistics. The main inverse variance weighting (IVW) method and supplementary MR method were used to verify the causal relationship between UA and DN, and sensitivity analysis was conducted to confirm the credibility of the results. RESULTS Our observational study enrolled 4363 participants with diabetes mellitus from NHANES, among them, 2682 (61.4%) participants were identified as DN. The multivariate logistic regression model showed that compared with those without hyperuricemia, the DN risk of the hyperuricemia population was significantly increased (P < 0.05). The MR results suggest a direct causal effect of hyperuricemia on DN (IVW odds ratio (OR): 1.37 (95% confidence interval 1.07-1.76); P = 0.01), which is consistent with findings from other MR methods. CONCLUSION The evidence from observational studies indicates a positive correlation between HUA and the onset of DN. And the causal effects of HUA on DN were supported by the MR analysis.
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Affiliation(s)
- Sensen Wu
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Hui Wang
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Dikang Pan
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Julong Guo
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Fan Zhang
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yachan Ning
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Department of Intensive Care Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yongquan Gu
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
| | - Lianrui Guo
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
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Seibert H, Pereira AML, Pestana JOM, Nogueira PCK. Serum uric acid concentration is associated with lower glomerular filtration rate in children undergoing kidney transplantation. Pediatr Transplant 2024; 28:e14683. [PMID: 38317345 DOI: 10.1111/petr.14683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 12/08/2023] [Accepted: 12/12/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND The relationship between serum concentration of uric acid (UA) and chronic kidney disease is complex due to many confounding variables. There is currently debate over whether hyperuricemia acts as a marker of kidney disease or as an independent risk factor. OBJECTIVES To test the impact of serum UA concentration on the estimated glomerular filtration rate (GFR) of children undergoing kidney transplantation. PATIENTS AND METHODS Prospective longitudinal study of children and adolescents after kidney transplantation. We analyzed clinical, anthropometric, and laboratory data at pre-transplant and 1, 3, and 6 months after transplant. We developed models of repeated measures analysis, using the generalized estimating equations technique for the outcome evolution of the estimated GFR at 1, 3 and 6 months. High serum UA concentration at 1 and 3 months was modeled as the main exposure variable. RESULTS We included 103 transplant patients. In a model adjusted for time, recipient sex and age, the occurrence of acute rejection episodes, and the estimated glomerular filtration at baseline, the trajectory of GFR exhibited an inverse relationship with UA (β = -7.1, 95% CI: -11.5 to -2.6, p < .01). CONCLUSION Serum UA increase was associated with lower graft function over time.
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Affiliation(s)
- Helena Seibert
- Departament of Pediatrics, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Aline Maria Luiz Pereira
- Departament of Pediatrics, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - José Osmar Medina Pestana
- Nephrology Division, Hospital do Rim e Hipertensão, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Paulo Cesar Koch Nogueira
- Departament of Pediatrics, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
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Muiesan ML, Agabiti Rosei C, Paini A, Casiglia E, Cirillo M, Grassi G, Iaccarino G, Mallamaci F, Maloberti A, Mazza A, Mengozzi A, Palatini P, Parati G, Reboldi G, Rivasi G, Russo E, Salvetti M, Tikhonoff V, Tocci G, Borghi C. Serum uric acid and left ventricular mass index independently predict cardiovascular mortality: The uric acid right for heart health (URRAH) project. Eur J Intern Med 2023; 114:58-65. [PMID: 37098447 DOI: 10.1016/j.ejim.2023.04.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 04/03/2023] [Accepted: 04/11/2023] [Indexed: 04/27/2023]
Abstract
A relationship between serum uric acid (SUA) and cardiovascular (CV) events has been documented in the Uric Acid Right for Heart Health (URRAH) study. AIM of this study was to investigate the association between SUA and left ventricular mass index (LVMI) and whether SUA and LVMI or their combination may predict the incidence of CV death. METHODS Subjects with echocardiographic measurement of LVMI included in the URRAH study (n=10733) were part of this analysis. LV hypertrophy (LVH) was defined as LVMI > 95 g/m2 in women and 115 g/m2 in men. RESULTS A significant association between SUA and LVMI was observed in multiple regression analysis in men: beta 0,095, F 5.47, P< 0.001 and women: beta 0,069, F 4.36, P<0.001. During follow-up 319 CV deaths occurred. Kaplan-Meier curves showed a significantly poorer survival rate in subjects with higher SUA (> 5.6 mg/dl in men and 5.1 mg/dl in women) and LVH (log-rank chi-square 298.105; P<0.0001). At multivariate Cox regression analysis in women LVH alone and the combination of higher SUA and LVH but not hyperuricemia alone, were associated with a higher risk of CV death, while in men hyperuricemia without LVH, LVH without hyperuricemia and their combination were all associated with a higher incidence of CV death. CONCLUSIONS Our findings demonstrate that SUA is independently associated with LVMI and suggest that the combination of hyperuricemia with LVH is an independent and powerful predictor for CV death both in men and women.
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Affiliation(s)
- Maria Lorenza Muiesan
- Department of Clinical and Experimental Sciences, University of Brescia, c/o 2 Medicina - ASST Spedali Civili Brescia, Piazzale Spedali Civili 1 Brescia, Italy.
| | - Claudia Agabiti Rosei
- Department of Clinical and Experimental Sciences, University of Brescia, c/o 2 Medicina - ASST Spedali Civili Brescia, Piazzale Spedali Civili 1 Brescia, Italy
| | - Anna Paini
- Department of Clinical and Experimental Sciences, University of Brescia, c/o 2 Medicina - ASST Spedali Civili Brescia, Piazzale Spedali Civili 1 Brescia, Italy
| | - Edoardo Casiglia
- Studium Patavinum, Department of Medicine, University of Padua, Padua, Italy
| | - Massimo Cirillo
- Department of Public Health, "Federico II" University of Naples, Naples, Italy
| | - Guido Grassi
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Guido Iaccarino
- Department of Advanced Biomedical Sciences, ''Federico II'' University of Naples, Naples, Italy
| | - Francesca Mallamaci
- CNR-IFC, Clinical Epidemiology of Renal Diseases and Hypertension, Reggio Cal Unit, Reggio Calabria, Italy
| | - Alessandro Maloberti
- Cardiology IV, ''A.De Gasperi's'' Department, Niguarda Ca' Granda Hospital, Milan, Italy; School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
| | - Alberto Mazza
- Department of Internal Medicine, Santa Maria Della Misericordia General Hospital, AULSS 5 Polesana, 11Rovigo, Italy
| | - Alessandro Mengozzi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa 56126, Italy; Center for Translational and Experimental Cardiology (CTEC), Department of Cardiology, University Hospital Zurich, University of Zurich, Schlieren, Switzerland; Scuola Superiore Sant'Anna, Pisa, Italy
| | - Paolo Palatini
- Studium Patavinum, Department of Medicine, University of Padua, Padua, Italy
| | - Gianfranco Parati
- IRCCS, Istituto Auxologico Italiano, Ospedale San Luca, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Gianpaolo Reboldi
- Department of Medical and Surgical Science, University of Perugia, Perugia, Italy
| | - Giulia Rivasi
- Department of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Italy
| | - Elisa Russo
- Department of Internal Medicine, University of Genoa IRCSS Ospedale Policlinico San Martino, Genova, Italy
| | - Massimo Salvetti
- Department of Clinical and Experimental Sciences, University of Brescia, c/o 2 Medicina - ASST Spedali Civili Brescia, Piazzale Spedali Civili 1 Brescia, Italy
| | | | - Giuliano Tocci
- Department of Clinical and Molecular Medicine, University of Rome Sapienza, Rome, Italy
| | - Claudio Borghi
- Department Hypertension and Cardiovascular Disease Research Center, Medical and Surgical Sciences Dept., Alma Mater Studiorum University of Bologna, Bologna, Italy; Heart-Chest-Vascular Dept., IRCCS AOU of Bologna, Bologna, Italy
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Longitudinal uric acid has nonlinear association with kidney failure and mortality in chronic kidney disease. Sci Rep 2023; 13:3952. [PMID: 36894586 PMCID: PMC9998636 DOI: 10.1038/s41598-023-30902-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 03/03/2023] [Indexed: 03/11/2023] Open
Abstract
We investigated the shape of the relationship between longitudinal uric acid (UA) and the hazard of kidney failure and death in chronic kidney disease (CKD) patients, and attempted to identify thresholds associated with increased hazards. We included CKD stage 3-5 patients from the CKD-REIN cohort with one serum UA measurement at cohort entry. We used cause-specific multivariate Cox models including a spline function of current values of UA (cUA), estimated from a separate linear mixed model. We followed 2781 patients (66% men, median age, 69 years) for a median of 3.2 years with a median of five longitudinal UA measures per patient. The hazard of kidney failure increased with increasing cUA, with a plateau between 6 and 10 mg/dl and a sharp increase above 11 mg/dl. The hazard of death had a U-shape relationship with cUA, with a hazard twice higher for 3 or 11 mg/dl, compared to 5 mg/dl. In CKD patients, our results indicate that UA above 10 mg/dl is a strong risk marker for kidney failure and death and that low UA levels below 5 mg/dl are associated with death before kidney failure.
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Yang B, Xin M, Liang S, Huang Y, Li J, Wang C, Liu C, Song X, Sun J, Sun W. Naringenin Ameliorates Hyperuricemia by Regulating Renal Uric Acid Excretion via the PI3K/AKT Signaling Pathway and Renal Inflammation through the NF-κB Signaling Pathway. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2023; 71:1434-1446. [PMID: 36525382 DOI: 10.1021/acs.jafc.2c01513] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Hyperuricemia characterized by high serum levels of uric acid (UA, >6.8 mg/dL) is regarded as a common chronic metabolic disease. When used as a food supplement, naringenin might have various pharmacological activities, including antioxidant, free-radical-scavenging, and inflammation-suppressing activities. However, the effects of naringenin on hyperuricemia and renal inflammation and the underlying mechanisms remain to be elucidated. Here, we comprehensively examined the effects of naringenin on hyperuricemia and the attenuation of renal impairment. Mice were injected with 250 mg/kg of potassium oxonate (PO) and given 5% fructose water to induce hyperuricemia. The pharmacological effects of naringenin (10 and 50 mg/kg) and benzbromarone (positive control group, 20 mg/kg) on hyperuricemic mice were evaluated in vivo. The disordered expression of urate transporters in HK-2 cells was stimulated by 8 mg/dL UA, which was used to determine the mechanisms underlying the effects of naringenin in vitro. Naringenin markedly reduced the serum UA level in a dose-dependent manner and improved renal dysfunction. Moreover, the increased elimination of UA in urine showed that the effects of naringenin were associated with the regulation of renal excretion. Further examination indicated that naringenin reduced the expression of GLUT9 by inhibiting the PI3K/AKT signaling pathway and reinforced the expression of ABCG2 by increasing the abundance of PDZK1 in vivo and in vitro. Furthermore, sirius red staining and western blotting indicated that naringenin plays a protective role in renal injury by suppressing increases in the levels of pro-inflammatory cytokines, including IL-6 and TNF-α, which contribute to the inhibition of the TLR4/NF-κB signaling pathway in vivo and in vitro. Naringenin supplementation might be a potential therapeutic strategy to ameliorate hyperuricemia by promoting UA excretion in the kidney and attenuating the inflammatory response by decreasing the release of inflammatory cytokines. This study shows that naringenin could be used as a functional food or dietary supplement for hyperuricemia prevention and treatment.
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Affiliation(s)
- Bendong Yang
- Institute of Biomedical Research, School of Life Sciences and Medicine, Shandong University of Technology, Zibo, Shandong 255000, People's Republic of China
| | - Meiling Xin
- Institute of Biomedical Research, School of Life Sciences and Medicine, Shandong University of Technology, Zibo, Shandong 255000, People's Republic of China
| | - Shufei Liang
- Institute of Biomedical Research, School of Life Sciences and Medicine, Shandong University of Technology, Zibo, Shandong 255000, People's Republic of China
| | - Yuhong Huang
- College of Life Science, Yangtze University, Jingzhou, Hubei 434100, People's Republic of China
| | - Jingda Li
- College of Life Science, Yangtze University, Jingzhou, Hubei 434100, People's Republic of China
| | - Chao Wang
- Institute of Biomedical Research, School of Life Sciences and Medicine, Shandong University of Technology, Zibo, Shandong 255000, People's Republic of China
| | - Chao Liu
- Key Laboratory of Novel Food Resources Processing, Ministry of Agriculture and Rural Affairs/Key Laboratory of Agro-Products Processing Technology of Shandong Province/Institute of Agro-Food Science and Technology, Shandong Academy of Agricultural Sciences, Jinan, Shandong 250100, People's Republic of China
| | - Xinhua Song
- Institute of Biomedical Research, School of Life Sciences and Medicine, Shandong University of Technology, Zibo, Shandong 255000, People's Republic of China
- Shandong Qingyujiangxing Biotechnology Company, Limited, Zibo, Shandong 255000, People's Republic of China
| | - Jinyue Sun
- Key Laboratory of Novel Food Resources Processing, Ministry of Agriculture and Rural Affairs/Key Laboratory of Agro-Products Processing Technology of Shandong Province/Institute of Agro-Food Science and Technology, Shandong Academy of Agricultural Sciences, Jinan, Shandong 250100, People's Republic of China
- School of Public Health and Management, Weifang Medical University, 7166 Baotong Road, Weifang, Shandong 261053, People's Republic of China
| | - Wenlong Sun
- Institute of Biomedical Research, School of Life Sciences and Medicine, Shandong University of Technology, Zibo, Shandong 255000, People's Republic of China
- Shandong Qingyujiangxing Biotechnology Company, Limited, Zibo, Shandong 255000, People's Republic of China
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Li CH, Lee CL, Hsieh YC, Chen CH, Wu MJ, Tsai SF. Hyperuricemia and diabetes mellitus when occurred together have higher risks than alone on all-cause mortality and end-stage renal disease in patients with chronic kidney disease. BMC Nephrol 2022; 23:157. [PMID: 35459096 PMCID: PMC9034537 DOI: 10.1186/s12882-022-02755-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 03/23/2022] [Indexed: 02/07/2023] Open
Abstract
Introduction Hyperuricemia and diabetes mellitus (DM) are associated with increased mortality risk in patients with chronic kidney disease (CKD). Here we aimed to evaluate the independent and joint risks of these two conditions on mortality and end stage kidney disease (ESKD) in CKD-patients. Methods This retrospective cohort study enrolled 4380 outpatients (with CKD stage 3–5) with mortality and ESKD linkage during a 7-year period (from 2007 to 2013). All-causes mortality and ESKD risks were analyzed by multivariable-adjusted Cox proportional hazards models (adjusted for age, sex, smoke, previous coronary arterial disease, blood pressure, and medications for hyperlipidemia, hyperuricemia and renin–angiotensin system inhibitors). Results Overall, 40.5% of participants had DM and 66.4% had hyperuricemia. In total, 356 deaths and 932 ESKD events occurred during the 7 years follow-up. With the multivariate analysis, increased risks for all-cause mortality were: hyperuricemia alone, HR = 1.48 (1–2.19); DM alone, and HR = 1.52 (1.02–2.46); DM and hyperuricemia together, HR = 2.12 (1.41–3.19). Similar risks for ESKD were: hyperuricemia alone, HR = 1.34 (1.03–1.73); DM alone, HR = 1.59 (1.15–2.2); DM and hyperuricemia together, HR = 2.46 (1.87–3.22). Conclusions DM and hyperuricemia are strongly associated with higher all-cause mortality and ESKD risk in patients with CKD stage 3–5. Hyperuricemia is similar to DM in terms of risk for all-cause mortality and ESKD. DM and hyperuricemia when occurred together further increase both risks of all-cause mortality and ESKD. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-022-02755-1.
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Affiliation(s)
- Cheng-Hung Li
- Department of cardiovascular disease, Taichung Veterans General Hospital, Taichung, Taiwan.,Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Chia-Lin Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Yu-Cheng Hsieh
- Department of cardiovascular disease, Taichung Veterans General Hospital, Taichung, Taiwan.,Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Cheng-Hsu Chen
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan.,Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, 160, Sec. 3, Taiwan Boulevard, Taichung, 407, Taiwan.,Department of Life Science, Tunghai University, Taichung, Taiwan
| | - Ming-Ju Wu
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan.,Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, 160, Sec. 3, Taiwan Boulevard, Taichung, 407, Taiwan
| | - Shang-Feng Tsai
- School of Medicine, National Yang-Ming University, Taipei, Taiwan. .,Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan. .,Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, 160, Sec. 3, Taiwan Boulevard, Taichung, 407, Taiwan. .,Department of Life Science, Tunghai University, Taichung, Taiwan.
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Hung YH, Huang CC, Lin LY, Chen JW. Uric Acid and Impairment of Renal Function in Non-diabetic Hypertensive Patients. Front Med (Lausanne) 2022; 8:746886. [PMID: 35141237 PMCID: PMC8818871 DOI: 10.3389/fmed.2021.746886] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 12/15/2021] [Indexed: 12/04/2022] Open
Abstract
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 m2 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, P = 0.001) and >50% decline (hazard ratio: 6.995; 95% confidence interval: 1.309–37.385, P = 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, P = 0.004) and >50% decline (hazard ratio: 6.653; 95% confidence interval: 1.395–31.737, P = 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.
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Affiliation(s)
- Yi-Hsin Hung
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chin-Chou Huang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Pharmacology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
- *Correspondence: Chin-Chou Huang ;
| | - Liang-Yu Lin
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Pharmacology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jaw-Wen Chen
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Pharmacology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Healthcare and Service Center, Taipei Veterans General Hospital, Taipei, Taiwan
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Geng YH, Zhang Z, Zhang JJ, Huang B, Guo ZS, Wang XT, Zhang LQ, Quan SX, Hu RM, Liu YF. Hyperuricemia aggravates the progression of IgA nephropathy. Int Urol Nephrol 2022; 54:2227-2237. [DOI: 10.1007/s11255-022-03125-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 01/11/2022] [Indexed: 10/19/2022]
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10
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Multiple Gouty Arthritis With Tophi Formation in a Patient With End-Stage Kidney Disease Treated After Kidney Transplant. Transplant Proc 2022; 54:528-532. [DOI: 10.1016/j.transproceed.2021.10.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 10/28/2021] [Indexed: 11/18/2022]
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Cheng Z, Zheng T, Zhang D, Yang J, Hu X, Yin C, Ren X, Li J, Shi D, Li N, Zheng S, Wang M, Bai Y. High-level uric acid in asymptomatic hyperuricemia could be an isolated risk factor of cardio-cerebrovascular diseases: A prospective cohort study. Nutr Metab Cardiovasc Dis 2021; 31:3415-3425. [PMID: 34663537 DOI: 10.1016/j.numecd.2021.08.043] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 08/19/2021] [Accepted: 08/19/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND AIMS Whether the asymptomatic hyperuricemia (AH) raise the cardiovascular disease risk with or without hyperuricemia-related comorbidities still remains contentious. Our study was aimed to quantitatively access the incidence risk of coronary heart disease (CHD) and stroke associated with AH. METHODS AND RESULTS In this prospective cohort study, multivariate-adjusted Cox regression models were applied to evaluate the risk of cardiovascular disease (CVD). Baseline serum uric acid beyond normouricemia (357 mmol/L) was quarterly stratified based on the distribution of healthy populations without CVD onset. 1062 CVD first-attack cases were collected among the 29,974 study population (age range: 18-91, mean age: 47.2 ± 13.9 years-old) with a mean follow-up duration of 5.78 ± 0.83 years. The AH showed overall non-association with the CVD incident. However, significantly increased adjusted hazard ratio (HR) of CVD with 95% confidence interval (CI) were observed when the fourth quartile compared with normouricemia stratum in the total cohort population (CHD: 1.42, 1.21-1.68; stroke: 1.27, 1.06-1.41), male (CHD: 1.26, 1.12-1.55), female (CHD: 1.34, 1.04-2.02; stroke: 2.06, 1.13-3.77) and aged over 50 years-old population. Meanwhile, the age-standardized incidence rate of CVD in the fourth quartile was 2-3 times higher than the normouricemia population. After excluded 14,464 baseline population with diabetes, dyslipidemia, and hypertension, consistent results were also observed in the AH population in absence of comorbidities (CHD: 1.51, 1.22-2.25; stroke: 1.68, 1.13-2.39). CONCLUSION Asymptomatic hyperuricemia patients exposed to a higher level of uric acid (>=428 mmol/L) could significantly increase the incidence risk of CHD and stroke, with or without hyperuricemia-related comorbidities.
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Affiliation(s)
- Zhiyuan Cheng
- School of Public Health and Emergency Management, Southern University of Science and Technology of China, Shenzhen, Guangdong 518055, China
| | - Tongzhang Zheng
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI 02901, USA
| | - Desheng Zhang
- Workers' Hospital of Jinchuan Corporation, Jinchuan Group CO., LTD, Jinchang, Gansu, 737100, PR China
| | - Jingli Yang
- Department of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu 730000, PR China
| | - Xiaobin Hu
- Department of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu 730000, PR China
| | - Chun Yin
- Workers' Hospital of Jinchuan Corporation, Jinchuan Group CO., LTD, Jinchang, Gansu, 737100, PR China
| | - Xiaowei Ren
- Department of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu 730000, PR China
| | - Juansheng Li
- Department of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu 730000, PR China
| | - Dian Shi
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI 02901, USA; School of Basic Medical Science, Lanzhou University, Lanzhou, Gansu, 73000, PR China
| | - Na Li
- Workers' Hospital of Jinchuan Corporation, Jinchuan Group CO., LTD, Jinchang, Gansu, 737100, PR China
| | - Shan Zheng
- Department of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu 730000, PR China
| | - Minzhen Wang
- Department of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu 730000, PR China
| | - Yana Bai
- Department of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu 730000, PR China.
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12
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Mason DL, Godugu K, Nnani D, Mousa SA. Effects of sevelamer carbonate versus calcium acetate on vascular calcification, inflammation, and endothelial dysfunction in chronic kidney disease. Clin Transl Sci 2021; 15:353-360. [PMID: 34599865 PMCID: PMC8841464 DOI: 10.1111/cts.13151] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/28/2021] [Accepted: 08/03/2021] [Indexed: 01/12/2023] Open
Abstract
Hyperphosphatemia is present in most patients with end‐stage renal disease (ESRD) and has been associated with increased cardiovascular mortality. Phosphate binders (calcium‐based and calcium free) are the mainstay pharmacologic treatment to lower phosphorus levels in patients with ESRD. We evaluated biochemical markers of vascular calcification, inflammation, and endothelial dysfunction in patients with chronic kidney disease (CKD) treated with sevelamer carbonate (SC) versus calcium acetate (CA). Fifty patients with CKD (stages 3 and 4) were enrolled and assigned to treatment with SC and CA for 12 weeks. At the end of the study the biomarkers of vascular calcification, inflammation, and endothelial dysfunction were analyzed. A significant increase in HDL‐cholesterol was observed with SC but not with CA in patients with CKD. Treatment with SC reduced serum phosphate, calcium phosphate, and FGF‐23 levels and there was no change with CA treatment. The inflammatory markers IL‐8, IFN‐γ, and TNFα decreased with response to both treatments. The levels of IL‐6 significantly increased with CA treatment and no change was observed in the SC treatment group. SC showed favorable effects on anti‐inflammatory and vascular calcification biomarkers compared to CA treatment in patients with CKD stages 3 and 4 with normal phosphorous values.
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Affiliation(s)
- Darius L Mason
- Methodist Le Bonheur Healthcare, Memphis, Tennessee, USA.,Department of Clinical Pharmacy & Translational Science, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Kavitha Godugu
- The Pharmaceutical Research Institute, Albany College of Pharmacy and Health Sciences, Rensselaer, New York, USA
| | - Daryl Nnani
- Department of Pharmacy, Montefiore Medical Center, The University Hospital for Albert Einstein College of Medicine, Bronx, New York, USA
| | - Shaker A Mousa
- The Pharmaceutical Research Institute, Albany College of Pharmacy and Health Sciences, Rensselaer, New York, USA
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13
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Hayfron-Benjamin CF, van den Born BJ, Amoah AGB, Maitland-van der Zee AH, Meeks KAC, Beune EJAJ, Klipstein-Grobusch K, Agyemang C. Associations of Serum Uric Acid Levels With Macrovascular and Renal Microvascular Dysfunction Among Individuals From Sub-Saharan Africa. JAMA Netw Open 2021; 4:e2128985. [PMID: 34648008 PMCID: PMC8517747 DOI: 10.1001/jamanetworkopen.2021.28985] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
IMPORTANCE Serum uric acid (SUA) level is associated with vascular dysfunction in Eurasian populations, but little is known about this association in individuals from sub-Saharan Africa, who have a high prevalence of both relatively high SUA levels and vascular dysfunction. OBJECTIVES To assess the associations of SUA levels with macrovascular and kidney microvascular dysfunction in individuals of sub-Saharan African ancestry and evaluate potential factors that could mediate these associations. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional analyses of baseline data from the multicenter Research on Obesity and Diabetes Among African Migrants study, conducted from 2012 to 2015, were performed from January to March 2021. The population included Ghanaian individuals living in Ghana and Europe. EXPOSURE Abnormal SUA levels. MAIN OUTCOMES AND MEASURES Logistic regression was used to examine the associations of SUA level quartiles with microvascular (albuminuria) and macrovascular (peripheral artery disease and coronary artery disease) dysfunction, with adjustments for age, sex, estimated glomerular filtration rate, site of residence, socioeconomic status, alcohol, smoking, diabetes, hypertension, waist-hip ratio, and total cholesterol level. Mediation analysis was performed to assess whether the association was via elevated blood pressure, hemoglobin A1c, and high-sensitivity C-reactive protein levels or via weight-hip ratio. The research questions were formulated after data collection. RESULTS A total of 4919 Ghanaian individuals (3047 [61.9%] women) aged 25-75 years (mean [SD], 46.26 [11.08] years) were included. There was a significant positive association between SUA quartiles and albuminuria, but not coronary artery disease or peripheral artery disease, after adjustment for covariates. After full adjustment, individuals in the fourth SUA quartile had higher odds of albuminuria (adjusted odds ratio [aOR], 1.54; 95% CI, 1.07-2.21), but not peripheral artery disease (aOR, 1.35; 95% CI, 0.87-2.08) or coronary artery disease (aOR, 1.09; 95% CI, 0.77-1.55), compared with individuals in the first quartile. After full adjustment, systolic and diastolic blood pressure significantly mediated the association between SUA concentrations and albuminuria, accounting for 19.4% of the total association for systolic and 17.2% for diastolic blood pressure; hemoglobin A1c, high-sensitivity C-reactive protein, and waist-hip ratio did not mediate this association. CONCLUSIONS AND RELEVANCE In this cross-sectional study among a sub-Saharan African population, elevated SUA levels were significantly associated with kidney microvascular dysfunction and mediated partly through elevated blood pressure. These findings suggest that individuals from sub-Saharan Africa with elevated SUA levels may benefit from periodic screening for kidney microvascular dysfunction to aid early detection or treatment.
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Affiliation(s)
- Charles F. Hayfron-Benjamin
- Department of Public Health, Amsterdam University Medical Centre (UMC), University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
- Department of Internal and Vascular Medicine, Amsterdam UMC, University of Amsterdam, Cardiovascular Sciences, Amsterdam, the Netherlands
- Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Department of Physiology, University of Ghana Medical School, Accra, Ghana
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
| | - Bert-Jan van den Born
- Department of Public Health, Amsterdam University Medical Centre (UMC), University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
- Department of Internal and Vascular Medicine, Amsterdam UMC, University of Amsterdam, Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Albert G. B. Amoah
- Department of Medicine and Therapeutics, University of Ghana Medical School, Ghana
| | | | - Karlijn A. C. Meeks
- Department of Public Health, Amsterdam University Medical Centre (UMC), University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
- Department of Anaesthesia, Korle Bu Teaching Hospital, Accra, Ghana
| | - Erik J. A. J. Beune
- Department of Public Health, Amsterdam University Medical Centre (UMC), University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Charles Agyemang
- Department of Public Health, Amsterdam University Medical Centre (UMC), University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
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Dhouibi R, Affes H, Salem MB, Moalla D, Marekchi R, Charfi S, Hammami S, Sahnoun Z, Jamoussi K, Zeghal KM, Ksouda K. Creation of an adequate animal model of hyperuricemia (acute and chronic hyperuricemia); study of its reversibility and its maintenance. Life Sci 2021; 268:118998. [PMID: 33417953 DOI: 10.1016/j.lfs.2020.118998] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 12/18/2020] [Accepted: 12/27/2020] [Indexed: 12/30/2022]
Abstract
AIM Hyperuricemia is defined by the European Rheumatology Society as a uric acid level greater than 6 mg/dl (60 mg/l or 360 μmol/l). Our goal was to evaluate the hypouricemic effect of nettle. For this reason, we have first of all try to create an hyperuricemic animal model which is very suitable because at the level of literature there is not an exact model, there are many models and our objective is to set an adequate model. MATERIALS AND METHODS An attempt has been made to test acute and chronic hyperuricemia by varying the duration and method of induction of potassium oxonate. Similarly, attempts have been made to induce chronic hyperuricemia through an animal and vegetable diet. The reversibility of hyperuricemia was tested with a maintenance protocol. KEY FINDINGS For the creation of the hyperuricemia model, it has been shown that acute hyperuricemia cannot be induced by short administration of potassium oxonate and persistent chronic hyperuricemia can be induced only after daily administration of oxonate of potassium by intraperitoneal injection for 15 days. Indeed, hyperuricemia was reversible after stopping the administration of potassium oxonate. The high-purine diet is also capable of inducing chronic hyperuricemia but to a less extent. SIGNIFICANCE After creating an adequate model of hyperuricemia while setting the dose of potassium oxonate, route of administration and duration. A maintenance protocol was followed which subsequently made it possible to deduce that the daily administration of potassium oxonate must be continued to maintain the hyperuricemia.
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Affiliation(s)
- Raouia Dhouibi
- Laboratory of Pharmacology, Faculty of Medicine of Sfax, University of Sfax, Tunisia.
| | - Hanen Affes
- Laboratory of Pharmacology, Faculty of Medicine of Sfax, University of Sfax, Tunisia.
| | - Maryem Ben Salem
- Laboratory of Pharmacology, Faculty of Medicine of Sfax, University of Sfax, Tunisia
| | - Dorsaf Moalla
- Laboratory of Pharmacology, Faculty of Medicine of Sfax, University of Sfax, Tunisia
| | - Rim Marekchi
- Laboratory of Biochemistry, CHU Hedi Cheker of Sfax, Tunisia
| | - Slim Charfi
- Department of Anatomopathology, CHU Habib Bourguiba of Sfax, Tunisia
| | - Serria Hammami
- Laboratory of Pharmacology, Faculty of Medicine of Sfax, University of Sfax, Tunisia
| | - Zouheir Sahnoun
- Laboratory of Pharmacology, Faculty of Medicine of Sfax, University of Sfax, Tunisia
| | - Kamel Jamoussi
- Laboratory of Biochemistry, CHU Hedi Cheker of Sfax, Tunisia
| | - Khaled Mounir Zeghal
- Laboratory of Pharmacology, Faculty of Medicine of Sfax, University of Sfax, Tunisia
| | - Kamilia Ksouda
- Laboratory of Pharmacology, Faculty of Medicine of Sfax, University of Sfax, Tunisia
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15
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Li Q, Zhang Y, Cao J, Zhang J, Nie J, Liang M, Li J, Zhang Y, Wang B, Huo Y, Wang X, Hou FF, Xu X, Qin X. Degree of blood pressure control and the risk of new-onset hyperuricemia in treated hypertensive patients. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1434. [PMID: 33313179 PMCID: PMC7723605 DOI: 10.21037/atm-20-3017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background The relationship between blood pressure (BP) control and the risk of new-onset hyperuricemia remains uncertain. We aimed to examine the association between degree of time-averaged on-treatment BP control and new-onset hyperuricemia in general hypertensive patients. Methods A total of 10,617 hypertensive patients with normal uric acid (UA) concentrations (<357 µmol/L) at baseline were included from the UA Sub-study of the China Stroke Primary Prevention Trial (CSPPT). Participants were randomized to receive a double-blind daily treatment of enalapril 10 mg and folic acid 0.8 mg or enalapril 10 mg alone. BP measurements were taken every three months after randomization. The primary outcome was new-onset hyperuricemia, defined as a UA concentration ≥417 µmol/L in men or ≥357 µmol/L in women at the exit visit. Results Over a median of 4.4 years, 1,664 (15.7%) participants developed new-onset hyperuricemia. Overall, there was a significantly positive association between time-averaged on-treatment diastolic BP (DBP) and new-onset hyperuricemia (per 10 mmHg increment; OR 1.13; 95% CI: 1.02–1.26). Consistently, a significantly higher risk of new-onset hyperuricemia was found in participants with time-averaged on-treatment DBP ≥82.9 mmHg (median) (vs. <82.9 mmHg; 17.3% vs. 14.1%; OR 1.25; 95% CI: 1.10–1.44). Furthermore, the lowest new-onset hyperuricemia risk (12.1%) was found in those with both time-averaged on-treatment SBP (median: 138.3 mmHg) and DBP below the median (P-interaction=0.023). The results were similar for time-averaged DBP during the first 12- or 24-month treatment period, or in the analysis using propensity scores. Furthermore, a non-significant higher risk of new-onset hyperuricemia was observed in participants with time-averaged on-treatment SBP ≥120 mmHg (vs. <120 mmHg; OR 1.61; 95% CI: 0.88–2.97). Conclusions A tight DBP control of <82.9 mmHg was associated with lower risk of new-onset hyperuricemia among hypertensive patients without hyperuricemia.
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Affiliation(s)
- Qinqin Li
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Guangzhou, China.,Institute of Biomedicine, Anhui Medical University, Hefei, China
| | - Yuanyuan Zhang
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Guangzhou, China
| | - Jingjing Cao
- Institute of Biomedicine, Anhui Medical University, Hefei, China
| | - Jingping Zhang
- Institute of Biomedicine, Anhui Medical University, Hefei, China
| | - Jing Nie
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Guangzhou, China
| | - Min Liang
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Guangzhou, China
| | - Jianping Li
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Yan Zhang
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Binyan Wang
- Institute of Biomedicine, Anhui Medical University, Hefei, China
| | - Yong Huo
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Xiaobin Wang
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Fan Fan Hou
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Guangzhou, China
| | - Xiping Xu
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Guangzhou, China
| | - Xianhui Qin
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Guangzhou, China.,Institute of Biomedicine, Anhui Medical University, Hefei, China
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16
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Hyperuricemia as a trigger of immune response in hypertension and chronic kidney disease. Kidney Int 2020; 98:1149-1159. [DOI: 10.1016/j.kint.2020.05.056] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 05/22/2020] [Accepted: 05/27/2020] [Indexed: 02/07/2023]
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17
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Aladdin NA, Husain K, Jalil J, Sabandar CW, Jamal JA. Xanthine oxidase inhibitory activity of a new isocoumarin obtained from Marantodes pumilum var. pumila leaves. BMC Complement Med Ther 2020; 20:324. [PMID: 33109178 PMCID: PMC7590683 DOI: 10.1186/s12906-020-03119-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 10/19/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND In traditional Malay medicine, Marantodes pumilum (Blume) Kuntze (family Primulaceae) is commonly used by women to treat parturition, flatulence, dysentery, dysmenorrhea, gonorrhea, and bone diseases. Preliminary screening of some Primulaceae species showed that they possess xanthine oxidase inhibitory activity. Thus, this study aimed to investigate the xanthine oxidase inhibitory activity of three varieties of M. pumilum and their phytochemical compounds. METHOD Dichloromethane, methanol, and water extracts of the leaves and roots of M. pumilum var. alata, M. pumilum var. pumila, and M. pumilum var. lanceolata were tested using an in vitro xanthine oxidase inhibitory assay. Bioassay-guided fractionation and isolation were carried out on the most active extract using chromatographic techniques. The structures of the isolated compounds were determined using spectroscopic techniques. RESULTS The most active dichloromethane extract of M. pumilum var. pumila leaves (IC50 = 161.6 μg/mL) yielded one new compound, 3,7-dihydroxy-5-methoxy-4,8-dimethyl-isocoumarin (1), and five known compounds, viz. ardisiaquinone A (2), maesanin (3), stigmasterol (4), tetracosane (5), and margaric acid (6). The new compound was found to be the most active xanthine oxidase inhibitor with an IC50 value of 0.66 ± 0.01 μg/mL, which was not significantly different (p > 0.05) from that of the positive control, allopurinol (IC50 = 0.24 ± 0.00 μg/mL). CONCLUSION This study suggests that the new compound 3,7-dihydroxy-5-methoxy-4,8-dimethyl-isocoumarin (1), which was isolated from the dichloromethane extract of M. pumilum var. pumila leaves, could be a potential xanthine oxidase inhibitor.
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Affiliation(s)
- Nor-Ashila Aladdin
- Drug and Herbal Research Centre, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Khairana Husain
- Drug and Herbal Research Centre, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Juriyati Jalil
- Drug and Herbal Research Centre, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Carla Wulandari Sabandar
- Department of Pharmacy, Faculty of Science and Technology, Universitas Sembilanbelas November Kolaka, Kolaka, Indonesia
| | - Jamia Azdina Jamal
- Drug and Herbal Research Centre, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
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18
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Pan J, Shi M, Ma L, Fu P. Mechanistic Insights of Soluble Uric Acid-related Kidney Disease. Curr Med Chem 2020; 27:5056-5066. [PMID: 30526453 DOI: 10.2174/0929867326666181211094421] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 11/21/2018] [Accepted: 12/03/2018] [Indexed: 02/07/2023]
Abstract
Hyperuricemia, defined as the presence of elevated serum uric acid (sUA), could lead to urate deposit in joints, tendons, kidney and other tissues. Hyperuricemia as an independent risk factor was common in patients during the causation and progression of kidney disease. Uric acid is a soluble final product of endogenous and dietary purine metabolism, which is freely filtered in kidney glomeruli where approximately 90% of filtered uric acid is reabsorbed. Considerable studies have demonstrated that soluble uric acid was involved in the pathophysiology of renal arteriolopathy, tubule injury, tubulointerstitial fibrosis, as well as glomerular hypertrophy and glomerulosclerosis. In the review, we summarized the mechanistic insights of soluble uric acid related renal diseases.
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Affiliation(s)
- Jing Pan
- Kidney Research Laboratory, Division of Nephrology, National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Min Shi
- Kidney Research Laboratory, Division of Nephrology, National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Liang Ma
- Kidney Research Laboratory, Division of Nephrology, National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Ping Fu
- Kidney Research Laboratory, Division of Nephrology, National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu 610041, China
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19
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Serum uric acid, predicts heart failure in a large Italian cohort: search for a cut-off value the URic acid Right for heArt Health study. J Hypertens 2020; 39:62-69. [PMID: 32694342 DOI: 10.1097/hjh.0000000000002589] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To assess the prognostic cut-off values of serum uric acid (SUA) in predicting fatal and morbid heart failure in a large Italian cohort in the frame of the Working Group on Uric Acid and Cardiovascular Risk of the Italian Society of Hypertension. METHODS The URic acid Right for heArt Health (URRAH) study is a nationwide, multicentre, cohort study involving data on individuals aged 18-95 years, recruited on a community basis from all regions of Italy under the patronage of the Italian Society of Hypertension with a mean follow-up period of 128 ± 65 months. Incident heart failure was defined on the basis of International Classification of Diseases Tenth Revision codes and double-checked with general practitioners and hospital files. Multivariate Cox regression models having fatal and morbid heart failure as dependent variables, adjusted for sex, age, SBP, diabetes, estimated glomerular filtration rate, smoking habit, ethanol intake, BMI, haematocrit, LDL cholesterol, previous diagnosis of heart failure and use of diuretics as possible confounders, were used to search for an association between SUA as a continuous variable and heart failure. By means of receiver operating characteristic curves, two prognostic cut-off values (one for all heart failure and one for fatal heart failure) were identified as able to discriminate between individuals doomed to develop the event. These cut-off values were used as independent predictors to divide individuals according to prognostic cut-off values in a multivariate Cox models, adjusted for confounders. RESULTS A total of 21 386 individuals were included in the analysis. In Cox analyses, SUA as a continuous variable was a significant predictor of all [hazard ratio 1.29 (1.23-1.359), P < 0.0001] and fatal [hazard ratio 1.268 (1.121-1.35), P < 0.0001] incident heart failure. Cut-off values of SUA able to discriminate all and fatal heart failure status were identified by mean of receiver operating characteristic curves in the whole database: SUA more than 5.34 mg/dl (confidence interval 4.37-5.6, sensitivity 52.32, specificity 63.96, P < 0.0001) was the univariate prognostic cut-off value for all heart failure, whereas SUA more than 4.89 mg/dl (confidence interval 4.78-5.78, sensitivity 68.29, specificity 49.11, P < 0.0001) for fatal heart failure. The cut-off for all heart failure and the cut-off value for fatal heart failure were accepted as independent predictors in the Cox analysis models, the hazard ratios being 1.645 (1.284-2.109, P < 0.0001) for all heart failure and 1.645 (1.284-2.109, P < 0.0001) for fatal heart failure, respectively. CONCLUSION The results of the current study confirm that SUA is an independent risk factor for all heart failure and fatal heart failure, after adjusting for potential confounding variables and demonstrate that a prognostic cut-off value can be identified for all heart failure (>5.34 mg/dl) and for fatal heart failure (>4.89 mg/dl).
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20
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Yoshida H, Inaguma D, Koshi-Ito E, Ogata S, Kitagawa A, Takahashi K, Koide S, Hayashi H, Hasegawa M, Yuzawa Y, Tsuboi N. Extreme hyperuricemia is a risk factor for infection-related deaths in incident dialysis patients: a multicenter prospective cohort study. Ren Fail 2020; 42:646-655. [PMID: 32662307 PMCID: PMC7470168 DOI: 10.1080/0886022x.2020.1788582] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Introduction There are few studies on the association between serum uric acid (UA) level and mortality in incident dialysis patients. We aimed to clarify whether the serum UA level at dialysis initiation is associated with mortality during maintenance dialysis. Methods We enrolled 1486 incident dialysis patients who participated in a previous multicenter prospective cohort study in Japan. We classified the patients into the following five groups according to their serum UA levels at dialysis initiation: G1 with a serum UA level <6 mg/dL; G2, 6.0–8.0 mg/dL; G3, 8.0–10.0 mg/dL; G4, 10.0–12.0 mg/dL; and G5, ≥12.0 mg/dL. We created three models (Model 1: adjusted for age and sex, Model 2: adjusted for Model 1 + 12 variables, and Model 3: stepwise regression adjusted for Model 2 + 13 variables) and performed a multivariate Cox proportional hazard regression analysis to examine the association between the serum UA level and outcomes, including infection-related mortality. Results Hazard ratios (HRs) were calculated relative to the G2, because the all-cause mortality rate was the lowest in G2. For Models 1 and 2, the all-cause mortality rate was significantly higher in G5 than in G2 (HR: 1.63, 95% confidence interval [CI]: 1.14–2.33 and HR: 1.78, 95% CI: 1.19–2.68, respectively). For Models 1, 2, and 3, the infection-related mortality rate was significantly higher in G5 than in G2 (HR: 2.75, 95% CI: 1.37–5.54, HR: 3.09, 95% CI: 1.45–6.59, HR: 3.37, and 95% CI: 1.24–9.15, respectively). Conclusions Extreme hyperuricemia (serum UA level ≥12.0 mg/dL) at dialysis initiation is a risk factor for infection-related deaths.
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Affiliation(s)
- Hiroyuki Yoshida
- Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Daijo Inaguma
- Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Eri Koshi-Ito
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Soshiro Ogata
- Faculty of Nursing, School of Health Sciences, Fujita Health University, Toyoake, Japan.,Department of Preventive Medicine & Epidemiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Akimitsu Kitagawa
- Department of Nephrology, Fujita Health University, Bantane Hospital, Nagoya, Japan
| | - Kazuo Takahashi
- Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Shigehisa Koide
- Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Hiroki Hayashi
- Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Midori Hasegawa
- Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Yukio Yuzawa
- Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Naotake Tsuboi
- Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Japan
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Hyperuricemia and Hypertension, Coronary Artery Disease, Kidney Disease: From Concept to Practice. Int J Mol Sci 2020; 21:ijms21114066. [PMID: 33561034 PMCID: PMC7312288 DOI: 10.3390/ijms21114066] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/12/2020] [Accepted: 05/18/2020] [Indexed: 02/07/2023] Open
Abstract
Since the publication of the Framingham Heart Study, which suggested that uric acid should no longer be associated with coronary heart disease after additional adjustment for cardiovascular disease risk factors, the number of publications challenging this statement has dramatically increased. The aim of this paper was to review and discuss the most recent studies addressing the possible relation between sustained elevated serum uric acid levels and the onset or worsening of cardiovascular and renal diseases. Original studies involving American teenagers clearly showed that serum uric acid levels were directly correlated with systolic and diastolic pressures, which has been confirmed in adult cohorts revealing a 2.21-fold increased risk of hypertension. Several studies involving patients with coronary artery disease support a role for serum uric acid level as a marker and/or predictor for future cardiovascular mortality and long-term adverse events in patients with coronary artery disease. Retrospective analyses have shown an inverse relationship between serum uric acid levels and renal function, and even a mild hyperuricemia has been shown to be associated with chronic kidney disease in patients with type 2 diabetes. Interventional studies, although of small size, showed that uric acid (UA)-lowering therapies induced a reduction of blood pressure in teenagers and a protective effect on renal function. Taken together, these studies support a role for high serum uric acid levels (>6 mg/dL or 60 mg/L) in hypertension-associated morbidities and should bring awareness to physicians with regards to patients with chronic hyperuricemia.
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Wu X, Jian G, Tang Y, Cheng H, Wang N, Wu J. Asymptomatic hyperuricemia and incident congestive heart failure in elderly patients without comorbidities. Nutr Metab Cardiovasc Dis 2020; 30:666-673. [PMID: 32127333 DOI: 10.1016/j.numecd.2019.12.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 11/25/2019] [Accepted: 12/13/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND AIMS Although hyperuricemia is associated with congestive heart failure (CHF), hyperuricemic patients frequently have other comorbidities. Thus, it is difficult to distinguish the role of hyperuricemia from that of other comorbid conditions in CHF. The aim of this study was to evaluate the association between hyperuricemia and CHF in elderly patients without comorbidities. METHODS AND RESULTS Subjects aged ≥65 years were analyzed at enrollment (2009-2012) and during the 4-year follow-up period at the Kangjian Community Health Center of Shanghai. Subjects were excluded if they had hypertension, diabetes mellitus, preexisting cardiovascular disease, hyperlipidemia, overweight or obesity, a history of gout or hyperuricemia and were taking medication for their condition, or chronic kidney disease. The primary outcome of this study was to investigate the impact of asymptomatic hyperuricemia on incident CHF. We used Cox regression to estimate the hazard ratio (HR) for incident CHF events between hyperuricemic (defined as an SUA level >7 mg/dL in men and ≥6 mg/dL in women) and normouricemic subjects. A total of 2749 subjects (70.9 ± 6.0 years) were followed for 47.4 ± 3.6 months. Asymptomatic hyperuricemia was associated with an increased cumulative incidence of incident CHF events (6.5% versus 3.1%, odds ratio [OR] = 2.15, 95% confidence index [CI]: 1.39-3.33, p = 0.001). After adjusting for confounding factors, including baseline eGFR, hyperuricemia independently predicted the risk of incident CHF events (HR = 2.34, 95% CI: 1.50-3.63, p < 0.001). CONCLUSION Asymptomatic hyperuricemia was a valuable biomarker for predicting the development of incident CHF in elderly patients without comorbidities.
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Affiliation(s)
- Xianfeng Wu
- Department of Nephrology, Affiliated Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Guihua Jian
- Department of Nephrology, Affiliated Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yuezhong Tang
- Kangjian Community Health Center, Xuhui District, Shanghai, China
| | - Huan Cheng
- Kangjian Community Health Center, Xuhui District, Shanghai, China
| | - Niansong Wang
- Department of Nephrology, Affiliated Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China.
| | - Junnan Wu
- Department of Nephrology, Affiliated Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China.
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Predictors of Hyperuricemia after Kidney Transplantation: Association with Graft Function. ACTA ACUST UNITED AC 2020; 56:medicina56030095. [PMID: 32106421 PMCID: PMC7143203 DOI: 10.3390/medicina56030095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 02/15/2020] [Accepted: 02/21/2020] [Indexed: 11/25/2022]
Abstract
Background and objectives: In kidney transplant recipients (KTR), hyperuricemia (HU) is a commonly-observed phenomenon, due to calcineurin inhibitors and reduced kidney graft function. Factors predicting HU, and its association with graft function, remains equivocal. Materials and Methods: We conducted a retrospective longitudinal study to assess factors associated with HU in KTR, and to determine risk factors associated with graft function, measured as glomerular filtration rate (GFR). Moreover, GFR > 60 mL/min/1.73 m2 was considered normal. HU was defined as a serum uric acid level of > 416 μmol/L (4.70 mg/dL) in men and >357 μmol/L (4.04 mg/dL) in women, or xanthine-oxidase inhibitor use. We built multiple logistic regression models to assess predictors of HU in KTR, as well as the association of demographic, clinical, and biochemical parameters of patients with normal GFR after a three-year follow-up. We investigated the effect modification of this association with HU. Results: There were 144 patients (mean age 46.6 ± 13.9), with 42.4% of them having HU. Predictors of HU in KTR were the presence of cystic diseases (OR = 9.68 (3.13; 29.9)), the use of diuretics (OR = 4.23 (1.51; 11.9)), and the male gender (OR = 2.45 (1.07; 5.56)). Being a younger age, of female gender, with a normal BMI, and the absence of diuretic medications increased the possibility of normal GFR. HU was the effect modifier of the association between demographic, clinical, and biochemical factors and a normal GFR. Conclusions: Factors associated with HU in KTR: Presence of cystic diseases, diuretic use, and male gender. HU was the effect modifier of the association of demographic, clinical, and biochemical factors to GFR.
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Kuwabara Y, Yasuno S, Kasahara M, Ueshima K, Nakao K. The association between uric acid levels and renal function of CKD patients with hyperlipidemia: a sub-analysis of the ASUCA trial. Clin Exp Nephrol 2019; 24:420-426. [PMID: 31875936 PMCID: PMC7174259 DOI: 10.1007/s10157-019-01840-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 12/13/2019] [Indexed: 11/07/2022]
Abstract
Background The influence of uric acid (UA) on renal function and the significance of UA-lowering therapy are unclear. The purpose of the sub-analysis of the Assessment of Clinical Usefulness in chronic kidney disease patients with Atorvastatin (ASUCA) trial was to evaluate the influence of serum UA levels on renal function in Japanese chronic kidney disease patients with hyperlipidemia. Methods Of 344 participants in the ASUCA trial, 279 participants whose UA levels at both baseline and 24 months were available were included. Based on UA level at baseline or mean UA level during the trial period, they were divided into four groups: < 5.0, 5.0–6.0, 6.0–7.0, or ≥ 7.0 mg/dL, irrespective of allocation. Changes in the estimated glomerular filtration rate (eGFR) after 24 months were compared among the groups in relation to baseline or mean UA levels. Results For baseline UA levels (< 5.0, 5.0–6.0, 6.0–7.0, or ≥ 7.0 mg/dL), the change in eGFR after 24 months was − 1.32 ± 10.3, − 1.74 ± 8.94, − 2.53 ± 7.34, and − 3.51 ± 9.10 mL/min/1.73 m2, respectively. A negative correlation between changes in eGFR after 24 months and baseline UA level was observed with adjustment for confounding factors. The relationship between changes in eGFR and mean UA levels during trial period showed a similar trend. Conclusion In CKD patients with dyslipidemia, hyperuricemia was an independent risk factor for CKD progression. An ongoing clinical trial (TARGET-UA, UMIN-ID 000,026,741) may reveal the significance of strict UA-lowering therapy in CKD patients. Electronic supplementary material The online version of this article (10.1007/s10157-019-01840-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yoshihiro Kuwabara
- Center for Accessing Early Promising Treatment, Kyoto University Hospital, Kyoto, 6068507, Japan.
| | - Shinji Yasuno
- Clinical Research Support Center, Jikei University School of Medicine, Tokyo, Japan
| | - Masato Kasahara
- Clinical Research Center, Nara Medical University, Kashihara, Japan
| | - Kenji Ueshima
- Center for Accessing Early Promising Treatment, Kyoto University Hospital, Kyoto, 6068507, Japan
| | - Kazuwa Nakao
- Medical Innovation Center, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Liu X, Gao Y, Chandrawati R, Hosta-Rigau L. Therapeutic applications of multifunctional nanozymes. NANOSCALE 2019; 11:21046-21060. [PMID: 31686088 DOI: 10.1039/c9nr06596b] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Nanozymes, which are functional nanomaterials with enzyme-like characteristics, have emerged as a highly-stable and low-cost alternative to natural enzymes. Apart from overcoming the limitations of natural enzymes (e.g., high cost, low stability or complex production), nanozymes are also equipped with the unique intrinsic properties of nanomaterials such as magnetism, luminescence or near infrared absorbance. Therefore, the development of nanozymes exhibiting additional functions to their catalytic activity has opened up new opportunities and applications within the biomedical field. To highlight the progress in the field, this review summarizes the novel applications of multifunctional nanozymes in various biomedical-related fields ranging from cancer diagnosis, cancer and antibacterial therapy to regenerative medicine. Future challenges and perspectives that may advance nanozyme research are also discussed at the end of the review.
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Affiliation(s)
- Xiaoli Liu
- Department of Health Technology, Centre for Nanomedicine and Theranostics, DTU Health Tech, Technical University of Denmark, 2800 Lyngby, Denmark.
| | - Yuan Gao
- School of Chemical Engineering and Australian Centre for Nanomedicine, The University of New South Wales (UNSW Sydney), Sydney, NSW 2052, Australia
| | - Rona Chandrawati
- School of Chemical Engineering and Australian Centre for Nanomedicine, The University of New South Wales (UNSW Sydney), Sydney, NSW 2052, Australia
| | - Leticia Hosta-Rigau
- Department of Health Technology, Centre for Nanomedicine and Theranostics, DTU Health Tech, Technical University of Denmark, 2800 Lyngby, Denmark.
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26
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Zhang F, Liu Z, Jiang L, Zhang H, Zhao D, Li Y, Zou H, Wang X, Li X, Shi B, Xu J, Yang H, Hu S, Qu S. A Randomized, Double-Blind, Non-Inferiority Study of Febuxostat Versus Allopurinol in Hyperuricemic Chinese Subjects With or Without Gout. Rheumatol Ther 2019; 6:543-557. [PMID: 31531831 PMCID: PMC6858416 DOI: 10.1007/s40744-019-00173-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Indexed: 12/27/2022] Open
Abstract
Introduction This 24-week randomized, double-blind, non-inferiority study compared the efficacy and safety of febuxostat, a xanthine oxidase inhibitor, with allopurinol using an up-titration method in hyperuricemic Chinese subjects with or without gout. Methods Eligible adults (serum uric acid [SUA] > 7.0 mg/dl with a history of gout, SUA ≥ 8.0 mg/dl with complications or SUA ≥ 9.0 mg/dl without complications) were randomized (1:1:1) to febuxostat 40 mg/day, 80 mg/day, or allopurinol 300 mg/day. Starting doses of febuxostat 20 mg/day and allopurinol 100 mg/day were up-titrated, up to 16 weeks, to the randomized doses and maintained to week 24. Primary endpoint was non-inferiority of febuxostat 40 mg/day versus allopurinol 300 mg/day based on the percentage of subjects with SUA ≤ 6.0 mg/dl at week 24. The same comparison was made between febuxostat 60 mg/day or 80 mg/day versus allopurinol 300 mg/day. Safety assessments included measurement of treatment-emergent adverse events (TEAEs). Results The per-protocol population comprised 472 subjects. Non-inferiority of febuxostat 40 mg/day versus allopurinol 300 mg/day was not demonstrated based on the protocol-defined margin of − 10% (44.7 vs. 50.0%; − 5.3% difference; 95% confidence interval [CI]: − 16.4%, 5.8%); however, superiority over allopurinol 300 mg/day was demonstrated for febuxostat 60 mg/day at week 16 (66.3 vs. 51.2%; a 15.0% difference; 95% CI: 4.2%, 25.9%) and febuxostat 80 mg/day at week 24 (70.0 vs. 50.0%; a 20.0% difference; 95% CI: 9.3%, 30.7%). The frequency of TEAEs was similar across groups, with gout flares occurring frequently. Conclusions Using a novel dose-titration method, although the primary endpoint of non-inferiority of febuxostat 40 mg/day versus allopurinol 300 mg/day was not reached, non-inferiority and superiority of febuxostat 60 mg/day and 80 mg/day versus allopurinol 300 mg/day was demonstrated at weeks 16 and 24, respectively. Febuxostat demonstrated an acceptable tolerability profile in the treatment of hyperuricemia in Chinese subjects with or without gout. Trial Registration JapicCTI-132106. Funding Astellas Pharma Global Development, Inc. Electronic Supplementary Material The online version of this article (10.1007/s40744-019-00173-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Fengchun Zhang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Zhichun Liu
- Department of Rheumatology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Lindi Jiang
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Hao Zhang
- Department of Nephrology, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Dongbao Zhao
- Department of Rheumatology and Immunology, Shanghai Changhai Hospital, Shanghai, China
| | - Yang Li
- Department of Rheumatology and Immunology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Hejian Zou
- Department of Rheumatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiaoyue Wang
- Department of Endocrinology, The First People Hospital of Yueyang, Yueyang, Hunan, China
| | - Xiangpei Li
- Department of Rheumatology and Immunology, The First Affiliated Hospital, University of Science and Technology of China, Hefei, Anhui, China
| | - Bingyin Shi
- Department of Endocrinology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Jianhua Xu
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Hongjie Yang
- Department of Endocrinology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Shaoxian Hu
- Department of Rheumatology and Immunology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Shen Qu
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, Zhabei, Shanghai, China
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Sato Y, Feig DI, Stack AG, Kang DH, Lanaspa MA, Ejaz AA, Sánchez-Lozada LG, Kuwabara M, Borghi C, Johnson RJ. The case for uric acid-lowering treatment in patients with hyperuricaemia and CKD. Nat Rev Nephrol 2019; 15:767-775. [PMID: 31296965 DOI: 10.1038/s41581-019-0174-z] [Citation(s) in RCA: 95] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2019] [Indexed: 02/07/2023]
Abstract
Hyperuricaemia is common among patients with chronic kidney disease (CKD), and increases in severity with the deterioration of kidney function. Although existing guidelines for CKD management do not recommend testing for or treatment of hyperuricaemia in the absence of a diagnosis of gout or urate nephrolithiasis, an emerging body of evidence supports a direct causal relationship between serum urate levels and the development of CKD. Here, we review randomized clinical trials that have evaluated the effect of urate-lowering therapy (ULT) on the rate of CKD progression. Among trials in which individuals in the control arm experienced progressive deterioration of kidney function (which we define as ≥4 ml/min/1.73 m² over the course of the study - typically 6 months to 2 years), treatment with ULT conferred consistent clinical benefits. In contrast, among trials where clinical progression was not observed in the control arm, treatment with ULT was ineffective, but this finding should not be used as an argument against the use of uric acid-lowering therapy. Although additional studies are needed to identify threshold values of serum urate for treatment initiation and to confirm optimal target levels, we believe that sufficient evidence exists to recommend routine measurement of serum urate levels in patients with CKD and consider initiation of ULT among those who are hyperuricaemic with evidence of deteriorating renal function, unless specific contraindications exist.
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Affiliation(s)
- Yuka Sato
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Daniel I Feig
- Division of Pediatric Nephrology, University of Alabama, Birmingham, AL, USA
| | - Austin G Stack
- Division of Nephrology, Department of Medicine, University Hospital Limerick, Limerick, Ireland.,Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Duk-Hee Kang
- Division of Nephrology, Department of Internal Medicine, Ewha Womans University College of Medicine Ewha Medical Research Center, Seoul, South Korea
| | - Miguel A Lanaspa
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - A Ahsan Ejaz
- Division of Nephrology, Hypertension and Renal Transplantation, University of Florida, Gainesville, FL, USA
| | - L Gabriela Sánchez-Lozada
- Laboratory of Renal Physiopathology, Department of Nephrology, INC Ignacio Chavez, Mexico City, Mexico
| | - Masanari Kuwabara
- Department of Cardiology and Intensive Care Unit, Toranomon Hospital, Tokyo, Japan
| | - Claudio Borghi
- Department of Medicine, University of Bologna, Bologna, Italy
| | - Richard J Johnson
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, CO, USA. .,Rocky Mountain Regional VA Medical Center, Aurora, CO, USA.
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Malik N, Dhiman P, Khatkar A. In Silico and 3D QSAR Studies of Natural Based Derivatives as Xanthine Oxidase Inhibitors. Curr Top Med Chem 2019; 19:123-138. [PMID: 30727896 DOI: 10.2174/1568026619666190206122640] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 11/23/2018] [Accepted: 01/27/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND A large number of disorders and their symptoms emerge from deficiency or overproduction of specific metabolites has drawn the attention for the discovery of new therapeutic agents for the treatment of disorders. Various approaches such as computational drug design have provided the new methodology for the selection and evaluation of target protein and the lead compound mechanistically. For instance, the overproduction of xanthine oxidase causes the accumulation of uric acid which can prompt gout. OBJECTIVE In the present study we critically discussed the various techniques such as 3-D QSAR and molecular docking for the study of the natural based xanthine oxidase inhibitors with their mechanistic insight into the interaction of xanthine oxidase and various natural leads. CONCLUSION The computational studies of deferent natural compounds were discussed as a result the flavonoids, anthraquinones, xanthones shown the remarkable inhibitory potential for xanthine oxidase inhibition moreover the flavonoids such as hesperidin and rutin were found as promising candidates for further exploration.
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Affiliation(s)
- Neelam Malik
- Department of Pharmaceutical sciences, Maharshi Dayanand University Rohtak, Haryana, India
| | - Priyanka Dhiman
- Department of Pharmaceutical sciences, Maharshi Dayanand University Rohtak, Haryana, India
| | - Anurag Khatkar
- Laboratory for Preservation Technology and Enzyme Inhibition Studies, Department of Pharmaceutical Sciences, Maharshi Dayanand University, Rohtak, Haryana, India
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Sorensen CJ, Butler-Dawson J, Dally M, Krisher L, Griffin BR, Johnson RJ, Lemery J, Asensio C, Tenney L, Newman LS. Risk Factors and Mechanisms Underlying Cross-Shift Decline in Kidney Function in Guatemalan Sugarcane Workers. J Occup Environ Med 2019; 61:239-250. [PMID: 30575695 PMCID: PMC6416034 DOI: 10.1097/jom.0000000000001529] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Identify early biomarkers and mechanisms of acute kidney injury in workers at risk of developing chronic kidney disease of unknown origin (CKDu). METHODS We assessed cross-shift changes in kidney function and biomarkers of injury in 105 healthy sugarcane workers. We obtained pre-harvest clinical data as well as daily environmental, clinical, and productivity data for each worker. RESULTS The average percent decline in cross-shift estimated glomerular filtration rate (eGFR) was 21.8% (standard deviation [SD] 13.6%). Increasing wet bulb globe temperature (WBGT), high uric acid, decreased urine pH, urinary leukocyte esterase, and serum hyperosmolality were risk factors for decline in kidney function. CONCLUSIONS Sugarcane workers with normal kidney function experience recurrent subclinical kidney injury, associated with elevations in biomarkers of injury that suggest exposure to high temperatures and extreme physical demands.
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Affiliation(s)
- Cecilia J Sorensen
- Center for Health, Work & Environment (Dr Sorensen, Dr Butler-Dawson, Ms Dally, Ms Krisher, Ms Tenney, Dr Newman); Department of Emergency Medicine, University of Colorado School of Medicine (Dr Sorensen, Dr Lemery); Colorado Consortium on Climate Change and Human Health (Dr Sorensen, Dr Butler-Dawson, Ms Dally, Ms Krisher, Dr Johnson, Dr Lemery, Ms Tenney, Dr Newman); Department of Environmental and Occupational Health (Dr Butler-Dawson, Ms Dally, Ms Krisher, Ms Tenney, Dr Newman), Colorado School of Public Health; Division of Renal Diseases and Hypertension (Dr Griffin, Dr Johnson); Pantaleon, Guatemala (Mr Asensio); Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, School of Medicine (Dr Newman), University of Colorado, Aurora, Colorado
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Asymptomatic hyperuricemia and incident stroke in elderly Chinese patients without comorbidities. Eur J Clin Nutr 2019; 73:1392-1402. [PMID: 30787471 DOI: 10.1038/s41430-019-0405-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 11/13/2018] [Accepted: 11/14/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND/OBJECTIVES Hyperuricemia is usually associated with other comorbidities; so it is difficult to distinguish the effects of hyperuricemia from other coexisting comorbidities in patients who suffer a stroke. SUBJECT/METHODS Data for this study were collected from the patients of Kangjian Community Health Center of Shanghai. Selected participants ≥65 years of age were available at enrollment (2009-2013). Subjects were excluded if they had hypertension, diabetes mellitus, pre-existing cardiovascular disease, or hyperlipidemia. Further, patients who were overweight or obese, had gout or drug-treated hyperuricemia, or had chronic kidney disease were also excluded. Cox regression was used in order to assess the hazard ratio (HR) for the incidence of stroke events between hyperuricemic and normouricemic patients. RESULTS A total of 3243 subjects without comorbidities (70.8 ± 6.0 years) were followed for 35.5 ± 3.0 months. Hyperuricemia conferred increased cumulative incident stroke events (6.9 versus 3.1%, odds ratio [OR] = 2.27, 95% confidence index [CI] 1.52-3.37, p < 0.001). Male and female hyperuricemic subjects also showed a significantly higher incident stroke incidence than normouricemic subjects (6.1 versus 2.7%, OR = 2.34, 95% CI 1.31-4.18, p = 0.003 and 7.6 versus 3.7%, OR = 2.16, 95% CI 1.25-3.72, p = 0.005, respectively). Cox regression showed that hyperuricemia independently predicted incident stroke risk (HR = 2.32, 95%CI 1.56-3.45). CONCLUSION Asymptomatic hyperuricemia carried a significant risk of stroke events in Chinese elderly without comorbidities.
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Relation between serum uric acid levels with the degree of coronary artery disease: A prospective study from Ecuador. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS 2018; 31:8-14. [PMID: 30390923 DOI: 10.1016/j.arteri.2018.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 08/09/2018] [Accepted: 09/15/2018] [Indexed: 12/15/2022]
Abstract
To analyze the relationship between serum levels of uric acid and the severity of coronary disease. METHODS This observational, descriptive and cross-sectional study included 77 patients previously selected using inclusion criteria, from September 2014 to May 2015. It was conducted in a third level regional hospital from Guayaquil, Ecuador. Patients enrolled in this study were older than 30 years with coronary disease undergoing coronary angiography, without prior diagnosis of any other condition that could influence in serum uric acid values. RESULTS (1) Direct relation between serum uric acid levels and the severity of coronary disease, with a 0.600 Spearman correlation coefficient (p<0.001); (2) other variables such as hypertension and medical history did not have an influence on the study's results; (3) serum uric acid levels didn't show difference among the different groups (p˃0.05). CONCLUSIONS Based on the results, it was possible to conclude that there is a relation between serum uric acid level and the severity of coronary artery disease; this relation was independent of clinical diagnosis and hypertension. According to this, serum uric acid levels can be taken as a practical and inexpensive parameter related to the severity of coronary artery disease. As a primary preventive intervention, we recommend maintaining levels within normal parameters in patients with cardiovascular risk.
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Shenoy R, Moideen F, Lashkari HP. A Child with Bulky Kidneys and Renal Failure. Indian J Med Paediatr Oncol 2018. [DOI: 10.4103/ijmpo.ijmpo_196_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AbstractAcute lymphoblastic leukemia (ALL) is the most common malignancy in children. Acute renal failure is a well-recognized complication of ALL after initiation of chemotherapy. Renal failure as the primary manifestation of ALL with no evidence of tumor lysis is rare.
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Affiliation(s)
- Ramnath Shenoy
- Department of Pediatric Oncolgy and Paediatrics, KMC Hospital, Manipal University, Mangalore, Karnataka, India
| | - Faheem Moideen
- Department of Pediatric Oncolgy and Paediatrics, KMC Hospital, Manipal University, Mangalore, Karnataka, India
| | - Harsha Prasada Lashkari
- Department of Pediatric Oncolgy and Paediatrics, KMC Hospital, Manipal University, Mangalore, Karnataka, India
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Orlando A, Cazzaniga E, Giussani M, Palestini P, Genovesi S. Hypertension in Children: Role of Obesity, Simple Carbohydrates, and Uric Acid. Front Public Health 2018; 6:129. [PMID: 29774210 PMCID: PMC5943632 DOI: 10.3389/fpubh.2018.00129] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 04/16/2018] [Indexed: 12/22/2022] Open
Abstract
Over the past 60 years there has been a dramatic increase in the prevalence of overweight in children and adolescents, ranging from 4% in 1975 to 18% in 2016. Recent estimates indicate that overweight or obese children and adolescents are more than 340 million. Obesity is often associated with hypertension, which is an important cardiovascular risk factor. Recent studies show that the presence of hypertension is a frequent finding in the pediatric age. Hypertensive children easily become hypertensive adults. This phenomenon contributes to increasing cardiovascular risk in adulthood. Primary hypertension is a growing problem especially in children and adolescents of western countries, largely because of its association with the ongoing obesity epidemic. Recently, it has been hypothesized that a dietary link between obesity and elevated blood pressure (BP) values could be simple carbohydrate consumption, particularly fructose, both in adults and in children. Excessive intake of fructose leads to increased serum uric acid (SUA) and high SUA values are independently associated with the presence of hypertension and weaken the efficacy of lifestyle modifications in children. The present review intends to provide an update of existing data regarding the relationship between BP, simple carbohydrates (particularly fructose), and uric acid in pediatric age. In addition, we analyze the national policies that have been carried out over the last few years, in order to identify the best practices to limit the socio-economic impact of the effects of excessive sugar consumption in children.
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Affiliation(s)
- Antonina Orlando
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Emanuela Cazzaniga
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Marco Giussani
- Family Pediatrician, Azienda Sanitaria Locale della Provincia di Milano, Milan, Italy
| | - Paola Palestini
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Simonetta Genovesi
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,Department of Cardiovascular, Neural and Metabolic Sciences, S. Luca Hospital, IRCCS, Istituto Auxologico Italiano, Milan, Italy
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Jing W, Zhong J, Ping LJ, Yan LH. Relationship between oxidative stress and inflammation in peripheral and cerebral system of oxonate-induced hyperuricemic rats. BRAZ J PHARM SCI 2018. [DOI: 10.1590/s2175-97902017000400229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Wu Jing
- Gansu Agricultural University, China; Pulmonary Hospital of Lanzhou, China
| | - Jia Zhong
- Gansu Agricultural University, China; Pulmonary Hospital of Lanzhou, China
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Prakash S, Chang T. In vitro and in vivo Uric Acid Lowering by Artificial Cells Containing Microencapsulated Genetically Engineered E. coli DH5 Cells. Int J Artif Organs 2018. [DOI: 10.1177/039139880002300704] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Increase in systemic uric acid occurs in renal insufficiency, gout, chemotherapy, and other diseases. Dialysis can lower this metabolite but is expensive. The use of drugs can, sometime, result in side effects. Therefore, a suitable affordable method for this is required. In this article, for the first time, we report the use of artificial cells containing micro encapsulated genetically engineered E. Coli DH5 cells for lowering uric acid in vitro and in vivo. Results show that this novel approach has the ability to significantly lower uric acid from 84.80±3.40 mg/dl to 9.32±0.05 mg/dl in vitro and from the plasma of the experimental animals from the control levels of 71.00±27.49 mg/dl to 20.33+17.92 mg/dl in vivo. Continued daily oral administration maintained the plasma uric acid concentration of experimental uremic rats to the normal plasma uric acid level range during the entire test period.
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Affiliation(s)
- S. Prakash
- Artificial Cells and Organs Research Center, Faculty of Medicine, Mc Gill University, Montreal, Quebec - Canada
| | - T.M.S. Chang
- Artificial Cells and Organs Research Center, Faculty of Medicine, Mc Gill University, Montreal, Quebec - Canada
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Mapoure YN, Ayeah CM, Ba H, Hentchoya R, Luma HN. The Prognostic Value of Serum Uric Acid in the Acute Phase of Ischemic Stroke in Black Africans. J Stroke Cerebrovasc Dis 2017; 27:783-792. [PMID: 29153396 DOI: 10.1016/j.jstrokecerebrovasdis.2017.10.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 09/04/2017] [Accepted: 10/11/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The association between hyperuricemia and stroke outcome still remains controversial worldwide. This study aims to determine the prevalence of hyperuricemia and its association with the outcome of patients with acute ischemic stroke in a tertiary care hospital. METHODS This was a hospital-based prospective cohort study that included patients with ischemic stroke with baseline uric acid levels and 3-month post-stroke follow-up data. Associations between hyperuricemia and stroke outcomes were analyzed using multiple logistic regression, Kaplan-Meier, and Cox proportional hazards regression analysis. RESULTS A total of 480 patients were reviewed with a mean age of 62.8 ± 13.3 years. The prevalence of hyperuricemia was 52.3% with mean uricemia of 71.1 ± 25.3 mg/dL. There was a significant association between hyperuricemia and mortality with unadjusted odds ratio (OR) = 4.120 [95% (confidence interval [CI]: 2.466-7.153); P = .001)], but on multivariate analysis, hyperuricemia was not an independent predictor of stroke mortality [OR = 1.270 (CI: .547-2.946); P = .578)]. An independent association between increasing uric acid levels and mortality was noted on Cox proportional hazards regression; adjusted hazard ratio (95% CI) of 3.395 (2.114-5.452), P value greater than .001. Stroke mortality significantly increased across higher uric acid quintiles in patients with acute stroke (P < .001). Hyperuricemia was an independent predictor of poor functional outcome within 3 months after stroke with adjusted OR (95% CI) of 2.820 (1.359-5.851); P = .005. CONCLUSIONS Half of black African patients with ischemic stroke present with hyperuricemia, and hyperuricemia is a predictor of mortality and adverse functional outcomes. Further studies are therefore warranted to determine whether reducing hyperuricemia after stroke would be beneficial within our setting.
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Affiliation(s)
- Yacouba Njankouo Mapoure
- Department of Clinical Sciences, University of Douala, Douala, Cameroon; Department of Internal Medicine, Douala General Hospital, Douala, Cameroon.
| | - Chia Mark Ayeah
- Department of Internal Medicine, Douala General Hospital, Douala, Cameroon; Department of Internal Medicine, Mboppi Baptist Hospital, Douala, Cameroon
| | - Hamadou Ba
- Department of Internal Medicine, University of Yaoundé I, Yaoundé, Cameroon
| | - Romuald Hentchoya
- Service of Intensive Care Unit, Douala General Hospital, Douala, Cameroon
| | - Henry Namme Luma
- Department of Internal Medicine, Douala General Hospital, Douala, Cameroon
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Wu J, Lei G, Wang X, Tang Y, Cheng H, Jian G, Wu X, Wang N. Asymptomatic hyperuricemia and coronary artery disease in elderly patients without comorbidities. Oncotarget 2017; 8:80688-80699. [PMID: 29113336 PMCID: PMC5655231 DOI: 10.18632/oncotarget.21079] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 09/03/2017] [Indexed: 02/07/2023] Open
Abstract
Because many subjects with hyperuricemia have comorbidities, it can be difficult to differentiate the role of hyperuricemia from that of other comorbidities of coronary artery disease (CAD). Subjects aged ≥ 65 years were enrolled in the study and were available at enrollment and at 5-year follow-up. Subjects were excluded if they were overweight or obese, hypertensive, diabetic, hyperlipidemic, had a pre-existing cardiovascular disease, a history of gout or hyperuricemia on medications, or chronic kidney disease as estimated by a glomerular filtration rate (eGFR) < 60 mL/min per 1.73 m2. We used Poisson regression to estimate the hazard ratio (HR) for incident CAD events between hyperuricemic (> 7 mg/dL in men and ≥ 6 mg/dL in women) and normouricemic subjects. A total of 2,142 subjects without comorbidities (mean age of 70.7 ± 5.9 years, 1,194 men) were followed for 57.4 ± 8.9 months. Hyperuricemia was associated with an increased cumulative incidence of incident CAD events (15.0% versus 8.8%, P < 0.001). After adjusting for confounding factors, hyperuricemia independently predicted the risk of incident CAD events (HR=1.71, 95% CI 1.26-2.34). In conclusion, asymptomatic hyperuricemia is a valuable biomarker for predicting the development of incident CAD events.
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Affiliation(s)
- Junnan Wu
- Department of Nephrology, Affiliated Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Guangtao Lei
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xiao Wang
- Department of Endocrinology, Affiliated Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yuezhong Tang
- Kangjian Community Health Center, Xuhui District, Shanghai, China
| | - Huan Cheng
- Kangjian Community Health Center, Xuhui District, Shanghai, China
| | - Guihua Jian
- Department of Nephrology, Affiliated Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xianfeng Wu
- Department of Nephrology, Affiliated Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Niansong Wang
- Department of Nephrology, Affiliated Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
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Kaur M, Kaur A, Mankotia S, Singh H, Singh A, Singh JV, Gupta MK, Sharma S, Nepali K, Bedi PMS. Synthesis, screening and docking of fused pyrano[3,2- d ]pyrimidine derivatives as xanthine oxidase inhibitor. Eur J Med Chem 2017; 131:14-28. [DOI: 10.1016/j.ejmech.2017.03.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Revised: 01/23/2017] [Accepted: 03/02/2017] [Indexed: 10/20/2022]
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Kuwabara M, Niwa K, Hisatome I, Nakagawa T, Roncal-Jimenez CA, Andres-Hernando A, Bjornstad P, Jensen T, Sato Y, Milagres T, Garcia G, Ohno M, Lanaspa MA, Johnson RJ. Asymptomatic Hyperuricemia Without Comorbidities Predicts Cardiometabolic Diseases: Five-Year Japanese Cohort Study. Hypertension 2017; 69:1036-1044. [PMID: 28396536 DOI: 10.1161/hypertensionaha.116.08998] [Citation(s) in RCA: 134] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 01/09/2017] [Accepted: 01/30/2017] [Indexed: 02/07/2023]
Abstract
Whether asymptomatic hyperuricemia in the absence of comorbidities increases the risk for cardiometabolic disorders and chronic kidney disease remains controversial. This study was conducted to clarify the association between asymptomatic hyperuricemia and cardiometabolic conditions. Subjects consisting of Japanese adults between 30 and 85 years of age were enrolled in the study at Center for Preventive Medicine, St Luke's International Hospital, Tokyo, and were available at enrollment (2004) and at 5-year follow-up (2009). Subjects were excluded if they were overweight or obese, hypertensive, diabetic, and dyslipidemic, had a history of gout or hyperuricemia on medications, or had chronic kidney disease as estimated glomerular filtration rate <60 mL/min per 1.73 m2 Linear and logistic regression analyses were used to examine the relationship between hyperuricemia and development of hypertension, diabetes mellitus, dyslipidemia, chronic kidney disease, and overweight/obesity (unadjusted and adjusted for age, sex, smoking, drinking habits, baseline estimated glomerular filtration rate, and body mass index). Five thousand eight hundred and ninety-nine subjects without comorbidities (mean age of 47±10 years, 1864 men) were followed for 5 years. Hyperuricemia (defined as >7 mg/dL in men and ≥6 mg/dL in women) was associated with increased cumulative incidence of hypertension (14.9% versus 6.1%; P<0.001), dyslipidemia (23.1% versus 15.5%; P<0.001), chronic kidney disease (19.0% versus 10.7%; P<0.001), and overweight/obesity (8.9% versus 3.0%; P<0.001), while diabetes mellitus (1.7% versus 0.9%; P=0.087) showed a trend but did not reach statistical significance. In conclusion, asymptomatic hyperuricemia carries a significant risk for developing cardiometabolic conditions in Japanese individual without comorbidities.
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Affiliation(s)
- Masanari Kuwabara
- From the Division of Renal Diseases and Hypertension, School of Medicine, University of Colorado Denver, Aurora (M.K., C.A.R.-J., A.A.-H., P.B., T.J., Y.S., T.M., G.G., M.A.L., R.J.J.); Department of Cardiology, Toranomon Hospital, Tokyo, Japan (M.K., M.O.); Cardiovascular Center, St Luke's International Hospital, Tokyo, Japan (M.K., K.N.); Division of Regenerative Medicine and Therapeutics, Tottori University Graduate School of Medical Sciences, Yonago, Japan (I.H.); Future Basic Medicine, Nara Medical University, Kashihara, Japan (T.N.); and Children's Hospital Colorado and Barbara Davis Center for Childhood Diabetes, Aurora (P.B.).
| | - Koichiro Niwa
- From the Division of Renal Diseases and Hypertension, School of Medicine, University of Colorado Denver, Aurora (M.K., C.A.R.-J., A.A.-H., P.B., T.J., Y.S., T.M., G.G., M.A.L., R.J.J.); Department of Cardiology, Toranomon Hospital, Tokyo, Japan (M.K., M.O.); Cardiovascular Center, St Luke's International Hospital, Tokyo, Japan (M.K., K.N.); Division of Regenerative Medicine and Therapeutics, Tottori University Graduate School of Medical Sciences, Yonago, Japan (I.H.); Future Basic Medicine, Nara Medical University, Kashihara, Japan (T.N.); and Children's Hospital Colorado and Barbara Davis Center for Childhood Diabetes, Aurora (P.B.)
| | - Ichiro Hisatome
- From the Division of Renal Diseases and Hypertension, School of Medicine, University of Colorado Denver, Aurora (M.K., C.A.R.-J., A.A.-H., P.B., T.J., Y.S., T.M., G.G., M.A.L., R.J.J.); Department of Cardiology, Toranomon Hospital, Tokyo, Japan (M.K., M.O.); Cardiovascular Center, St Luke's International Hospital, Tokyo, Japan (M.K., K.N.); Division of Regenerative Medicine and Therapeutics, Tottori University Graduate School of Medical Sciences, Yonago, Japan (I.H.); Future Basic Medicine, Nara Medical University, Kashihara, Japan (T.N.); and Children's Hospital Colorado and Barbara Davis Center for Childhood Diabetes, Aurora (P.B.)
| | - Takahiko Nakagawa
- From the Division of Renal Diseases and Hypertension, School of Medicine, University of Colorado Denver, Aurora (M.K., C.A.R.-J., A.A.-H., P.B., T.J., Y.S., T.M., G.G., M.A.L., R.J.J.); Department of Cardiology, Toranomon Hospital, Tokyo, Japan (M.K., M.O.); Cardiovascular Center, St Luke's International Hospital, Tokyo, Japan (M.K., K.N.); Division of Regenerative Medicine and Therapeutics, Tottori University Graduate School of Medical Sciences, Yonago, Japan (I.H.); Future Basic Medicine, Nara Medical University, Kashihara, Japan (T.N.); and Children's Hospital Colorado and Barbara Davis Center for Childhood Diabetes, Aurora (P.B.)
| | - Carlos A Roncal-Jimenez
- From the Division of Renal Diseases and Hypertension, School of Medicine, University of Colorado Denver, Aurora (M.K., C.A.R.-J., A.A.-H., P.B., T.J., Y.S., T.M., G.G., M.A.L., R.J.J.); Department of Cardiology, Toranomon Hospital, Tokyo, Japan (M.K., M.O.); Cardiovascular Center, St Luke's International Hospital, Tokyo, Japan (M.K., K.N.); Division of Regenerative Medicine and Therapeutics, Tottori University Graduate School of Medical Sciences, Yonago, Japan (I.H.); Future Basic Medicine, Nara Medical University, Kashihara, Japan (T.N.); and Children's Hospital Colorado and Barbara Davis Center for Childhood Diabetes, Aurora (P.B.)
| | - Ana Andres-Hernando
- From the Division of Renal Diseases and Hypertension, School of Medicine, University of Colorado Denver, Aurora (M.K., C.A.R.-J., A.A.-H., P.B., T.J., Y.S., T.M., G.G., M.A.L., R.J.J.); Department of Cardiology, Toranomon Hospital, Tokyo, Japan (M.K., M.O.); Cardiovascular Center, St Luke's International Hospital, Tokyo, Japan (M.K., K.N.); Division of Regenerative Medicine and Therapeutics, Tottori University Graduate School of Medical Sciences, Yonago, Japan (I.H.); Future Basic Medicine, Nara Medical University, Kashihara, Japan (T.N.); and Children's Hospital Colorado and Barbara Davis Center for Childhood Diabetes, Aurora (P.B.)
| | - Petter Bjornstad
- From the Division of Renal Diseases and Hypertension, School of Medicine, University of Colorado Denver, Aurora (M.K., C.A.R.-J., A.A.-H., P.B., T.J., Y.S., T.M., G.G., M.A.L., R.J.J.); Department of Cardiology, Toranomon Hospital, Tokyo, Japan (M.K., M.O.); Cardiovascular Center, St Luke's International Hospital, Tokyo, Japan (M.K., K.N.); Division of Regenerative Medicine and Therapeutics, Tottori University Graduate School of Medical Sciences, Yonago, Japan (I.H.); Future Basic Medicine, Nara Medical University, Kashihara, Japan (T.N.); and Children's Hospital Colorado and Barbara Davis Center for Childhood Diabetes, Aurora (P.B.)
| | - Thomas Jensen
- From the Division of Renal Diseases and Hypertension, School of Medicine, University of Colorado Denver, Aurora (M.K., C.A.R.-J., A.A.-H., P.B., T.J., Y.S., T.M., G.G., M.A.L., R.J.J.); Department of Cardiology, Toranomon Hospital, Tokyo, Japan (M.K., M.O.); Cardiovascular Center, St Luke's International Hospital, Tokyo, Japan (M.K., K.N.); Division of Regenerative Medicine and Therapeutics, Tottori University Graduate School of Medical Sciences, Yonago, Japan (I.H.); Future Basic Medicine, Nara Medical University, Kashihara, Japan (T.N.); and Children's Hospital Colorado and Barbara Davis Center for Childhood Diabetes, Aurora (P.B.)
| | - Yuka Sato
- From the Division of Renal Diseases and Hypertension, School of Medicine, University of Colorado Denver, Aurora (M.K., C.A.R.-J., A.A.-H., P.B., T.J., Y.S., T.M., G.G., M.A.L., R.J.J.); Department of Cardiology, Toranomon Hospital, Tokyo, Japan (M.K., M.O.); Cardiovascular Center, St Luke's International Hospital, Tokyo, Japan (M.K., K.N.); Division of Regenerative Medicine and Therapeutics, Tottori University Graduate School of Medical Sciences, Yonago, Japan (I.H.); Future Basic Medicine, Nara Medical University, Kashihara, Japan (T.N.); and Children's Hospital Colorado and Barbara Davis Center for Childhood Diabetes, Aurora (P.B.)
| | - Tamara Milagres
- From the Division of Renal Diseases and Hypertension, School of Medicine, University of Colorado Denver, Aurora (M.K., C.A.R.-J., A.A.-H., P.B., T.J., Y.S., T.M., G.G., M.A.L., R.J.J.); Department of Cardiology, Toranomon Hospital, Tokyo, Japan (M.K., M.O.); Cardiovascular Center, St Luke's International Hospital, Tokyo, Japan (M.K., K.N.); Division of Regenerative Medicine and Therapeutics, Tottori University Graduate School of Medical Sciences, Yonago, Japan (I.H.); Future Basic Medicine, Nara Medical University, Kashihara, Japan (T.N.); and Children's Hospital Colorado and Barbara Davis Center for Childhood Diabetes, Aurora (P.B.)
| | - Gabriela Garcia
- From the Division of Renal Diseases and Hypertension, School of Medicine, University of Colorado Denver, Aurora (M.K., C.A.R.-J., A.A.-H., P.B., T.J., Y.S., T.M., G.G., M.A.L., R.J.J.); Department of Cardiology, Toranomon Hospital, Tokyo, Japan (M.K., M.O.); Cardiovascular Center, St Luke's International Hospital, Tokyo, Japan (M.K., K.N.); Division of Regenerative Medicine and Therapeutics, Tottori University Graduate School of Medical Sciences, Yonago, Japan (I.H.); Future Basic Medicine, Nara Medical University, Kashihara, Japan (T.N.); and Children's Hospital Colorado and Barbara Davis Center for Childhood Diabetes, Aurora (P.B.)
| | - Minoru Ohno
- From the Division of Renal Diseases and Hypertension, School of Medicine, University of Colorado Denver, Aurora (M.K., C.A.R.-J., A.A.-H., P.B., T.J., Y.S., T.M., G.G., M.A.L., R.J.J.); Department of Cardiology, Toranomon Hospital, Tokyo, Japan (M.K., M.O.); Cardiovascular Center, St Luke's International Hospital, Tokyo, Japan (M.K., K.N.); Division of Regenerative Medicine and Therapeutics, Tottori University Graduate School of Medical Sciences, Yonago, Japan (I.H.); Future Basic Medicine, Nara Medical University, Kashihara, Japan (T.N.); and Children's Hospital Colorado and Barbara Davis Center for Childhood Diabetes, Aurora (P.B.)
| | - Miguel A Lanaspa
- From the Division of Renal Diseases and Hypertension, School of Medicine, University of Colorado Denver, Aurora (M.K., C.A.R.-J., A.A.-H., P.B., T.J., Y.S., T.M., G.G., M.A.L., R.J.J.); Department of Cardiology, Toranomon Hospital, Tokyo, Japan (M.K., M.O.); Cardiovascular Center, St Luke's International Hospital, Tokyo, Japan (M.K., K.N.); Division of Regenerative Medicine and Therapeutics, Tottori University Graduate School of Medical Sciences, Yonago, Japan (I.H.); Future Basic Medicine, Nara Medical University, Kashihara, Japan (T.N.); and Children's Hospital Colorado and Barbara Davis Center for Childhood Diabetes, Aurora (P.B.)
| | - Richard J Johnson
- From the Division of Renal Diseases and Hypertension, School of Medicine, University of Colorado Denver, Aurora (M.K., C.A.R.-J., A.A.-H., P.B., T.J., Y.S., T.M., G.G., M.A.L., R.J.J.); Department of Cardiology, Toranomon Hospital, Tokyo, Japan (M.K., M.O.); Cardiovascular Center, St Luke's International Hospital, Tokyo, Japan (M.K., K.N.); Division of Regenerative Medicine and Therapeutics, Tottori University Graduate School of Medical Sciences, Yonago, Japan (I.H.); Future Basic Medicine, Nara Medical University, Kashihara, Japan (T.N.); and Children's Hospital Colorado and Barbara Davis Center for Childhood Diabetes, Aurora (P.B.)
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Khichar S, Choudhary S, Singh VB, Tater P, Arvinda RV, Ujjawal V. Serum uric acid level as a determinant of the metabolic syndrome: A case control study. Diabetes Metab Syndr 2017; 11:19-23. [PMID: 27381965 DOI: 10.1016/j.dsx.2016.06.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 06/17/2016] [Indexed: 11/25/2022]
Abstract
AIMS To determine whether elevations of uric acid levels are associated with the cluster of disorders described in metabolic syndrome and to evaluate whether hyperuricemia may be considered a component of this syndrome. METHODS One year case-control study was conducted in Bikaner, Rajasthan, India from January to December 2013. The study population consisted of 200 subjects, 100 with metabolic syndrome (case) and 100 without metabolic syndrome (control) aged between 18 and 80 years, attending OPD at PBM Hospital were studied. Controls were age and sex matched to the cases. Blood tests and all physical variables were examined using standard methods. Subjects were divided into 6 groups according to their possession of 0, 1, 2, 3, 4 or 5 components of the metabolic syndrome. Statistical analysis was done using ANOVA, linear regression analysis and multivariate linear regression model. RESULTS Mean serum UA level was significantly associated with all components of metabolic syndrome (p<0.001) and had strong positive correlation (r=+0.66 to +0.77, p<0.0001) with all of them except serum HDL with which it showed strong negative correlation(r=-0.71, p<0.0001). It increased as the number of metabolic factors increased showing a highly significant trend (p<0.0001). On multivariate regression analysis UA contributed to 66.84% variance of metabolic syndrome. CONCLUSION The current multivariate regression analysis clearly infers that uric acid can be considered as a marker and potential modifier of metabolic syndrome.
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Affiliation(s)
- Satyendra Khichar
- The Department of Medicine, Dr. S.P. Medical College, Bikaner, India.
| | - Shyama Choudhary
- Department Of Pediatrics, Dr. S.P. Medical College, Bikaner, India
| | | | - Priyanka Tater
- The Department of Medicine, Dr. S.P. Medical College, Bikaner, India
| | - R V Arvinda
- The Department of Medicine, Dr. S.P. Medical College, Bikaner, India
| | - Vivek Ujjawal
- The Department of Medicine, Dr. S.P. Medical College, Bikaner, India
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Sensitive electrochemical sensor for simultaneous determination of uric acid and xanthine in human biological fluids based on the nano-boron doped ceria modified glassy carbon paste electrode. J Electroanal Chem (Lausanne) 2016. [DOI: 10.1016/j.jelechem.2016.09.016] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Kim HS, Lim SW, Jin L, Jin J, Chung BH, Yang CW. The Protective Effect of Febuxostat on Chronic Tacrolimus-Induced Nephrotoxicity in Rats. Nephron Clin Pract 2016; 135:61-71. [PMID: 27701176 DOI: 10.1159/000449289] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 08/10/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The use of calcineurin inhibitors is a well-known risk factor for hyperuricemia in kidney transplant recipients. We evaluated the effect of febuxostat (Fx), a new uric acid-lowering drug, on hyperuricemia and renal injury in an experimental model of chronic tacrolimus (Tac)-induced nephropathy. METHODS Chronic Tac nephropathy was induced by administering Tac (1.5 mg/kg/day) to rats on a low-salt diet (0.05%) with oxonic acid (OA, 2%, 0.2 g/kg/day) for 28 days. Two doses of Fx (5 and 10 mg/kg) were concomitantly administered with Tac or vehicle (Vh). We evaluated the effect of Fx on hyperuricemia by measuring serum uric acid (SUA) levels, fractional excretion of uric acid (FEUA), and urate transporters in Tac-induced nephropathy. The effects of Fx on Tac-induced renal injury were evaluated in terms of renal function and arteriolopathy, tubulointerstitial fibrosis, inflammation, and apoptosis. We evaluated oxidative stress as a protective mechanism via xanthine oxidase (XO) activity, and as a marker of oxidative stress (via evaluation of levels of 8-hydroxy-2'-deoxyguanosine (8-OHdG) and 4-hydroxy-2-hexenal (4-HHE)). RESULTS The Tac group showed higher SUA levels and lower FEUA than did the Vh group, but Fx treatment significantly decreased SUA levels in a dose-dependent manner, with an increase of FEUA at a high dose (10 mg/kg). Tac treatment increased urate-anion exchanger 1 and decreased organic anion transporter type 1 expression in renal tubular cells, but Fx treatment reversed the effects on those transporters. Impaired renal function and histological injury (interstitial fibrosis, inflammation, and arteriolopathy) in the Tac group were markedly improved by Fx administration. Increases in apoptotic cell death and activation of proapoptotic caspase-3 by Tac were remarkably decreased by Fx treatment. Tac administration increased the activity of XO in kidney tissue and serum, and the levels of 8-OHdG in urine and 8-OHdG and 4-HHE of kidney tissue, but combined treatment with Fx decreased the levels of these parameters. CONCLUSIONS Fx is effective in controlling hyperuricemia and in preventing Tac-induced renal injury, via a reduction of oxidative stress. Therefore, a targeted therapy aimed at inhibiting uric acid by Fx may be a useful approach in the management of the progression of nephropathy in renal transplant patients treated with Tac.
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Affiliation(s)
- Hyun Seon Kim
- Transplant Research Center, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
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Li S, Yang H, Guo Y, Wei F, Yang X, Li D, Li M, Xu W, Li W, Sun L, Gao Y, Wang Y. Comparative efficacy and safety of urate-lowering therapy for the treatment of hyperuricemia: a systematic review and network meta-analysis. Sci Rep 2016; 6:33082. [PMID: 27605442 PMCID: PMC5015109 DOI: 10.1038/srep33082] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 08/19/2016] [Indexed: 12/22/2022] Open
Abstract
The prevalence of hyperuricemia and gout has been increasing, but the comparative effectiveness and safety of different treatments remain uncertain. We aimed to compare the effectiveness and safety of different treatments for hyperuricemia using network meta-analysis methodology. We systematically reviewed fifteen randomized controlled trials (involving 7,246 patients through January 2016) that compared the effects of different urate-lowering drugs (allopurinol, benzbromarone, febuxostat, pegloticase and probenecid) on hyperuricemia. Drug efficacy and safety, as outcomes, were measured by whether the target level of serum urate acid was achieved and whether any adverse events occurred, respectively. We derived pooled effect sizes expressed as odds ratios (ORs) and 95% confidence intervals (CIs). The efficacy and safety of the drugs were ranked by cumulative ranking probabilities. Our findings show that febuxostat, benzbromarone, probenecid, pegloticase, and allopurinol were all highly effective at reducing the risk of hyperuricemia compared to placebo. Febuxostat had the best efficacy and safety compared to the other drugs. Furthermore, febuxostat 120 mg QD was more effective at achieving urate-lowering targets (OR: 0.17, 95% CI: 0.12-0.24) and safer (OR: 0.72, 95% CI: 0.56-0.91) than allopurinol.
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Affiliation(s)
- Shu Li
- Department of Health Service & Care Management, School of Public Health, Tianjin Medical University, Tianjin, 300070, China
- Metabolic Disease Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, 300070, China
| | - Hongxi Yang
- Department of Health Service & Care Management, School of Public Health, Tianjin Medical University, Tianjin, 300070, China
- Metabolic Disease Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, 300070, China
| | - Yanan Guo
- Department of Health Service & Care Management, School of Public Health, Tianjin Medical University, Tianjin, 300070, China
| | - Fengjiang Wei
- Research Center of Basic Medical Sciences, Tianjin Medical University, Tianjin, 300070, China
| | - Xilin Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, 300070, China
| | - Daiqing Li
- Metabolic Disease Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, 300070, China
| | - Mingzhen Li
- Metabolic Disease Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, 300070, China
| | - Weili Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, 300070, China
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Weidong Li
- Research Center of Basic Medical Sciences, Tianjin Medical University, Tianjin, 300070, China
| | - Li Sun
- Department of Health Service & Care Management, School of Public Health, Tianjin Medical University, Tianjin, 300070, China
| | - Ying Gao
- Department of Health Service & Care Management, School of Public Health, Tianjin Medical University, Tianjin, 300070, China
| | - Yaogang Wang
- Department of Health Service & Care Management, School of Public Health, Tianjin Medical University, Tianjin, 300070, China
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Hayashino Y, Okamura S, Tsujii S, Ishii H. Association of serum uric acid levels with the risk of development or progression of albuminuria among Japanese patients with type 2 diabetes: a prospective cohort study [Diabetes Distress and Care Registry at Tenri (DDCRT 10)]. Acta Diabetol 2016; 53:599-607. [PMID: 26935413 DOI: 10.1007/s00592-015-0825-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Accepted: 12/06/2015] [Indexed: 12/22/2022]
Abstract
AIMS To assess the prospective association between baseline serum uric acid level and subsequent risk of development or progression in albuminuria. METHODS Longitudinal data were obtained from 2518 patients with type 2 diabetes in the development cohort and registered in a Japanese diabetes registry. To assess the independent correlations between baseline serum uric acid quartiles and either the development or progression of diabetic nephropathy for 2 years, the Cox proportional hazards model was used and adjusted for potential confounders. RESULTS The mean patient age, body mass index, and glycated hemoglobin (HbA1c) level were 66.1 years, 24.6 kg/m(2), and 7.5 % (57.6 mmol/mol), respectively. The baseline serum uric acid levels, with mean values of 3.6, 4.9, 5.8, and 7.3 mg/dL from the first to fourth quartiles, were significantly associated with the urinary albumin/creatinine ratio at baseline (p < 0.001). Baseline uric acid levels were not significantly associated with the development of nephropathy, but they were with the progression of nephropathy. The multivariable-adjusted hazards ratios for the progression from microalbuminuria to macroalbuminuria were 2.17 [95 % confidence interval (CI) 1.15-4.08; p = 0.016], 3.04 (95 % CI 1.67-5.53; p < 0.001), and 3.56 (95 % CI 1.83-6.93; p < 0.0011) for the first, third, and fourth quartiles of serum uric acid levels, respectively, as compared to that for the second quartile. We did not observe significant association between uric acid levels and change in estimated glomerular filtration rate. CONCLUSIONS Low and high serum uric levels, independent of possible confounders, were associated with a subsequent risk of progression, not development, in albuminuria in type 2 diabetes patients. Therefore, serum uric acid levels may be useful for predicting the future risk of progression of microalbuminuria.
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Affiliation(s)
- Yasuaki Hayashino
- Department of Endocrinology, Tenri Hospital, 200 Mishima-cho, Tenri City, Nara, 632-8552, Japan.
| | - Shintaro Okamura
- Department of Endocrinology, Tenri Hospital, 200 Mishima-cho, Tenri City, Nara, 632-8552, Japan
| | - Satoru Tsujii
- Department of Endocrinology, Tenri Hospital, 200 Mishima-cho, Tenri City, Nara, 632-8552, Japan
| | - Hitoshi Ishii
- Department of Diabetology, Nara Medical University, Kashihara, Nara, 634-8521, Japan
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Abstract
Previous epidemiological studies have suggested that uric acid is an independent risk factor for incident hypertension, whereas few studies have evaluated the effect of hyperuricemia on blood pressure control in hypertensive patients. We investigated whether hyperuricemia predicts uncontrolled hypertension through a large-scale prospective cohort study with hypertensive patients treated with fimasartan in the Republic of Korea (the Kanarb-Metabolic Syndrome study).Of the 10,601 hypertensive patients who were recruited from 582 private clinics and 11 university hospitals at baseline, 7725 completed the follow-up after 3 months of fimasartan medication, and 6506 were included in the analysis after excluding those with missing values. We estimated the risk of uncontrolled hypertension after 3 months (≥130/80 mm Hg in those with diabetes or chronic renal failure and ≥140/90 mm Hg in the remaining patients) related with baseline hyperuricemia (serum uric acid ≥7 mg/dL in males ≥6 mg/dL in females) using multiple logistic regression models.Hyperuricemia increased the risk of uncontrolled hypertension after 3 months of fimasartan medication (odds ratio, 1.247; 95% confidence interval, 1.063-1.462). Males in the highest quartile of uric acid level were at a 1.322 (95% confidence interval, 1.053-1.660) times higher risk of uncontrolled hypertension in reference to the lowest quartile; the same analyses in females were not significant. Patients without metabolic syndrome had significantly higher odds of uncontrolled hypertension with hyperuricemia (odds ratio, 1.328; 95% confidence interval, 1.007-1.751).Hyperuricemia predicted uncontrolled hypertension even after 3 months of fimasartan treatment in hypertensive patients.
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Affiliation(s)
- Jaelim Cho
- Department of Occupational and Environmental Medicine, Gachon University Gil Medical Center, Incheon
| | - Changsoo Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul
- Correspondence: Changsoo Kim, Department of Preventive Medicine, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Korea (e-mail: ); Dae Ryong Kang, Department of Humanities and Social Medicine, Ajou University School of Medicine, Yeongtong-gu, Suwon, Korea (e-mail: )
| | - Dae Ryong Kang
- Department of Humanities and Social Medicine, Ajou University School of Medicine, Suwon
- Correspondence: Changsoo Kim, Department of Preventive Medicine, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Korea (e-mail: ); Dae Ryong Kang, Department of Humanities and Social Medicine, Ajou University School of Medicine, Yeongtong-gu, Suwon, Korea (e-mail: )
| | - Jeong Bae Park
- Department of Medicine/Cardiology, Cheil General Hospital, Kwandong University College of Medicine, Seoul, Korea
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Neupane S, Dubey RK, Gautam N, Agrawal KK, Jayan A, Shrestha S, Jha AC. Association between serum uric acid, urinary albumin excretion, and glycated hemoglobin in Type 2 diabetic patient. Niger Med J 2016; 57:119-23. [PMID: 27226687 PMCID: PMC4872489 DOI: 10.4103/0300-1652.182074] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background: Diabetes mellitus (DM) is a chronic disease characterized by insulin deficiency or peripheral resistance resulting in hyperglycemia. Poor glycemic control leads to diabetic complications. Hyperuricemia has been reported with increased risk of renal insufficiency. The aim of this study was to evaluate the relationship between serum uric acid concentration, degree of urinary albumin excretion (UAE) and glycated hemoglobin (HbA1c) in Type 2 DM (T2DM) patients. Materials and Methods: Serum uric acid concentrations, urine microalbumin, and HbA1c were measured in fifty T2DM patients. We then evaluated relationship between uric acid concentrations, degree of UAE and glycemic control as well as other confounding variables. Results: Serum uric acid concentration correlated positively with UAE (r = 0.323, P < 0.05), age (r = 0.337, P < 0.05), age at onset (r = 0.341, P < 0.05), and duration of DM (r = 0.312, P < 0.05). Multiple regression analysis demonstrated that serum uric acid concentration (β = 0.293, P < 0.0001), duration of DM (β = 0.261, P < 0.0001), HbA1c (β = 0.173, P < 0.005), and systolic blood pressure (β = 0.268, P < 0.005) were independent determinants of UAE. Conclusions: Serum uric acid concentration is associated with microalbuminuria and HbA1c in T2DM patients.
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Affiliation(s)
- Sunita Neupane
- Department of Biochemistry, Universal College of Medical Sciences, Bhairawaha, Nepal
| | - Raju Kumar Dubey
- Department of Biochemistry, Universal College of Medical Sciences, Bhairawaha, Nepal
| | - Narayan Gautam
- Department of Biochemistry, Universal College of Medical Sciences, Bhairawaha, Nepal
| | - Krishna Kumar Agrawal
- Department of Internal Medicine, Universal College of Medical Sciences, Bhairawaha, Nepal
| | - Archana Jayan
- Department of Biochemistry, Universal College of Medical Sciences, Bhairawaha, Nepal
| | - Sujata Shrestha
- Department of Biochemistry, Universal College of Medical Sciences, Bhairawaha, Nepal
| | - Amit Chandra Jha
- Department of Biochemistry, Universal College of Medical Sciences, Bhairawaha, Nepal
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Febuxostat and Increased Dialysis as a Treatment for Severe Tophaceous Gout in a Hemodialysis Patient. Case Rep Nephrol 2016; 2016:9106935. [PMID: 27200198 PMCID: PMC4856909 DOI: 10.1155/2016/9106935] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 04/05/2016] [Indexed: 11/18/2022] Open
Abstract
Uric acid accumulates in renal failure and is thought to be a uremic toxin—that is, higher levels of uric acid are more damaging to the kidneys. Urate crystals can precipitate in the kidney tubules, cause urate stones, and promote inflammatory changes in the renal interstitium and vascular endothelium. Uric acid is also a small non-protein-bound molecule and therefore easily dialyzable. Here, we present the case of an anuric hemodialysis patient with severe tophaceous gout who regained some renal function and whose gout burden significantly decreased resulting in marked improvement in functional status using a new gout medication, febuxostat, and increased frequency of dialysis.
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Kanbay M, Jensen T, Solak Y, Le M, Roncal-Jimenez C, Rivard C, Lanaspa MA, Nakagawa T, Johnson RJ. Uric acid in metabolic syndrome: From an innocent bystander to a central player. Eur J Intern Med 2016; 29:3-8. [PMID: 26703429 PMCID: PMC4826346 DOI: 10.1016/j.ejim.2015.11.026] [Citation(s) in RCA: 232] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 11/24/2015] [Accepted: 11/29/2015] [Indexed: 02/07/2023]
Abstract
Uric acid, once viewed as an inert metabolic end-product of purine metabolism, has been recently incriminated in a number of chronic disease states, including hypertension, metabolic syndrome, diabetes, non-alcoholic fatty liver disease, and chronic kidney disease. Several experimental and clinical studies support a role for uric acid as a contributory causal factor in these conditions. Here we discuss some of the major mechanisms linking uric acid to metabolic and cardiovascular diseases. At this time the key to understanding the importance of uric acid in these diseases will be the conduct of large clinical trials in which the effect of lowering uric acid on hard clinical outcomes is assessed. Elevated uric acid may turn out to be one of the more important remediable risk factors for metabolic and cardiovascular diseases.
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Affiliation(s)
- Mehmet Kanbay
- Department of Medicine, Division of Nephrology, Koc University School of Medicine, Istanbul, Turkey.
| | - Thomas Jensen
- Division of Renal Diseases and Hypertension, University of Colorado, Aurora, CO, USA
| | - Yalcin Solak
- Department of Medicine, Division of Nephrology, Sakarya Training and Research Hospital, Sakarya, Turkey
| | - Myphuong Le
- Division of Renal Diseases and Hypertension, University of Colorado, Aurora, CO, USA
| | - Carlos Roncal-Jimenez
- Division of Renal Diseases and Hypertension, University of Colorado, Aurora, CO, USA
| | - Chris Rivard
- Division of Renal Diseases and Hypertension, University of Colorado, Aurora, CO, USA
| | - Miguel A Lanaspa
- Division of Renal Diseases and Hypertension, University of Colorado, Aurora, CO, USA
| | - Takahiko Nakagawa
- TMK Project, Medical Innovation Center, Kyoto University, Kyoto, Japan
| | - Richard J Johnson
- Division of Renal Diseases and Hypertension, University of Colorado, Aurora, CO, USA; Division of Nephrology, Eastern Colorado Health Care System, Department of Veteran Affairs, Denver, CO, USA
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Xia M, Abais JM, Koka S, Meng N, Gehr TW, Boini KM, Li PL. Characterization and Activation of NLRP3 Inflammasomes in the Renal Medulla in Mice. Kidney Blood Press Res 2016; 41:208-21. [PMID: 27010539 DOI: 10.1159/000443424] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND/AIMS Recent studies have indicated that local inflammatory mediators are importantly involved in the regulation of renal function. However, it remains unknown how such local inflammation is triggered intracellularly in the kidney. The present study was designed to characterize the inflammasome centered by Nlrp3 in the kidney and also test the effect of its activation in the renal medulla. METHODS AND RESULTS By immunohistochemistry analysis, we found that inflammasome components, Nlrp3, Asc and caspase-1, were ubiquitously distributed in different kidney areas. The caspase-1 activity and IL-1β production were particularly high in the renal outer medulla compared to other kidney regions. Further confocal microscopy and RT-PCR analysis showed that Nlrp3, Asc and caspase-1 were particularly enriched in the thick ascending limb of Henle's loop. In anesthetized mice, medullary infusion of Nlrp3 inflammasome activator, monosodium urate (MSU), induced significant decreases in sodium excretion and medullary blood flow without changes in mean arterial blood pressure and renal cortical blood flow. Caspase-1 inhibitor, Ac-YVAD-CMK and deletion of Nlrp3 or Asc gene abolished MSU-induced decreases in renal sodium excretion and MBF. CONCLUSION Our results indicate that renal medullary Nlrp3 inflammasomes represent a new regulatory mechanism of renal MBF and sodium excretion which may not depend on classical inflammatory response.
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Affiliation(s)
- Min Xia
- Department of Pharmacology & Toxicology, Virginia Commonwealth University, Richmond, VA, USA
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Do kidney stone formers have a kidney disease? Kidney Int 2015; 88:1240-1249. [PMID: 26376133 PMCID: PMC4675687 DOI: 10.1038/ki.2015.254] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 07/09/2015] [Accepted: 07/15/2015] [Indexed: 12/13/2022]
Abstract
Nephrolithiasis is a highly prevalent disorder affecting approximately one in eleven people and is associated with multiple complications including hypertension, cardiovascular disease, and chronic kidney disease. Significant epidemiologic associations with chronic kidney disease and ESRD have been noted and are reviewed herein, but debate persists in the literature as to whether kidney stone formation is a pathogenic process contributing to kidney disease. Corroborating evidence supporting the presence of kidney disease in stone formers includes the variability of renal function by stone type, the positive association of stone size with renal dysfunction, the presence of markers of renal injury in the urine of even asymptomatic stone formers, and direct evidence of renal tissue injury on histopathology. Proposed pathogenic mechanisms include recurrent obstruction and comorbid conditions such as recurrent urinary tract infections and structural abnormalities. Recent work evaluating the renal histopathology of different groups of stone formers adds further granularity, suggesting variability in mechanisms of renal injury by stone type and confirming the pathogenic effects of crystal formation. Genetic abnormalities leading to stone formation including cystinuria and primary hyperoxaluria, among others, contribute to the burden of disease in the stone-forming population.
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