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Kang MG, Baek JY, Jo Y, Ryu D, Jang IY, Jung HW, Kim BJ. Higher serum uric acid as a risk factor for frailty in older adults: A nationwide population-based study. J Cachexia Sarcopenia Muscle 2024. [PMID: 39155060 DOI: 10.1002/jcsm.13561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 06/22/2024] [Accepted: 07/18/2024] [Indexed: 08/20/2024] Open
Abstract
BACKGROUND Uric acid (UA), the terminal breakdown product of purine metabolism, possesses contradictory roles, functioning both as an inflammatory mediator and as an antioxidant. Its clinical relevance, particularly in geriatric populations, remains a topic of ongoing debate. Aiming to elucidate whether circulating UA is detrimental or beneficial to human health, we investigate the association between serum UA concentrations and the frailty index-a comprehensive measure of biological aging in a nationally representative cohort of community-dwelling older adults. METHODS We conducted a population-based, cross-sectional study utilizing data from the Korea National Health and Nutrition Examination Survey. The sample included 4268 participants aged 65 years and above. A deficit accumulation frailty index (FI) was constructed using 38 items that assess physical, cognitive, psychological, and social domains. Based on the FI, participants were categorized into non-frail (FI ≤ 0.15), pre-frail (0.15 < FI ≤ 0.25), or frail (FI > 0.25). Serum UA levels were quantified through a colorimetric enzymatic assay. RESULTS After controlling for confounders such as age, sex, socioeconomic status (including income and education level), lifestyle factors (smoking status), and medical history (hypertension, diabetes, dyslipidemia, stroke, cardiovascular diseases), and body mass index, serum UA levels were observed to be significantly higher in frail participants compared with their non-frail counterparts (P < 0.001). Furthermore, serum UA concentrations demonstrated a positive correlation with the FI (P < 0.001), and the odds ratio for frailty per 1 mg/dL increase in serum UA was 1.22 (P < 0.001). Additionally, older adults in the highest quartile of UA levels exhibited a significantly higher FI and 1.66-fold increased odds of frailty compared with those in the lowest quartile (P = 0.011 and P = 0.005, respectively). CONCLUSIONS These findings suggest that elevated circulating UA levels may act as a pro-aging factor rather than an anti-aging one in older adults, highlighting its potential role in accelerating biological aging. The data further support the utility of serum UA as a potential blood-based biomarker for frailty in this demographic, contributing to the expanding evidence on its significance in geriatric health assessments.
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Affiliation(s)
- Min-Gu Kang
- Department of Internal Medicine, Chonnam National University Bitgoeul Hospital, Gwangju, South Korea
| | - Ji Yeon Baek
- Department of Internal Medicine, Division of Geriatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yunju Jo
- Department of Biomedical Science and Engineering, Gwangju Institute of Science and Technology, Gwangju, South Korea
| | - Dongryeol Ryu
- Department of Biomedical Science and Engineering, Gwangju Institute of Science and Technology, Gwangju, South Korea
| | - Il-Young Jang
- Department of Internal Medicine, Division of Geriatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hee-Won Jung
- Department of Internal Medicine, Division of Geriatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Beom-Jun Kim
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Johnson RJ, Mandell BF, Schlessinger N, Mount DB, Botson JK, Abdellatif AA, Rhoades R, Singh JA. Controversies and practical management of patients with gout and chronic kidney disease. Kidney Int 2024:S0085-2538(24)00473-3. [PMID: 39033815 DOI: 10.1016/j.kint.2024.05.033] [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: 02/20/2024] [Revised: 04/05/2024] [Accepted: 05/28/2024] [Indexed: 07/23/2024]
Abstract
Uric acid is a toxin retained with advancing kidney disease. Clinical manifestations of hyperuricemia include gout and systemic inflammation that are associated with increased risk of cardiovascular mortality. As many as one-third of all patients with chronic kidney disease have a history of gout, yet <25% of these patients are effectively treated to target serum urate levels of ≤6 mg/dl. A major reason for ineffective management of gout and hyperuricemia is the complexity in managing these patients, with some medications contraindicated and others requiring special dosing, potential drug interactions, and other factors. Consequently, many nephrologists do not primarily manage gout despite it being a common complication of chronic kidney disease, leaving management to the primary physician or rheumatologist. We believe that kidney specialists should consider gout as a major complication of chronic kidney disease and actively manage it in their patients. Here, we present insights from nephrologists and rheumatologists into a team approach to gout management that includes the nephrologist.
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Affiliation(s)
- Richard J Johnson
- Division of Renal Diseases, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Brian F Mandell
- Department of Rheumatologic and Immunologic Disease, Cleveland Clinic Lerner College of Medicine of Case Western University, Cleveland, Ohio, USA
| | - Naomi Schlessinger
- Division of Rheumatology, Spencer Fox Eccles School of Medicine, University of Utah, XXXX, Utah, USA
| | - David B Mount
- Renal Divisions, Brigham and Women's Hospital and VA Boston Healthcare System, Harvard Medical School, Boston; Massachusetts, USA
| | - John K Botson
- Orthopedic Physicians Alaska, Anchorage, Alaska, USA
| | | | | | - Jasvinder A Singh
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
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Liu Y, Han Y, Liu Y, Huang C, Feng W, Cui H, Li M. Xanthoceras sorbifolium leaves alleviate hyperuricemic nephropathy by inhibiting the PI3K/AKT signaling pathway to regulate uric acid transport. JOURNAL OF ETHNOPHARMACOLOGY 2024; 327:117946. [PMID: 38447615 DOI: 10.1016/j.jep.2024.117946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 01/27/2024] [Accepted: 02/19/2024] [Indexed: 03/08/2024]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE In China, Xanthoceras sorbifolium Bunge was first documented as "Wen Guan Hua" in the "Jiu Huang Ben Cao" in 1406 A.D. According to the "National Compilation of Chinese Herbal Medicine," X. sorbifolium leaves are sweet and flat in nature and can dispel wind and dampness, suggesting that their extract can be used to treat rheumatoid arthritis. X. sorbifolium Bunge has also been used to treat arteriosclerosis, hyperlipidemia, hypertension, chronic hepatitis, and rheumatism, complications associated with hyperuricemic nephropathy (HN), a condition characterized by kidney damage resulting from high levels of uric acid (UA) in the blood. AIM OF THE STUDY The purpose of this study was to investigate the effects and underlying mechanisms of a 70% ethanol extract from X. sorbifolium leaves (EX) in alleviating HN. MATERIALS AND METHODS A mouse model of hyperuricemia was established to initially evaluate the hypouricemic effects and determine the effective dose of EX. Phytochemical analyses were conducted using ultra high-performance liquid chromatography and liquid chromatography-mass spectroscopy. The potential key pathways of EX in the alleviation of HN were inferred using network pharmacology and bioinformatics. An HN rat model was then established, and experiments including biomarker detection, western blotting, reverse transcription quantitative polymerase chain reaction, immunohistochemical and Masson's trichrome staining, and transmission electron microscopy were conducted to evaluate the effect of EX on UA transporter expression in vitro. RESULTS Network pharmacology and bioinformatics analyses revealed that the phosphoinositide 3-kinase (PI3K)/AKT signaling pathway was the key pathway for the alleviation of HN progression by EX. EX treatment reduced serum biomarkers in HN rats, downregulated the expression of p-PI3K, p-AKT, glucose transporter 9 (GLUT9), urate transporter 1 (URAT1), Collagen I, matrix metalloproteinase (MMP)-2, and MMP-9, and upregulated the expression of ATP binding cassette subfamily G member 2 (ABCG2) to improve renal interstitial fibrosis in HN rats. A high content of both quercitrin and cynaroside were identified in EX; their administration inhibited the increased expression of GLUT9 and URAT1 in damaged HK-2 cells. CONCLUSION Our study provides evidence that EX alleviates HN. The potential mechanism underlying this effect may be the regulation of UA transporters, such as GLUT9 and URAT1, by limiting the activation of the PI3K/AKT signaling pathway to improve renal injury.
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Affiliation(s)
- Yuchao Liu
- Qiqihar Medical University, Qiqihar, 161006, China
| | - Yunqi Han
- Peking University Cancer Hospital (Inner Mongolia Campus)/Affiliated Cancer Hospital of Inner Mongolia Medical University, Hohhot, 010020, China
| | - Yuquan Liu
- Traditional Chinese Medicine Hospital of Inner Mongolia Autonomous Region, Hohhot, 010020, China
| | | | - Wanze Feng
- Baotou Medical College, Baotou, 014040, China
| | - Hongwei Cui
- Peking University Cancer Hospital (Inner Mongolia Campus)/Affiliated Cancer Hospital of Inner Mongolia Medical University, Hohhot, 010020, China.
| | - Minhui Li
- Baotou Medical College, Baotou, 014040, China; Qiqihar Medical University, Qiqihar, 161006, China; Traditional Chinese Medicine Hospital of Inner Mongolia Autonomous Region, Hohhot, 010020, China; Inner Mongolia Key Laboratory of Characteristic Geoherbs Resources Protection and Utilization, Baotou, 014040, China.
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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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Liu YF, Han L, Geng YH, Wang HH, Yan JH, Tu SH. Nonlinearity association between hyperuricemia and all-cause mortality in patients with chronic kidney disease. Sci Rep 2024; 14:673. [PMID: 38182707 PMCID: PMC10770354 DOI: 10.1038/s41598-023-51010-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 12/29/2023] [Indexed: 01/07/2024] Open
Abstract
Controversy surrounds the role of serum uric acid and whether treatment intervention is favorable in retarding the progression of chronic kidney disease (CKD). The association of serum uric acid levels and CKD patient mortality risk needs to be further determined by large sample cohort studies. The National Health and Nutrition Examination Survey participants with CKD from 1998 to 2017 were enrolled in the study. Multivariable Cox regression models were used to reveal the association of serum uric acid concentrations and CKD mortality risks. A total of 9891 CKD patients were enrolled in the study, and 3698 individuals died during the follow-up. Increasing serum uric acid levels are independently relevant to higher mortality risks of CKD patients (HR per SD increase). A restricted cubic spline curve showed a nonlinear association between serum uric acid and CKD mortality risks (p for nonlinearity = 0.046). CKD patients with higher levels of serum uric acid (≥ 5.900 mg/dL) show a significant increase in mortality risks (HR = 1.102, 95% CI 1.043-1.165). Sensitivity analysis demonstrated that the results were stable and robust. High serum uric acid levels (≥ 5.900 mg/dL) may be associated with increased mortality risks in CKD patients.
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Affiliation(s)
- Ya-Fei Liu
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe East Road, Zhengzhou, 450052, Henan, China.
| | - Liang Han
- Institute of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, Hubei, China
| | - Yin-Hong Geng
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe East Road, Zhengzhou, 450052, Henan, China
| | - Huan-Huan Wang
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe East Road, Zhengzhou, 450052, Henan, China
| | - Jia-Hui Yan
- Institute of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, Hubei, China
| | - Sheng-Hao Tu
- Institute of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, Hubei, China
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Lu J, He Y, Yang Y, Zhong X, Chen S, Wu B, Pan Y, Wang Y, Xiu J, Kang Y, Liu J, Liu Y, Chen S, Chen K, Chen L. Age-Related Effect of Uric Acid on Contrast-Induced Acute Kidney Injury of Patients Undergoing Coronary Angiography. Clin Interv Aging 2023; 18:2053-2061. [PMID: 38088947 PMCID: PMC10712252 DOI: 10.2147/cia.s419370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 11/08/2023] [Indexed: 12/18/2023] Open
Abstract
Background The association between uric acid (UA) and contrast-induced acute kidney injury (CI-AKI) following coronary angiography (CAG) has been established. However, whether the association would vary with age remained undetermined. Methods We performed the retrospective analysis based on the Cardio-renal Improvement II study, (ClinicalTrials.gov NCT05050877), which enrolled consecutive patients undergoing coronary angiography in 5 teaching hospitals in China from 2007 to 2020. The primary outcome was CI-AKI defined as the rise of serum creatinine (SCr) ≥ 0.5 mg/dL or 25% compared with the baseline value within 48 hours following CAG. The effect of age on the association between uric acid and CI-AKI was assessed by the logistic regression model. Results A total of 36,550 patients (mean age 63.08±5.6-year-old, 41.7% men) were included in the study. After adjusting for the confounders, the risk of CI-AKI between each quartile of uric acid was insignificant in the young group. In patients of the middle group, lower UA was associated with a lower risk of CI-AKI while higher UA was associated with a higher risk (Q1 OR: 0.853, 95% CI: 0.734-0.993; Q4 OR: 1.797, 95% CI: 1.547-2.09). In patients of the elder group, lower and higher UA were both associated with a higher risk of CI-AKI (Q1 OR: 1.247, 95% CI: 1.003-1.553; Q4 OR: 1.688, 95% CI: 1.344-2.124). The restricted cubic spline indicated a non-linear association between UA and CI-AKI in middle and elder age groups but a linear association in the young age group. Conclusion The association between uric acid and CI-AKI vary in patients of different age. Patients with elder age should maintain a middle level of uric acid while patients with middle age should consider a lower level of uric acid to reduce the risk of CI-AKI. The level of UA was an insignificant risk factor for CI-AKI in young patients.
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Affiliation(s)
- Jin Lu
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, People’s Republic of China
| | - Yibo He
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, People’s Republic of China
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, People’s Republic of China
| | - Yanfang Yang
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, People’s Republic of China
| | - Xuejing Zhong
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, People’s Republic of China
| | - Shaowen Chen
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, People’s Republic of China
| | - Bo Wu
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, People’s Republic of China
| | - Yuxiong Pan
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, People’s Republic of China
| | - Yizhang Wang
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, People’s Republic of China
| | - Jiaming Xiu
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, People’s Republic of China
| | - Yu Kang
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, People’s Republic of China
- Department of Cardiology, Shantou University Medical College, Shantou, 515041, People’s Republic of China
| | - Jin Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, People’s Republic of China
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, People’s Republic of China
| | - Yong Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, People’s Republic of China
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, People’s Republic of China
| | - Shiqun Chen
- Global Health Research Center, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Science, Southern Medical University, Guangzhou, 510100, People’s Republic of China
| | - Kaihong Chen
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, People’s Republic of China
| | - Liling Chen
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, People’s Republic of China
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Song J, Li H, Fang X. Inverted U-shaped relationship between coffee consumption and serum uric acid in American chronic kidney disease population. Front Nutr 2023; 10:1286430. [PMID: 38099187 PMCID: PMC10719848 DOI: 10.3389/fnut.2023.1286430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/17/2023] [Indexed: 12/17/2023] Open
Abstract
Objective The objective of this study was to examine the contentious relationship between coffee consumption and serum uric acid (SUA) levels, specifically within American population with chronic kidney disease (CKD). Methods A total of 23,381 participants from the 2001-2018 National Health and Nutrition Examination Survey (NHANES) were selected for inclusion in this investigation. Linear regression models and generalized additive models with smooth curve fitting were employed to analyze the association between log coffee consumption and serum uric acid levels. Furthermore, the robustness of the findings was assessed across diverse populations. Results The results of the linear regression analysis indicate a positive and marginally statistically significant (p = 0.0307) association between log coffee consumption and SUA, even after controlling for other variables. Furthermore, the generalized additive model revealed a nonlinear relationship characterized by an inverted U-shape between log coffee consumption and SUA. The inflection point, identified as 11.43 g/day, marks the point at which this relationship changes direction. Moreover, this inverted U-shaped relationship was consistently observed across various subgroups, including gender, age (<60 and ≥ 60 years), hypertensive and non-hypertensive individuals, those with and without cardiovascular disease, non-diabetic individuals, and those who consumed coffee with or without caffeine or sugar. Conclusion An inverse U-shaped correlation has been observed between log coffee consumption and SUA levels. This finding implies that once coffee consumption surpasses a specific threshold, it promotes a decline in SUA levels.
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Affiliation(s)
- Jianling Song
- Department of Nephrology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Hong Li
- Department of Medical Records, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xiangdong Fang
- Department of Nephrology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
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Xu K, Zhang L, Wang T, Ren Z, Yu T, Zhang Y, Zhao X. Untargeted metabolomics reveals dynamic changes in metabolic profiles of rat supraspinatus tendon at three different time points after diabetes induction. Front Endocrinol (Lausanne) 2023; 14:1292103. [PMID: 38053726 PMCID: PMC10694349 DOI: 10.3389/fendo.2023.1292103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/01/2023] [Indexed: 12/07/2023] Open
Abstract
Objective To investigate the dynamic changes of metabolite composition in rat supraspinatus tendons at different stages of diabetes by untargeted metabolomics analysis. Methods A total of 80 Sprague-Dawley rats were randomly divided into normal (NG, n = 20) and type 2 diabetes mellitus groups (T2DM, n = 60) and subdivided into three groups according to the duration of diabetes: T2DM-4w, T2DM-12w, and T2DM-24w groups; the duration was calculated from the time point of T2DM rat model establishment. The three comparison groups were set up in this study, T2DM-4w group vs. NG, T2DM-12w group vs. T2DM-4w group, and T2DM-24w group vs. T2DM-12w group. The metabolite profiles of supraspinatus tendon were obtained using tandem mass spectrometry. Metabolomics multivariate statistics were used for metabolic data analysis and differential metabolite (DEM) determination. The intersection of the three comparison groups' DEMs was defined as key metabolites that changed consistently in the supraspinatus tendon after diabetes induction; then, Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis was performed. Results T2DM-4w group vs. NG, T2DM-12w group vs. T2DM-4w group, and T2DM-24w group vs. T2DM-12w group detected 94 (86 up-regulated and 8 down-regulated), 36 (13 up-regulated and 23 down-regulated) and 86 (24 up-regulated and 62 down-regulated) DEMs, respectively. Seven key metabolites of sustained changes in the supraspinatus tendon following induction of diabetes include D-Lactic acid, xanthine, O-acetyl-L-carnitine, isoleucylproline, propoxycarbazone, uric acid, and cytidine, which are the first identified biomarkers of the supraspinatus tendon as it progresses through the course of diabetes. The results of KEGG pathway enrichment analysis showed that the main pathway of supraspinatus metabolism affected by diabetes (p < 0.05) was purine metabolism. The results of the KEGG metabolic pathway vs. DEMs correlation network graph revealed that uric acid and xanthine play a role in more metabolic pathways. Conclusion Untargeted metabolomics revealed the dynamic changes of metabolite composition in rat supraspinatus tendons at different stages of diabetes, and the newly discovered seven metabolites, especially uric acid and xanthine, may provide novel research to elucidate the mechanism of diabetes-induced tendinopathy.
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Affiliation(s)
- Kuishuai Xu
- Department of Sports Medicine, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Liang Zhang
- Department of Sports Medicine, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Tianrui Wang
- Department of Sports Medicine, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Zhongkai Ren
- Department of Sports Medicine, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Tengbo Yu
- Department of Sports Medicine, Qingdao Municipal Hospital, Qingdao, Shandong, China
| | - Yingze Zhang
- Department of Sports Medicine, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xia Zhao
- Department of Sports Medicine, Affiliated Hospital of Qingdao University, Qingdao, China
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Lee JJ, Lee JS, Chung MK, Ahn JK, Choi HJ, Hong SJ, Yoon CH, Kim SH, Jeong KH, Kim JW, Kim BY, Shin JH, Kim WG, Kim SY, Kim HJ, Song JS, Jun JB, Park HA, Chae SC, Choi BS, Kim TN, Kim HA. Korean guidelines for the management of gout. Korean J Intern Med 2023; 38:641-650. [PMID: 37635283 PMCID: PMC10493448 DOI: 10.3904/kjim.2023.206] [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: 05/06/2023] [Revised: 06/19/2023] [Accepted: 07/03/2023] [Indexed: 08/29/2023] Open
Abstract
Gout is the most common form of arthritis, with the prevalence increasing worldwide. The present treatment guidelines provide recommendations for the appropriate treatment of acute gout, management during the inter-critical period, and prevention of chronic complications. The guidelines were developed based on evidence-based medicine and draft recommendations finalized after expert consensus. These guidelines are designed to provide clinicians with clinical evidence to enable efficient treatment of gout.
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Affiliation(s)
- Jennifer Jooha Lee
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji Soo Lee
- Division of Rheumatology, Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Min Kyung Chung
- Division of Rheumatology, Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Joong Kyong Ahn
- Division of Rheumatology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyo-Jin Choi
- Division of Rheumatology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Seung-Jae Hong
- Division of Rheumatology, Department of Internal Medicine, Kyung Hee University Hospital, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Chong-Hyeon Yoon
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Su-Hyun Kim
- Division of Nephrology, Department of Internal Medicine, Chung-Ang University School of Medicine, Seoul, Korea
| | - Kyung-Hwan Jeong
- Division of Nephrology, Department of Internal Medicine, Kyung Hee University Medical Center, Seoul, Korea
| | - Jong-Woo Kim
- Department of Family Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Bo-Yeon Kim
- Division of Endocrinology & Metabolism, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Jin-Ho Shin
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, Korea
| | - Woo Gyu Kim
- Lights & Salt Internal Medicine, Goyang, Korea
| | - Soo-Young Kim
- Department of Family Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Hyun-Jung Kim
- Institute for Evidence-Based Medicine, Cochrane Korea, Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
| | - Jeong-Soo Song
- Division of Rheumatology, Department of Internal Medicine, Chung-Ang University, School of Medicine, Seoul, Korea
| | - Jae-Bum Jun
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Hyun-Ah Park
- Department of Family Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Shung Chull Chae
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Bum Soon Choi
- Division of Nephrology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Tae Nyun Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Haundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Hyun Ah Kim
- Division of Rheumatology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
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Żyłka W, Tęcza K, Szemela K, Prach P, Żyłka M, Jakubczyk D, Błądziński M, Gala-Błądzińska A, Jakubczyk P. Optical monitoring of hemodialysis using noninvasive measurement of uric acid in the dialysate. Sci Rep 2023; 13:13384. [PMID: 37591932 PMCID: PMC10435447 DOI: 10.1038/s41598-023-40335-x] [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] [Received: 04/06/2023] [Accepted: 08/09/2023] [Indexed: 08/19/2023] Open
Abstract
The aim of this study was to present a methodology for predicting changes in uric acid concentrations in the blood of chronically hemodialyzed patients based on an optical measurement of the intensity of selected wavelengths in the dialysate. Blood samples were taken from the arterial line every 30 min throughout the hemodialysis period, to measure uric acid levels. Simultaneously, optical measurements were made on dialysate flowing from the dialyzer. Uric acid concentration can be measured either directly from the blood or from dialyzer outflow with acceptable error. In addition, both methods reveal any increased dynamics in uric acid concentration in the initial phase of hemodialysis. The wavelength of the light was adjusted for optimal uric acid particle detection. Comparing the uric acid concentration measured in the blood of patients with the intensity of wave absorption in the dialysate, the functional relationship between the uric acid concentration levels was determined. Using the optical method for measuring uric acid concentration in the dialysate, the concentration of uric acid in the blood during hemodialysis can be non-invasively and accurately estimated. This method can be used to assess the adequacy of hemodialysis by computer acquisition of uric acid concentrations determined in on-line dialysate.
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Affiliation(s)
- Wojciech Żyłka
- Institute of Materials Engineering, College of Natural Sciences, University of Rzeszow, Rzeszow, Poland.
| | - Krystyna Tęcza
- Institute of Medical Sciences, Medical College of Rzeszow University, Rzeszow, Poland
| | - Krzysztof Szemela
- Institute of Physics, College of Natural Sciences, University of Rzeszow, Rzeszow, Poland
| | - Piotr Prach
- University of Information Technology and Management in Rzeszow, Rzeszow, Poland
| | - Marta Żyłka
- The Faculty of Mechanical Engineering and Aeronautics, Department of Aerospace Engineering, Rzeszow University of Technology, Rzeszow, Poland
| | - Dorota Jakubczyk
- Faculty of Mathematics and Applied Physics, Rzeszow University of Technology, Rzeszow, Poland
| | - Maciej Błądziński
- Institute of Medical Sciences, Medical College of Rzeszow University, Rzeszow, Poland
| | - Agnieszka Gala-Błądzińska
- Institute of Medical Sciences, Medical College of Rzeszow University, Rzeszow, Poland
- Department of Internal Medicine, Nephrology and Endocrinology, St. Queen Jadwiga Clinical District Hospital No. 2 in Rzeszow, Rzeszow, Poland
| | - Paweł Jakubczyk
- Institute of Physics, College of Natural Sciences, University of Rzeszow, Rzeszow, Poland
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Kim YK, Yang YM. An analysis of the associations of high-sensitivity C-reactive protein and uric acid with metabolic syndrome components in Korean adults by sex: a cross-sectional study using the Korea national health and nutrition examination survey 2016-2018. BMC Endocr Disord 2023; 23:163. [PMID: 37537612 PMCID: PMC10398993 DOI: 10.1186/s12902-023-01417-z] [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: 08/04/2022] [Accepted: 07/17/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND Low-grade inflammation plays a role in the pathogenesis of metabolic syndrome (MetS), and measuring levels of inflammatory molecules, such as high-sensitivity C-reactive protein (hs-CRP), may indicate Mets progression. Serum uric acid (SUA) has also been identified as an independent risk factor for MetS. This study aimed to investigate the association between MetS components and levels of serum hs-CRP and SUA using representative and reliable data for the Korean population. METHODS This study used the data of the Korea National Health and Nutrition Examination Survey 2016-2018, a cross-sectional and nationally representative survey performed by the Korean Centers for Disease Control and Prevention. RESULTS We analysed the data of 13,454 individuals. High hs-CRP levels were observed in 1,164 (8.7%) subjects while 3,296 (24.5%) subjects had high SUA levels. Moreover, hs-CRP was negatively correlated with serum high-density lipoprotein (HDL) (OR, 1.703; 95% CI, 1.431-2.027). When stratified by sex, this trend remained, but the correlation was stronger in women than in men. Furthermore, high SUA levels were significantly associated with hypertension (HTN) (OR, 1.399; 95% CI, 1.210-1.616), hypertriglyceridemia (OR, 1.735; 95% CI, 1.486-2.026), and low HDL (OR, 1.257; 95% CI, 1.106-1.429), but not with diabetes mellitus (DM) (OR, 0.478; 95% CI, 0.382-0.597). When grouped by sex, this trend remained, however, all MetS components were found to be more prevalent in women with high SUA. CONCLUSIONS Our findings showed that low HDL was more prevalent in subjects with high hs-CRP, and high SUA levels were observed in subjects with HTN, hypertriglyceridemia, and low HDL. However, the prevalence of high SUA was lower in diabetic subjects.
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Affiliation(s)
- Young Kyun Kim
- Department of Pharmacy, College of Pharmacy, Chosun University, 309 Pilmun-daero, Dong-gu, Gwangju, 61452, Republic of Korea
| | - Young-Mo Yang
- Department of Pharmacy, College of Pharmacy, Chosun University, 309 Pilmun-daero, Dong-gu, Gwangju, 61452, Republic of Korea.
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Fan K, Sun T, Yin F. J-shaped association between uric acid and breast cancer risk: a prospective case-control study. J Cancer Res Clin Oncol 2023; 149:7629-7636. [PMID: 36995406 PMCID: PMC10374747 DOI: 10.1007/s00432-023-04725-y] [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] [Received: 03/07/2023] [Accepted: 03/24/2023] [Indexed: 03/31/2023]
Abstract
BACKGROUND/AIM In terms of breast cancer risk, there is no consensus on the effect of uric acid (UA) levels. The aim of our study was to clarify the link between UA and breast cancer risk in a prospective case-control study and to find the UA threshold point. METHODS We designed a case-control study with 1050 females (525 newly diagnosed breast cancer patients and 525 controls). We measured the UA levels at baseline and confirmed the incidence of breast cancer through postoperative pathology. We used binary logistic regression to study the association between breast cancer and UA. In addition, we performed restricted cubic splines to evaluate the potential nonlinear links between UA and breast cancer risk. We used threshold effect analysis to identify the UA cut-off point. RESULTS After adjusting for multiple confounding factors, we found that compared with the referential level (3.5-4.4 mg/dl), the odds ratio (OR) of breast cancer was 1.946 (95% CI 1.140-3.321) (P < 0.05) in the lowest UA level and 2.245 (95% CI 0.946-5.326) (P > 0.05) in the highest level. Using the restricted cubic bar diagram, we disclosed a J-shaped association between UA and breast cancer risk (P-nonlinear < 0.05) after adjusting for all confounders. In our study, 3.6 mg/dl was found to be the UA threshold which acted as the optimal turning point of the curve. The OR for breast cancer was 0.170 (95% CI 0.056-0.512) to the left and 1.283 (95% CI 1.074-1.532) to the right of 3.6 mg/dl UA (P for log likelihood ratio test < 0.05). CONCLUSION We found a J-shaped association between UA and breast cancer risk. Controlling the UA level around the threshold point of 3.6 mg/dl provides a novel insight into breast cancer prevention.
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Affiliation(s)
- Kexin Fan
- Department of Internal Medicine, Hebei Medical University, Shijiazhuang, Hebei, China
- Department of Pneumology, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei, China
| | - Tengfei Sun
- Department of Gastrology, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei, China
| | - Fuzai Yin
- Department of Internal Medicine, Hebei Medical University, Shijiazhuang, Hebei, China.
- Department of Endocrinology, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei, China.
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Lee JJ, Lee JS, Chung MK, Ahn JK, Choi HJ, Hong SJ, Yoon CH, Kim SH, Jeong KH, Kim JW, Kim BY, Shin JH, Kim WG, Kim SY, Kim HJ, Song JS, Jun JB, Park HA, Chae SC, Choi BS, Kim TN, Kim HA. Korean guidelines for the management of gout. JOURNAL OF RHEUMATIC DISEASES 2023; 30:141-150. [PMID: 37476677 PMCID: PMC10351368 DOI: 10.4078/jrd.2023.0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/19/2023] [Accepted: 06/20/2023] [Indexed: 07/22/2023]
Abstract
Gout is the most common form of arthritis, with the prevalence increasing worldwide. The present treatment guidelines provide recommendations for the appropriate treatment of acute gout, management during the inter-critical period, and prevention of chronic complications. The guidelines were developed based on evidence-based medicine and draft recommendations finalized after expert consensus. These guidelines are designed to provide clinicians with clinical evidence to enable efficient treatment of gout.
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Affiliation(s)
- Jennifer Jooha Lee
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji Soo Lee
- Division of Rheumatology, Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Min Kyung Chung
- Division of Rheumatology, Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Joong Kyong Ahn
- Division of Rheumatology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyo-Jin Choi
- Division of Rheumatology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Seung-Jae Hong
- Division of Rheumatology, Department of Internal Medicine, Kyung Hee University Hospital, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Chong-Hyeon Yoon
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Su-Hyun Kim
- Division of Nephrology, Department of Internal Medicine, Chung-Ang University School of Medicine, Seoul, Korea
| | - Kyung-Hwan Jeong
- Division of Nephrology, Department of Internal Medicine, Kyung Hee University Medical Center, Seoul, Korea
| | - Jong-Woo Kim
- Department of Family Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Bo-Yeon Kim
- Division of Endocrinology & Metabolism, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Jin-Ho Shin
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, Korea
| | - Woo Gyu Kim
- Lights & Salt Internal Medicine, Goyang, Korea
| | - Soo-Young Kim
- Department of Family Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Hyun-Jung Kim
- Institute for Evidence-Based Medicine, Cochrane Korea, Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
| | - Jeong-Soo Song
- Division of Rheumatology, Department of Internal Medicine, Chung-Ang University School of Medicine, Seoul, Korea
| | - Jae-Bum Jun
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Hyun-Ah Park
- Department of Family Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Shung Chull Chae
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Bum Soon Choi
- Division of Nephrology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Tae Nyun Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Hyun Ah Kim
- Division of Rheumatology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
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Yuan SL, Kim MH, Lee KM, Jin X, Song ZY, Park JS, Cho YR, Lim K, Yun SC. Sex differences between serum uric acid levels and cardiovascular outcomes in patients with coronary artery disease after stent implantation. Front Cardiovasc Med 2023; 10:1021277. [PMID: 36815018 PMCID: PMC9939523 DOI: 10.3389/fcvm.2023.1021277] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 01/16/2023] [Indexed: 02/09/2023] Open
Abstract
Background The relationship between elevated serum uric acid (SUA) levels and cardiovascular outcomes after stent implantation remains uncertain. This study sought to evaluate the impact of SUA on 12-month cardiovascular outcomes after stent implantation. Methods We performed a retrospective study of patients who successfully underwent stent implantation and enrolled 3,222 patients with coronary artery disease (CAD) from a single center. SUA levels were measured before stent implantation. The patients were divided into six groups (<4, 4-4.9, 5-5.9, 6-6.9, 7-7.9 and ≥ 8 mg/dL) at SUA intervals of 1.0 mg/dL. The incidence of cardiovascular outcomes in the six groups was monitored for 1 year after stent implantation and the hazard ratios were estimated. Hazard ratios (HRs) and 95% confidence intervals (95% CIs) for cardiovascular outcomes were estimated using a Cox proportional hazard regression analysis. The primary endpoint was all-cause death. The secondary endpoint was a composite of all-cause death, myocardial infarction, target vessel revascularization, stent thrombosis and stroke. The follow-up duration was 12 months. Results Over the 12-month follow-up period, there were 101 all-cause deaths and 218 MACCE. After adjustment for several parameters, the group with SUA levels of more than or equal to 8 mg/dL had significantly higher hazard ratios in the incidence of all-cause death or MACCE. The group with <4.0 mg/dL had significantly higher hazard ratios in all-cause death only in male patients. In contrast, there were no significant differences observed for cardiovascular outcomes in female patients. Conclusions Our study identified a U-shaped association between SUA levels and cardiovascular outcomes during 12-month follow-up for males, but not for females. Further studies are warranted to clarify the sex differences between SUA levels and clinical outcomes.
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Affiliation(s)
- Song Lin Yuan
- Department of Cardiology, Dong-A University Hospital, Busan, Republic of Korea
| | - Moo Hyun Kim
- Department of Cardiology, Dong-A University Hospital, Busan, Republic of Korea,*Correspondence: Moo Hyun Kim ✉
| | - Kwang Min Lee
- Department of Cardiology, Dong-A University Hospital, Busan, Republic of Korea
| | - Xuan Jin
- Department of Cardiology, Dong-A University Hospital, Busan, Republic of Korea
| | - Zhao Yan Song
- Department of Cardiology, Dong-A University Hospital, Busan, Republic of Korea
| | - Jong-Sung Park
- Department of Cardiology, Dong-A University Hospital, Busan, Republic of Korea
| | - Young-Rak Cho
- Department of Cardiology, Dong-A University Hospital, Busan, Republic of Korea
| | - Kyunghee Lim
- Department of Cardiology, Dong-A University Hospital, Busan, Republic of Korea
| | - Sung-Cheol Yun
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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15
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Wang Y, Zhang Q, Ren P, Pan Y, Liu Y, Li C, Fan Z, Han F, Zhang X, Chen J. The significance of follow-up serum uric acid levels in predicting all-cause mortality and cardiovascular mortality in peritoneal dialysis patients. Ther Apher Dial 2023; 27:83-90. [PMID: 35670149 PMCID: PMC10084356 DOI: 10.1111/1744-9987.13892] [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: 02/04/2022] [Revised: 05/27/2022] [Accepted: 06/02/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND This study aimed to analyze the change of serum uric acid (SUA) level post peritoneal dialysis (PD), and the correlation between follow-up SUA and prognosis in patients with PD. METHODS A total of 1402 patients with PD were evaluated. We graded SUA levels into four grades at baseline, 6 months, 12 months, 18 months, and 24 months post PD, and then compared all-cause mortality and cardiovascular mortality among patients with different SUA grades at each time point. Kaplan-Meier and Cox proportional-hazards regression models were used in the analysis. RESULTS The SUA levels were 7.97 ± 1.79, 7.12 ± 1.48, 7.05 ± 1.33, 7.01 ± 1.30, and 6.93 ± 1.26 mg/dl at baseline, 6, 12, 18, and 24 months, respectively. There was significant difference on all-cause mortality among patients with PD with different graded SUA levels at 6 months post PD (p = 0.010), and the all-cause mortality was lowest in patients with the grade of 5.65 mg/dl ≤ SUA <7.13 mg/dl. CONCLUSION SUA level decreased after PD during follow-up. At 6 months post PD, the grade of 5.65 mg/dl ≤ SUA <7.13 mg/dl was appropriate for better patients' survival.
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Affiliation(s)
- Yaomin Wang
- Kidney Disease Center, The First Affiliated Hospital, Zhejiang University School of Medicine; Institute of Nephrology, Zhejiang University, Key Laboratory of Kidney Disease Prevention and Control Technology, Hangzhou, China
| | - Qilong Zhang
- Kidney Disease Center, The First Affiliated Hospital, Zhejiang University School of Medicine; Institute of Nephrology, Zhejiang University, Key Laboratory of Kidney Disease Prevention and Control Technology, Hangzhou, China.,Anji People's Hospital, Huzhou, China
| | - Pingping Ren
- Kidney Disease Center, The First Affiliated Hospital, Zhejiang University School of Medicine; Institute of Nephrology, Zhejiang University, Key Laboratory of Kidney Disease Prevention and Control Technology, Hangzhou, China
| | - Yixuan Pan
- Kidney Disease Center, The First Affiliated Hospital, Zhejiang University School of Medicine; Institute of Nephrology, Zhejiang University, Key Laboratory of Kidney Disease Prevention and Control Technology, Hangzhou, China
| | - Yi Liu
- Anji People's Hospital, Huzhou, China
| | | | | | - Fei Han
- Kidney Disease Center, The First Affiliated Hospital, Zhejiang University School of Medicine; Institute of Nephrology, Zhejiang University, Key Laboratory of Kidney Disease Prevention and Control Technology, Hangzhou, China
| | - Xiaohui Zhang
- Kidney Disease Center, The First Affiliated Hospital, Zhejiang University School of Medicine; Institute of Nephrology, Zhejiang University, Key Laboratory of Kidney Disease Prevention and Control Technology, Hangzhou, China
| | - Jianghua Chen
- Kidney Disease Center, The First Affiliated Hospital, Zhejiang University School of Medicine; Institute of Nephrology, Zhejiang University, Key Laboratory of Kidney Disease Prevention and Control Technology, Hangzhou, China
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16
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Bletsa E, Paschou SA, Tsigkou V, Stampouloglou PK, Vasileiou V, Kassi GN, Oikonomou E, Siasos G. The effect of allopurinol on cardiovascular outcomes in patients with type 2 diabetes: a systematic review. Hormones (Athens) 2022; 21:599-610. [PMID: 36197637 DOI: 10.1007/s42000-022-00403-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 09/27/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Cardiovascular disease (CVD) remains the main cause of death in patients with type 2 diabetes (T2D). Although hyperuricemia has been associated with multiple CV complications, it is not officially recognized as a target parameter for CVD risk reduction. AIM To systematically review the literature in order to determine whether treating hyperuricemia with allopurinol in patients with T2D reduces CVD risk. METHODS A thorough literature search in the PubMed, CENTRAL, and EMBASE databases from inception to August 2022 was performed. After application of selection criteria, 6 appropriate studies were identified. RESULTS Detailed analysis of the data derived indicated that there is an association between allopurinol treatment and CV benefits, resulting in a reduced risk of CVD events and mortality rates. This association can be attributed mainly to the reduction of inflammation and oxidative burden, as well as to the improvement of glycemic and lipid profiles. CONCLUSIONS This systematic review provides evidence that allopurinol may reduce CVD risk in patients with T2D. Randomized, placebo-controlled trials should be performed in order to confirm these findings and identify specific subgroups of patients who will benefit most.
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Affiliation(s)
- Evanthia Bletsa
- 3rd Department of Cardiology, School of Medicine, Sotiria Chest Disease Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Stavroula A Paschou
- Endocrine Unit and Diabetes Centre, Department of Clinical Therapeutics, School of Medicine, Alexandra Hospital, National and Kapodistrian University of Athens, 80 Vasilisis Sophias Ave, 11528, Athens, Greece.
| | - Vasiliki Tsigkou
- 3rd Department of Cardiology, School of Medicine, Sotiria Chest Disease Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiota K Stampouloglou
- 3rd Department of Cardiology, School of Medicine, Sotiria Chest Disease Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Georgia N Kassi
- Department of Endocrinology, Alexandra Hospital, Athens, Greece
| | - Evangelos Oikonomou
- 3rd Department of Cardiology, School of Medicine, Sotiria Chest Disease Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Gerasimos Siasos
- 3rd Department of Cardiology, School of Medicine, Sotiria Chest Disease Hospital, National and Kapodistrian University of Athens, Athens, Greece
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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17
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Qiu W, Chen H, Dincer AB, Lundberg S, Kaeberlein M, Lee SI. Interpretable machine learning prediction of all-cause mortality. COMMUNICATIONS MEDICINE 2022; 2:125. [PMID: 36204043 PMCID: PMC9530124 DOI: 10.1038/s43856-022-00180-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 08/31/2022] [Indexed: 11/06/2022] Open
Abstract
Background Unlike linear models which are traditionally used to study all-cause mortality, complex machine learning models can capture non-linear interrelations and provide opportunities to identify unexplored risk factors. Explainable artificial intelligence can improve prediction accuracy over linear models and reveal great insights into outcomes like mortality. This paper comprehensively analyzes all-cause mortality by explaining complex machine learning models. Methods We propose the IMPACT framework that uses XAI technique to explain a state-of-the-art tree ensemble mortality prediction model. We apply IMPACT to understand all-cause mortality for 1-, 3-, 5-, and 10-year follow-up times within the NHANES dataset, which contains 47,261 samples and 151 features. Results We show that IMPACT models achieve higher accuracy than linear models and neural networks. Using IMPACT, we identify several overlooked risk factors and interaction effects. Furthermore, we identify relationships between laboratory features and mortality that may suggest adjusting established reference intervals. Finally, we develop highly accurate, efficient and interpretable mortality risk scores that can be used by medical professionals and individuals without medical expertise. We ensure generalizability by performing temporal validation of the mortality risk scores and external validation of important findings with the UK Biobank dataset. Conclusions IMPACT's unique strength is the explainable prediction, which provides insights into the complex, non-linear relationships between mortality and features, while maintaining high accuracy. Our explainable risk scores could help individuals improve self-awareness of their health status and help clinicians identify patients with high risk. IMPACT takes a consequential step towards bringing contemporary developments in XAI to epidemiology.
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Affiliation(s)
- Wei Qiu
- Paul G. Allen School of Computer Science and Engineering, University of Washington, Seattle, WA USA
| | - Hugh Chen
- Paul G. Allen School of Computer Science and Engineering, University of Washington, Seattle, WA USA
| | - Ayse Berceste Dincer
- Paul G. Allen School of Computer Science and Engineering, University of Washington, Seattle, WA USA
| | | | - Matt Kaeberlein
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA USA
| | - Su-In Lee
- Paul G. Allen School of Computer Science and Engineering, University of Washington, Seattle, WA USA
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18
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Cheang C, Law S, Ren J, Chan W, Wang C, Dong Z. Prevalence of hyperuricemia in patients with severe obesity and the relationship between serum uric acid and severe obesity: A decade retrospective cross-section study in Chinese adults. Front Public Health 2022; 10:986954. [PMID: 36091568 PMCID: PMC9462510 DOI: 10.3389/fpubh.2022.986954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 08/12/2022] [Indexed: 01/26/2023] Open
Abstract
Objective Undoubtedly, the relationship between serum uric acid (SUA) and obesity is less data for Chinese patients with obesity. This study aimed to examine the prevalence of hyperuricemia (HUA) and the association between SUA and patients with obesity. Methods All participants were categorized as overweight, obesity I, obesity II, and obesity III. In addition, based on SUA concentration, the participants were stratified into four quartiles. The authors used descriptive analysis, independent t-test, ANOVA, correlation analysis, and multiple linear regression models to verify the SUA level and obesity among Chinese adults. Results Overall, the estimated prevalence of HUA was 69.8%. In the BMI categories, the prevalence of HUA was 5.1% in overweight, 15.2% in obesity I, 16.9% in obesity II, and 32.5% in obesity III. Correlation analysis shows that SUA is strongly correlated with BMI, waist circumference (WC), and hip circumference (HC). Multiple linear regression analysis shows that high density-lipoprotein cholesterol (HDL-C) is a protective predictor of serum uric acid levels in patients with obesity. Compared with the overweight, obesity I, obesity II, and obesity III were more likely to have higher levels in the SUA levels. Conclusion We mainly showed that the serum uric acid levels in Chinese patients with severe obesity declined slightly as age increased.
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Affiliation(s)
- Chonin Cheang
- School of Medicine, Jinan University, Guangzhou, China
| | - Saikam Law
- School of Medicine, Jinan University, Guangzhou, China
| | - Jieru Ren
- School of Medicine, Jinan University, Guangzhou, China
| | - Wengtong Chan
- School of Medicine, Jinan University, Guangzhou, China
| | - Cunchuan Wang
- Department of Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Zhiyong Dong
- Department of Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China,*Correspondence: Zhiyong Dong
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Dissanayake LV, Zietara A, Levchenko V, Spires DR, Angulo MB, El-Meanawy A, Geurts AM, Dwinell MR, Palygin O, Staruschenko A. Lack of xanthine dehydrogenase leads to a remarkable renal decline in a novel hypouricemic rat model. iScience 2022; 25:104887. [PMID: 36039296 PMCID: PMC9418856 DOI: 10.1016/j.isci.2022.104887] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 06/20/2022] [Accepted: 08/02/2022] [Indexed: 11/20/2022] Open
Abstract
Uric acid (UA) is the final metabolite in purine catabolism in humans. Previous studies have shown that the dysregulation of UA homeostasis is detrimental to cardiovascular and kidney health. The Xdh gene encodes for the Xanthine Oxidoreductase enzyme group, responsible for producing UA. To explore how hypouricemia can lead to kidney damage, we created a rat model with the genetic ablation of the Xdh gene on the Dahl salt-sensitive rat background (SSXdh−/−). SSXdh−/− rats lacked UA and exhibited impairment in growth and survival. This model showed severe kidney injury with increased interstitial fibrosis, glomerular damage, crystal formation, and an inability to control electrolyte balance. Using a multi-omics approach, we highlighted that lack of Xdh leads to increased oxidative stress, renal cell proliferation, and inflammation. Our data reveal that the absence of Xdh leads to kidney damage and functional decline by the accumulation of purine metabolites in the kidney and increased oxidative stress. A novel rat model of hypouricemia was created by the gene ablation of the Xdh gene The SSXdh-/- rat showed a failure to thrive, kidney injury, and functional decline Multi-omics revealed increased inflammation and oxidative stress in SSXdh-/- rats
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Aghsaeifard Z, Alizadeh R, Bagheri N. Association between neutrophil gelatinase-associated lipocalin (NGAL) and iron profile in chronic renal disease. Arch Physiol Biochem 2022; 128:703-707. [PMID: 31994917 DOI: 10.1080/13813455.2020.1720742] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
NGAL, also known as lipocalin 2, is a stress protein located on the cell surface that is known for its involvement in iron transport. This study is aimed to evaluate the correlation between the iron profile and NGAL concentration in serum among chronic kidney disease patients under dialysis in order to find its diagnostic value with regards to iron deficiency anaemia (IDA). 47 patients under chronic haemodialysis in end-stage renal disease (ESRD) and 15 healthy controls were evaluated to determine the correlation between serum NGAL concentration and IDA characteristics. Our results recorded a significant correlation between IDA (TSAT < 20%) and NGAL serum concentration with a Spearman's coefficient of 0.314. Serum NGAL was also significantly related to serum ferritin, TIBC, uric acid, creatinine and blood sugar whereas, an inverse relationship with albumin, total cholesterol and LDL. Our study reports a positive correlation between IDA and serum NGAL levels in CKD patients.
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Affiliation(s)
- Ziba Aghsaeifard
- Department of Internal Medicine, School of Medicine, Sina Hospital Tehran University of Medical Sciences, Tehran, Iran
- Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Alizadeh
- Department of Anesthesiology and Intensive Care, AJA University of Medical Sciences, Tehran, Iran
| | - Nazilla Bagheri
- Department of Adult Nephrology, School of Medicine, Ayatollah Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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21
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Ji P, Zhu J, Feng J, Li H, Yu Q, Qin H, Wei L, Zhang J. Serum uric acid levels and diabetic kidney disease in patients with type 2 diabetes mellitus: A dose-response meta-analysis. Prim Care Diabetes 2022; 16:457-465. [PMID: 35305901 DOI: 10.1016/j.pcd.2022.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 02/26/2022] [Accepted: 03/06/2022] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Our study aimed to assess the existing evidence on whether serum uric acid (SUA) levels are associated with diabetic kidney disease (DKD) in patients with type 2 diabetes mellitus (T2DM). METHODS We conducted a systematic search of articles up to October 2021 in Medline, Embase, The Cochrane Library and Web of Science that estimated DKD by SUA levels in patients with T2DM. Pooled relative risks with 95% CI were calculated using random effects models RESULTS: A total of eight cohort studies involving 25,741 T2DM patients were included. Meta-analysis showed that compared the highest with the lowest category of SUA level, the summary risk ratios were 2.04 (95%CI 1.43-2.92, P < 0.001). The linear dose-response analysis revealed that the risk of DKD increased by 24% for each 1 mg/dl increase of SUA. The non-linear dose-response analysis also showed a significant relevance between SUA and the risk of DKD in patients with type 2 diabetes mellitus (P < 0.001). CONCLUSIONS Serum uric acid is associated with an increased risk of diabetic kidney disease in patients with type 2 diabetes mellitus. Serum uric acid level could be a good indicator for predicting diabetic kidney disease in patients with type 2 diabetes mellitus.
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Affiliation(s)
- Pan Ji
- Department of General Practice, The Second Affiliated Hospital of Guangxi Medical University, Nanning 530007, China.
| | - Jieyun Zhu
- International Medical Services, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, China.
| | - Jihua Feng
- Department of Emergency Medicine, The Second Affiliated Hospital of Guangxi Medical University, Nanning 530007, China.
| | - Hongyuan Li
- Department of General Practice, The Second Affiliated Hospital of Guangxi Medical University, Nanning 530007, China.
| | - Qiao Yu
- Department of General Practice, The Second Affiliated Hospital of Guangxi Medical University, Nanning 530007, China.
| | - Han Qin
- Department of General Practice, The Second Affiliated Hospital of Guangxi Medical University, Nanning 530007, China.
| | - Lile Wei
- Department of General Practice, The Second Affiliated Hospital of Guangxi Medical University, Nanning 530007, China.
| | - Jianfeng Zhang
- Department of General Practice, The Second Affiliated Hospital of Guangxi Medical University, Nanning 530007, China; Department of Emergency Medicine, The Second Affiliated Hospital of Guangxi Medical University, Nanning 530007, China.
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22
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Cardiovascular risk and mortality in patients with hyperuricemia treated with febuxostat or allopurinol: a retrospective nation-wide cohort study in Austria 2014-2017. Rheumatol Int 2022; 42:1597-1603. [PMID: 35589988 PMCID: PMC9349126 DOI: 10.1007/s00296-022-05139-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 04/27/2022] [Indexed: 11/30/2022]
Abstract
Patients with hyperuricemia and gout are at an increased risk for cardiovascular (CV) disease. Inhibition of the xanthine oxidase with allopurinol or febuxostat have become the mainstay for urate lowering therapy. However, it has been suggested that febuxostat increases the risk for CV mortality as compared to allopurinol. The aim of this retrospective cohort study was to assess the CV risk among patients with febuxostat or allopurinol therapy. Patients who initiated urate lowering therapy with febuxostat or allopurinol between 2014 and 2017 were selected from the drug reimbursement database of the Austrian health insurances funds. The primary CV endpoint was a composite of angina pectoris, nonfatal myocardial infarction, nonfatal subarachnoid or cerebral hemorrhage, nonfatal ischemic stroke, or death from any cause. In total, 28.068 patients (62.1% male) with a mean age of 71 years were included. 7.767 initiated febuxostat treatment and 20.301 received allopurinol. The incidence rate per 100 patient-years of the composite primary endpoint was 448 (febuxostat) and 356 (allopurinol) with a corresponding adjusted hazard ratio (HR) of 0.58 (95% CI 0.53–0.63) for allopurinol vs. febuxostat initiators. Similar HR were found for secondary endpoints including all-cause mortality [0.61 (95% CI 0.55–0.68)] and separate analyses of cardiac events [0.48 (95% CI 0.38–0.61)] and ischemic stroke [0.47 (95% CI 0.36–0.61)]. Data from this Austrian population-based study suggests that febuxostat initiators are at an increased risk for nonfatal CV events or death from any cause as compared to those with allopurinol. This is consistent with CV concerns of other trials, which limited the broad therapeutic use of febuxostat.
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23
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Crawley WT, Jungels CG, Stenmark KR, Fini MA. U-shaped association of uric acid to overall-cause mortality and its impact on clinical management of hyperuricemia. Redox Biol 2022; 51:102271. [PMID: 35228125 PMCID: PMC8889273 DOI: 10.1016/j.redox.2022.102271] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 02/12/2022] [Accepted: 02/14/2022] [Indexed: 12/12/2022] Open
Abstract
Serum uric acid (SUA) is significantly elevated in obesity, gout, type 2 diabetes mellitus, and the metabolic syndrome and appears to contribute to the renal, cardiovascular and pulmonary comorbidities that are associated with these disorders. Most previous studies have focused on the pathophysiologic effects of high levels of uric acid (hyperuricemia). More recently, research has also shifted to the impact of hypouricemia, with multiple studies showing the potentially damaging effects that can be caused by abnormally low levels of SUA. Along with these observations, recent inconclusive data from human studies evaluating the treatment of hyperuricemia with xanthine oxidoreductase (XOR) inhibitors have added to the debate about the causal role of UA in human disease processes. SUA, which is largely derived from hepatic degradation of purines, appears to exert both systemic pro-inflammatory effects that contribute to disease and protective antioxidant properties. XOR, which catalyzes the terminal two steps of purine degradation, is the major source of both reactive oxygen species (O2.-, H2O2) and UA. This review will summarize the evidence that both elevated and low SUA may be risk factors for renal, cardiovascular and pulmonary comorbidities. It will also discuss the mechanisms through which modulation of either XOR activity or SUA may contribute to vascular redox hemostasis. We will address future research studies to better account for the differential effects of high versus low SUA in the hope that this will identify new evidence-based approaches for the management of hyperuricemia.
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Affiliation(s)
- William T Crawley
- Cardiovascular and Pulmonary Research Laboratory, Department of Medicine, Anschutz Medical Campus, University of Colorado-Denver School of Medicine, Aurora, Colorado, USA
| | - Cyprien G Jungels
- Cardiovascular and Pulmonary Research Laboratory, Department of Medicine, Anschutz Medical Campus, University of Colorado-Denver School of Medicine, Aurora, Colorado, USA
| | - Kurt R Stenmark
- Cardiovascular and Pulmonary Research Laboratory, Department of Medicine, Anschutz Medical Campus, University of Colorado-Denver School of Medicine, Aurora, Colorado, USA; Division of Pulmonary and Critical Care, Department of Pediatrics, Anschutz Medical Campus, University of Colorado-Denver School of Medicine, Aurora, Colorado, USA
| | - Mehdi A Fini
- Cardiovascular and Pulmonary Research Laboratory, Department of Medicine, Anschutz Medical Campus, University of Colorado-Denver School of Medicine, Aurora, Colorado, USA; Division of Pulmonary and Critical Care, Department of Medicine, Anschutz Medical Campus, University of Colorado-Denver School of Medicine, Aurora, Colorado, USA.
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24
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Zheng Y, Ji B, Chen S, Zhou R, Ni R. The impact of uremic toxins on Alzheimer's disease. Curr Alzheimer Res 2022; 19:104-118. [PMID: 35048807 DOI: 10.2174/1567205019666220120113305] [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: 08/18/2021] [Revised: 11/27/2021] [Accepted: 12/14/2021] [Indexed: 11/22/2022]
Abstract
Alzheimer's disease (AD) is the most common type of dementia, pathologically characterized by accumulation of senile plaques and neurofibrillary tangles. Chronic kidney disease (CKD) is highly prevalent in elderly population closely associated with occurrence of dementia. Recent epidemiological and experimental studies suggest a potential association of CKD with AD. Both diseases share a panel of identical risk factors, such as type 2 diabetes; and hypertension. However, the relationship between CKD and AD is unclear. Lower clearance of a panel of uremic toxin including cystatin-C, guanidine, and adiponectin due to CKD is implied to contribute to AD pathogenesis. In this review we summarize the current evidence from epidemiological, experimental and clinical studies on the potential contribution of uremic toxins to AD pathogenesis. We describe outstanding questions and propose an outlook on the link between uremic toxins and AD.
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Affiliation(s)
- Yuqi Zheng
- Department of Nephrology, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Bin Ji
- Department of Radiopharmacy and Molecular Imaging, School of Pharmacy, Fudan University, Shanghai, China
| | - Sijun Chen
- Department of Nephrology, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Rong Zhou
- Department of Nephrology, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Ruiqing Ni
- Institute for Regenerative Medicine, University of Zurich, Zurich, Switzerland
- Institute for Biomedical Engineering, University of Zurich & ETH Zurich, Zurich, Switzerland
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25
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Nakahashi T, Tada H, Sakata K, Yoshida T, Tanaka Y, Nomura A, Terai H, Horita Y, Ikeda M, Namura M, Takamura M, Kawashiri MA. The Association Between Serum Uric Acid and Mortality in Patients with Acute Coronary Syndrome After Percutaneous Coronary Intervention. Int Heart J 2022; 63:447-453. [DOI: 10.1536/ihj.21-764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
| | - Hayato Tada
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences
| | - Kenji Sakata
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences
| | - Taiji Yoshida
- Department of Cardiology, Kanazawa Cardiovascular Hospital
| | - Yoshihiro Tanaka
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine
| | - Akihiro Nomura
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences
| | - Hidenobu Terai
- Department of Cardiology, Kanazawa Cardiovascular Hospital
| | - Yuki Horita
- Department of Cardiology, Kanazawa Cardiovascular Hospital
| | | | | | - Masayuki Takamura
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences
| | - Masa-aki Kawashiri
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences
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26
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Goldberg A, Garcia-Arroyo F, Sasai F, Rodriguez-Iturbe B, Sanchez-Lozada LG, Lanaspa MA, Johnson RJ. Mini Review: Reappraisal of Uric Acid in Chronic Kidney Disease. Am J Nephrol 2021; 52:837-844. [PMID: 34673651 DOI: 10.1159/000519491] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 09/06/2021] [Indexed: 12/16/2022]
Abstract
Hyperuricemia predicts the development of chronic kidney disease (CKD) and metabolic complications, but whether it has a causal role has been controversial. This is especially true given the 2 recently conducted randomized controlled trials that failed to show a benefit of lowering uric acid in type 1 diabetes-associated CKD and subjects with stage 3-4 CKD. While these studies suggest that use of urate-lowering drugs in unselected patients is unlikely to slow the progression of CKD, there are subsets of subjects with CKD where reducing uric acid synthesis may be beneficial. This may be the case in patients with gout, hyperuricemia (especially associated with increased production), and urate crystalluria. Here, we discuss the evidence and propose that future clinical trials targeting these specific subgroups should be performed.
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Affiliation(s)
- Avi Goldberg
- Clalit Health Services, Hebrew University of Jerusalem, Jerusalem, Israel
| | | | - Fumihiko Sasai
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | | | | | - Miguel A Lanaspa
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Richard J Johnson
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Rocky Mountain VA Medical Center, Aurora, Colorado, USA
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27
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Koo BS, Jeong HJ, Son CN, Kim SH, Kim GH, Jun JB. J-shaped Relationship Between Chronic Kidney Disease and Serum Uric Acid Levels: A Cross-sectional Study on the Korean Population. JOURNAL OF RHEUMATIC DISEASES 2021; 28:225-233. [PMID: 37476359 PMCID: PMC10324904 DOI: 10.4078/jrd.2021.28.4.225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/05/2021] [Accepted: 06/08/2021] [Indexed: 07/22/2023]
Abstract
Objective Both hypouricemia and hyperuricemia are reportedly associated with reduced kidney function This study investigated the association between uric acid levels and the risk of reduced renal function in men and women. Methods We conducted a cross-sectional study using data from a government-funded health examinee cohort of a Korean genome and epidemiological study A total of 172,970 participants (58,981 men, 113,989 women) aged 40∼79 years were included A logistic regression test was performed, and the odds ratio (OR) and 95% confidence interval (CI) were calculated to examine the relationship between stratified uric acid levels and the frequency of chronic kidney disease. Results As the uric acid level increased, the risk of reduced renal function increased Moreover, for uric acid levels ≤20 mg/dL, the risk of reduced renal function was higher than that of the reference group Among the total, man, and woman groups, a statistically significant association was observed in men (OR 171, 95% CI 0945∼3111, OR 5003, 95% CI 1405∼17809, and OR 1377, 95% CI 0696∼2724, respectively). Conclusion The OR of reduced renal function according to uric acid levels formed a J-shaped curve in both genders.
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Affiliation(s)
- Bon San Koo
- Department of Internal Medicine, Inje University Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Hye-Jin Jeong
- Department of Rheumatology, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Chang-Nam Son
- Department of Rheumatology, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Sang-Hyon Kim
- Department of Rheumatology, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Gheun-Ho Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Jae-Bum Jun
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
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The Association Between Uric Acid and Symmetric Dimethylarginine Levels in the Patients Undergoing Twice-weekly Hemodialysis. Nephrourol Mon 2021. [DOI: 10.5812/numonthly.117476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Uric acid (UA) levels are associated with increased risk of cardiovascular events and mortality in hemodialysis patients. However, there are still conflicting data on the mechanism of increased risks related to uric acid levels. Objectives: This study assessed the association between uric acid levels and symmetric dimethylarginine (SDMA), as a marker of cardiovascular disease, in the subjects undergoing hemodialysis twice weekly. Methods: This was a cross-sectional study conducted in a tertiary hospital in Jakarta, Indonesia. We included all the adults who underwent hemodialysis twice weekly for at least three months in our hospital. Subjects already on uric acid lowering therapy, pregnant or lactating women and those with a history of malignancy were excluded. Uric acid and SDMA levels were measured at the same time in pre-dialysis venous blood samples. Bivariate analysis was performed using the Mann-Whitney U test or one-way ANOVA. Results: A total of 126 subjects were included. The median level of UA was 8.4 mg/dL (IQR: 2.6, min: 4.1, max: 13.6), and 72 subjects (57.14%) had UA levels of 8 mg/dL or higher. The median SDMA level was 535.5 (312.7) mmol/dL (min: 119.7, max: 1895.5). Subjects with UA levels > 8 mg/dL had significantly higher SDMA levels compared to subjects with UA levels < 8 mg/dL (550.1 (IQR: 357.25) vs 491.35 (IQR: 181.1), P: 0.0475). Conclusions: In twice-weekly hemodialysis patients, UA levels above 8 mg/dL were associated with increased SDMA levels.
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Chang DY, Wang JW, Chen M, Zhang LX, Zhao MH. Association between serum uric acid level and mortality in China. Chin Med J (Engl) 2021; 134:2073-2080. [PMID: 34320567 PMCID: PMC8439999 DOI: 10.1097/cm9.0000000000001631] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Whether there is an association between serum uric acid (SUA) level and risk of mortality in the general population remains unclear. Based on the China National Survey of Chronic Kidney Disease linked to mortality data, a population-based cohort study was performed to investigate the association between SUA level and all-cause mortality, cardiovascular disease (CVD) mortality, and cancer mortality in China. METHODS The survival status of participants in the cross-sectional survey was identified from January 1, 2006 to December 31, 2017. Only 33,268 individuals with complete SUA data among the 47,204 participants were included in the analysis. We determined the rates of all-cause mortality, CVD mortality, and cancer mortality. We used Cox proportional hazards regression models to evaluate the effect of the SUA level on mortality. RESULTS During a total of 297,538.4 person-years of follow-up, 1282 deaths occurred. In the Cox proportional hazards regression model, the rate of all-cause mortality, CVD mortality, and cancer mortality had a U-shaped association with SUA levels only in men, whereas no significant associations were detected in women. For all-cause mortality in men, the multivariable-adjusted hazard ratios (HRs) in the first, second, and fourth quartiles compared with the third quartile were 1.31 (95% confidence interval [CI] 1.04-1.67), 1.17 (95% CI 0.92-1.47), and 1.55 (95% CI 1.24-1.93), respectively. For CVD mortality, the corresponding HRs were 1.47 (95% CI 1.00-2.18), 1.17 (95% CI 0.79-1.75), and 1.67 (95% CI 1.16-2.43), respectively. For the cancer mortality rate, only a marginally significant association was detected in the fourth quartile compared with the third quartile with an HR of 1.43 (95% CI 0.99-2.08). CONCLUSIONS The association between SUA and mortality differed by sex. We demonstrated a U-shaped association with SUA levels for all-cause and CVD mortalities among men in China.
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Affiliation(s)
- Dong-Yuan Chang
- Renal Division, Department of Medicine, Peking University First Hospital, Institute of Nephrology, Peking University, Beijing 100034, China
- Key Laboratory of Renal Disease, National Health Commission of the People's Republic of China, Beijing 100034, China
- Key Laboratory of Chronic Kidney Disease Prevention and Treatment, Peking University, Ministry of Education, Beijing 100034, China
- Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences; Beijing 100034, China
| | - Jin-Wei Wang
- Renal Division, Department of Medicine, Peking University First Hospital, Institute of Nephrology, Peking University, Beijing 100034, China
- Key Laboratory of Renal Disease, National Health Commission of the People's Republic of China, Beijing 100034, China
- Key Laboratory of Chronic Kidney Disease Prevention and Treatment, Peking University, Ministry of Education, Beijing 100034, China
- Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences; Beijing 100034, China
| | - Min Chen
- Renal Division, Department of Medicine, Peking University First Hospital, Institute of Nephrology, Peking University, Beijing 100034, China
- Key Laboratory of Renal Disease, National Health Commission of the People's Republic of China, Beijing 100034, China
- Key Laboratory of Chronic Kidney Disease Prevention and Treatment, Peking University, Ministry of Education, Beijing 100034, China
- Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences; Beijing 100034, China
| | - Lu-Xia Zhang
- Renal Division, Department of Medicine, Peking University First Hospital, Institute of Nephrology, Peking University, Beijing 100034, China
- Key Laboratory of Renal Disease, National Health Commission of the People's Republic of China, Beijing 100034, China
- Key Laboratory of Chronic Kidney Disease Prevention and Treatment, Peking University, Ministry of Education, Beijing 100034, China
- Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences; Beijing 100034, China
| | - Ming-Hui Zhao
- Renal Division, Department of Medicine, Peking University First Hospital, Institute of Nephrology, Peking University, Beijing 100034, China
- Key Laboratory of Renal Disease, National Health Commission of the People's Republic of China, Beijing 100034, China
- Key Laboratory of Chronic Kidney Disease Prevention and Treatment, Peking University, Ministry of Education, Beijing 100034, China
- Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences; Beijing 100034, China
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Gulab A, Torres R, Pelayo J, Lo KB, Shahzad A, Pradhan S, Rangaswami J. Uric acid as a cardiorenal mediator: pathogenesis and mechanistic insights. Expert Rev Cardiovasc Ther 2021; 19:547-556. [PMID: 34112023 DOI: 10.1080/14779072.2021.1941873] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Introduction: The role of serum uric acid as a connector in cardiorenal interactions has been long debated and studied extensively in the past decade. Epidemiological, and clinical data suggest that hyperuricemia may be an independent risk factor as well as a strong predictor of morbidity and mortality in cardiovascular diseases (CVD) and renal diseases. New data suggesting that urate lowering therapies may improve outcomes in cardiovascular diseases have generated interest.Areas Covered: This review attempts to summarize the pathophysiological mechanisms by which hyperuricemia causes cardiorenal dysfunction. It also provides a summary of the recent evidence for urate lowering therapies and the possible underlying mechanisms which lead to cardiovascular benefits. This was a narrative review with essential references or cross references obtained via expert opinion.Expert Opinion: Emphasis on newer drugs that address the cardio-renal metabolic axis and the relation to their effects on uric acid may help further elucidate underlying mechanisms responsible for their cardiovascular and renal benefits. Once these benefits are well established, we will be able to come up with guidelines for targeting hyperuricemia. This can potentially lead to a change in clinical practice and can possibly lead to improved cardiovascular and renal outcomes.
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Affiliation(s)
- Asma Gulab
- Department of Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | - Ricardo Torres
- Department of Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | - Jerald Pelayo
- Department of Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | - Kevin Bryan Lo
- Department of Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | - Anum Shahzad
- Department of Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | - Supriya Pradhan
- Department of Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | - Janani Rangaswami
- Department of Medicine, Einstein Medical Center, Philadelphia, PA, USA.,Department of Internal Medicine, Sidney Kimmel College of Thomas Jefferson University, Philadelphia, PA, USA
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31
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Zhang J, Lu X, Li H, Wang S. Serum Uric Acid and Mortality in Patients with Chronic Kidney Disease: A Systematic Review and Meta-Analysis. Blood Purif 2021; 50:758-766. [PMID: 33744888 DOI: 10.1159/000513944] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 12/16/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Existing studies suggested conflicting relationships between serum uric acid (SUA) and mortality in CKD patients. The present meta-analysis aimed to determine whether SUA can be a predictor for mortality in CKD cohorts. METHOD A systematical search was conducted on PubMed, EMBASE, and The Cochrane Library to identify studies reporting the relationship between SUA level and all-cause and cardiovascular mortality in CKD populations. In addition, random-effects models were adopted to calculate the hazard ratios (HRs) and corresponding 95% confidence intervals (CIs). RESULTS On the whole, 29 studies were involved. In the present meta-analysis, patients exhibiting the maximum SUA level showed an association with a significantly higher risk for all-cause mortality (HR, 1.30; 95% CI, 1.06-1.59) compared with patients exhibiting the minimum SUA level. As revealed from the meta-analysis of 8 studies, low level of SUA was another predictor for all-cause mortality in patients with CKD (HR, 1.36; 95% CI, 1.20-1.54). No significant relationship was identified between SUA and cardiovascular mortality. CONCLUSIONS Higher and lower SUA levels are both associated with significantly increased risk of all-cause mortality in patients with CKD. A appreciate dose of treatment of lowering SUA agents should be confirmed.
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Affiliation(s)
- Jialing Zhang
- Department of Blood Purification, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xiangxue Lu
- Department of Blood Purification, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Han Li
- Department of Blood Purification, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China,
| | - Shixiang Wang
- Department of Blood Purification, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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Wang H, Liu J, Xie D, Liu H, Zhen L, Guo D, Liu X. Elevated serum uric acid and risk of cardiovascular or all-cause mortality in maintenance hemodialysis patients: A meta-analysis. Nutr Metab Cardiovasc Dis 2021; 31:372-381. [PMID: 33485730 DOI: 10.1016/j.numecd.2020.11.017] [Citation(s) in RCA: 5] [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: 08/11/2020] [Revised: 11/08/2020] [Accepted: 11/17/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND AIMS Studies have shown inconsistent results about the association between serum uric acid (SUA) levels and mortality in hemodialysis patients. We performed this meta-analysis to determine whether higher SUA values comprised a risk factor of cardiovascular or all-cause mortality in maintenance hemodialysis patients. METHODS AND RESULTS Pubmed, Embase and the Cochrane library were searched up to August 31, 2020 for the longitudinal studies that investigated the association between the elevated SUA and cardiovascular or all-cause mortality risk in maintenance hemodialysis patients. Pooled adjusted hazard ratios (HR) and corresponding 95% confidence interval (CI) were calculated using a random-effects model. We included 10 studies with an overall sample of 264,571 patients with hemodialysis in this meta-analysis. Patients with the highest SUA were associated with a decreased risk of cardiovascular mortality (HR = 0.72, 95% CI 0.59-0.87) compared with patients with the lowest SUA after adjustment for potential confounders in a random effects model. Moreover, for each increase of 1 mg/dl of SUA, the overall risks of all-cause and cardiovascular mortality decreased by 6% and 9%, respectively (HR = 0.94, 95% CI 0.90-0.99; HR = 0.91, 95% CI 0.89-0.94). CONCLUSION Elevated SUA levels are strongly and independently associated with lower risk of cardiovascular mortality in maintenance hemodialysis patients. More designed studies, especially randomized controlled trials, should be conducted to determine whether high SUA levels is an independent risk factor of all-cause mortality in hemodialysis patients.
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Affiliation(s)
- Huifang Wang
- Department of Nephrology, the Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong, China
| | - Jun Liu
- Department of Nephrology, the Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong, China
| | - Demin Xie
- Department of Nephrology, the Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong, China
| | - Hang Liu
- Department of Nephrology, the Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong, China
| | - Li Zhen
- Department of Nephrology, the Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong, China
| | - Dandan Guo
- Department of Nephrology, the Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong, China
| | - Xuemei Liu
- Department of Nephrology, the Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong, China.
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Li M, Ye ZC, Li CM, Zhao WB, Tang H, Liu X, Peng H, Lou TQ. Low serum uric acid levels increase the risk of all-cause death and cardiovascular death in hemodialysis patients. Ren Fail 2021; 42:315-322. [PMID: 32223483 PMCID: PMC7170277 DOI: 10.1080/0886022x.2020.1745234] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background Elevated serum uric acid (SUA) is associated with increased cardiovascular (CV) and all-cause mortality risk in the general population, but the impact of UA on mortality in hemodialysis patients is still controversial. The aim of the study was to explore the relationship between SUA and all-cause mortality and CV mortality in hemodialysis patients. Methods This retrospective, observational cohort study included 210 HD patients with a mean age of 56.6 ± 16.6 years. All demographic and laboratory data were recorded at baseline. The Kaplan–Meier method and Cox proportional hazard regression model were used to examine the association between SUA and all-cause mortality and CV mortality in HD patients. Results With 420 µmol/L (20th percentile) and 644 µmol/L (80th percentile) as the boundary points, the patients were divided into three groups. After a median follow-up of 49.8 months, 68 (32.4%) all-cause deaths and 34 (16.2%) CV deaths were recorded. The Kaplan–Meier method showed that with a decrease in SUA, all-cause mortality (log rank χ2 = 15.61, p = .000), and CV mortality (log rank χ2=14.28, p = .000) increased. Each 100 µmol/L increase in SUA was associated with lower all-cause mortality with an hazard ratio (HR) of 0.792 (0.645–0.972) and lower CV mortality with an HR of 0.683 (0.505–0.924) after adjusting for age, sex, and complications. Compared to the lowest quartile, all-cause mortality [HR 0.351(0.132–0.934), p = .036] and CV mortality [HR 0.112 (0.014–0.925), p = .042] were lower in the highest SUA quartile. Conclusion A lower SUA level in HD patients was associated with a higher risk of all-cause mortality and CV mortality. Moreover, higher SUA concentrations may be cardioprotective in HD patients.
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Affiliation(s)
- Ming Li
- Department of Nephrology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Zeng-Chun Ye
- Department of Nephrology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Can-Ming Li
- Department of Nephrology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Wen-Bo Zhao
- Department of Nephrology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Hua Tang
- Department of Nephrology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Xun Liu
- Department of Nephrology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Hui Peng
- Department of Nephrology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Tan-Qi Lou
- Department of Nephrology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
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Hyperuricemia in Kidney Disease: A Major Risk Factor for Cardiovascular Events, Vascular Calcification, and Renal Damage. Semin Nephrol 2020; 40:574-585. [PMID: 33678312 DOI: 10.1016/j.semnephrol.2020.12.004] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Kidney disease, especially when it is associated with a reduction in estimated glomerular filtration rate, can be associated with an increase in serum urate (uric acid), suggesting that hyperuricemia in subjects with kidney disease may be a strictly secondary phenomenon. Mendelian randomization studies that evaluate genetic scores regulating serum urate also generally have not found evidence that serum urate is a causal risk factor in chronic kidney disease. Nevertheless, this is countered by a large number of epidemiologic, experimental, and clinical studies that have suggested a potentially important role for uric acid in kidney disease and cardiovascular disease. Here, we review the topic in detail. Overall, the studies strongly suggest that hyperuricemia does have an important pathogenic role that likely is driven by intracellular urate levels. An exception may be the role of extracellular uric acid in atherosclerosis and vascular calcification. One of the more striking findings on reviewing the literature is that the primary benefit of lowering serum urate in subjects with CKD is not by slowing the progression of renal disease, but rather by reducing the incidence of cardiovascular events and mortality. We recommend large-scale clinical trials to determine if there is a benefit in lowering serum urate in hyperuricemic subjects in acute and chronic kidney disease and in the reduction of cardiovascular morbidity and mortality in subjects with end-stage chronic kidney disease.
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Yang Y, Qin X, Li Y, Yang S, Chen J, He Y, Huang Y, Lin Z, Li Y, Kong Y, Lu Y, Zhao Y, Wan Q, Wang Q, Huang S, Liu Y, Liu A, Liu F, Hou FF, Liang M. Relationship between Serum Uric Acid and Mortality Risk in Hemodialysis Patients: A Multicenter Prospective Cohort Study. Am J Nephrol 2020; 51:823-832. [PMID: 33070128 DOI: 10.1159/000509258] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 06/08/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Several studies have reported that low serum uric acid (SUA) levels are related to increased risk of mortality in maintenance hemodialysis (MHD) patients. However, the possible detrimental effects of high SUA on the mortality risk have not been well examined. Moreover, the possible effect modifiers for the SUA-mortality association have not been fully investigated. To address the aforementioned gap, we aimed to explore the nonlinear relationship between SUA levels and all-cause and cardiovascular disease (CVD) mortality risk, and to examine any possible effect modifiers in MHD patients. METHODS We conducted a multicenter, prospective cohort study among 1,018 MHD patients from 8 hemodialysis centers. The primary outcome was all-cause mortality, and the secondary outcomes were CVD mortality and non-CVD mortality. RESULTS The mean value for SUA in the total population was 8.5 ± 1.9 mg/dL. The lowest and highest quintiles of SUA were <7.0 and >10.1 mg/dL, respectively. Over a median follow-up of 45.6 months, 343 deaths were recorded, of which 202 (58.9%) were due to CVD. When SUA was assessed as quintiles, a significantly higher risk of all-cause mortality was found in patients in quintile 1 (<7.0 mg/dL; hazard ratio [HR], 1.33; 95% confidence interval [CI]: 1.02-1.73) or quintile 5 (≥10.1 mg/dL; HR, 1.47; 95% CI: 1.09-2.00), compared to those in quintiles 2-4 (7-10.1 mg/dL). Moreover, the U-shaped SUA-mortality association was mainly found in those with lower C-reactive protein levels (<3 compared with ≥3 mg/L; p for interaction = 0.018). Similar trends were found for CVD mortality and non-CVD mortality. CONCLUSION There was a U-shaped relationship between SUA levels and the risk of all-cause mortality, CVD mortality, and non-CVD mortality in MHD patients.
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Affiliation(s)
- Yaya Yang
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xianhui Qin
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yumin Li
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Shenglin Yang
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Junzhi Chen
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yanhuan He
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yan Huang
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zizhen Lin
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Youbao Li
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yaozhong Kong
- The First People's Hospital of Foshan, Foshan, China
| | - Yongxin Lu
- People's Hospital of Yuxi City, Yuxi, China
| | | | - Qijun Wan
- Shenzhen Second People's Hospital, Shenzhen, China
| | - Qi Wang
- Huadu District People's Hospital of Guangzhou, Guangzhou, China
| | - Sheng Huang
- Southern Medical University Affiliated Nanhai Hospital, Foshan, China
| | - Yan Liu
- Nephrology Department, Guangzhou Red Cross Hospital, Medical College of Jinan University, Guangzhou, China
| | - Aiqun Liu
- The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Fanna Liu
- Jinan University First Affiliated Hospital, Guangzhou, China
| | - Fan Fan Hou
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Min Liang
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China,
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Zawada AM, Carrero JJ, Wolf M, Feuersenger A, Stuard S, Gauly A, Winter AC, Ramos R, Fouque D, Canaud B. Serum Uric Acid and Mortality Risk Among Hemodialysis Patients. Kidney Int Rep 2020; 5:1196-1206. [PMID: 32775819 PMCID: PMC7403560 DOI: 10.1016/j.ekir.2020.05.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 04/29/2020] [Accepted: 05/18/2020] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Although high serum uric acid (SUA) has been consistently associated with an increased risk of death in the general population and in persons with nondialysis chronic kidney disease (CKD), studies in patients undergoing dialysis are conflicting. It has been postulated that low SUA simply reflects poor nutritional status in dialysis patients. We here characterize the association between SUA and the risk of death in a large dialysis cohort and explore effect modification by underlying nutritional status as reflected by body composition. METHODS In this retrospective cohort study, we included 16,057 hemodialysis (HD) patients treated during 2007 to 2016 in NephroCare centers as recorded in the European Clinical Database (EuCliD). The association between SUA, all-cause, and cardiovascular (CV)-related mortality was evaluated with competing risk models and characterized with splines. Effect modification was explored by lean tissue index (LTI) and fat tissue index (FTI). RESULTS During a mean of 1.8 years of follow-up, 2791 patients (17.4%) died. We found a multivariable-adjusted U-shaped pattern between SUA and all-cause mortality. Patients with SUA levels of 6.5 mg/dl (387 μmol/l) were at the lowest risk of death (subdistribution hazard ratio = 0.94 [confidence interval {CI} 0.91; 0.96]). The form of association was not meaningfully affected by underlying LTI and FTI. CONCLUSION We found a U-shaped pattern between SUA levels and all-cause mortality among HD patients, which was independent of the patients' body composition.
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Affiliation(s)
- Adam M. Zawada
- Fresenius Medical Care Deutschland GmbH, EMEA Medical Office, Bad Homburg, Germany
| | - Juan Jesus Carrero
- European Renal Nutrition (ERN) Working Group of the European Renal Association–European Dialysis Transplant Association (ERA-EDTA), London, United Kingdom
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Melanie Wolf
- Fresenius Medical Care Deutschland GmbH, EMEA Medical Office, Bad Homburg, Germany
| | - Astrid Feuersenger
- Fresenius Medical Care Deutschland GmbH, EMEA Medical Office, Bad Homburg, Germany
| | - Stefano Stuard
- Fresenius Medical Care Deutschland GmbH, Global Medical Office—Clinical & Therapeutic Governance EMEA, Bad Homburg, Germany
| | - Adelheid Gauly
- Fresenius Medical Care Deutschland GmbH, EMEA Medical Office, Bad Homburg, Germany
| | - Anke C. Winter
- Fresenius Medical Care Deutschland GmbH, EMEA Medical Office, Bad Homburg, Germany
| | - Rosa Ramos
- Fresenius Medical Care España, S.A., Departamento Dirección Médica, Tres Cantos, Spain
| | - Denis Fouque
- European Renal Nutrition (ERN) Working Group of the European Renal Association–European Dialysis Transplant Association (ERA-EDTA), London, United Kingdom
- Department of Nephrology, Université de Lyon, UCBL, Carmen, Centre Hospitalier Lyon-Sud, Pierre Bénite, France
| | - Bernard Canaud
- Fresenius Medical Care Deutschland GmbH, Global Medical Office, Bad Homburg, Germany
- University of Montpellier, School of Medicine, Montpellier, France
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Haghighat N, Mohammadshahi M, Shayanpour S, Haghighizadeh MH. Effect of Synbiotic and Probiotic Supplementation on Serum Levels of Endothelial Cell Adhesion Molecules in Hemodialysis Patients: a Randomized Control Study. Probiotics Antimicrob Proteins 2020; 11:1210-1218. [PMID: 30293208 DOI: 10.1007/s12602-018-9477-9] [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] [Indexed: 12/18/2022]
Abstract
The aim of this study was to investigate the effect of synbiotic and probiotic supplementation on serum vascular dysfunction and necrosis markers in hemodialysis (HD) patients. In this randomized, double-blind, placebo-controlled trial, 75 HD patients were randomly assigned to either the synbiotic or probiotic or placebo group. The patients in the synbiotic group received 15 g of prebiotics and 5 g probiotic powder containing Lactobacillus acidophilus strain T16 (IBRC-M10785), Bifidobacterium bifidum strain BIA-6, Bifidobacterium lactis strain BIA-6, Bifidobacterium longum strain LAF-5 (2.7 × 107 CFU/g each) in sachets (n = 25), whereas the probiotic group received 5 g probiotics same to the first group with 15 g of maltodextrin powder in sachets (n = 25) and the placebo group received 20 g of maltodextrin powder in sachets (n = 25) for 12 weeks. At baseline and the end of the study, serum concentrations of soluble intercellular adhesion molecule type 1 (sICAM-1), soluble vascular cell adhesion molecule type 1 (sVCAM-1), cytokeratin 18 (CK-18) as the necrosis marker, uric acid, and phosphate levels were measured. Feces also were collected for microbiota colony counting. Serum ICAM-1 level reduced significantly in the synbiotic group after the intervention period (P = 0.02), and this reduction was significantly different in the synbiotic group in comparison to the placebo group (P = 0.03). Serum levels of VCAM-1 and CK-18 were not significantly different between the groups. However, the reduction in serum levels of VCAM-1 in the synbiotic group was significantly higher in comparison to the placebo group (P = 0.01). Multivariate linear regression analysis revealed that ∆ phosphate was the sole independent determinant of ∆ICAM-1 (P = 0 < 001). The study indicated that synbiotic supplementation reduced serum ICAM-1 level, which is a risk factor for cardiovascular diseases in HD patients, but has no effect on the necrosis marker. Trial registration: www.irct.ir (IRCT2017041233393N1).
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Affiliation(s)
- Neda Haghighat
- Department of Nutrition, Nutrition and Metabolic Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Majid Mohammadshahi
- Department of Nutrition, Nutrition and Metabolic Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. .,Department of Nutrition, Hyperlipidemia Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Shokouh Shayanpour
- Department of Nephrology, Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohammad Hossein Haghighizadeh
- Department of Biostatistics and Epidemiology, Faculty of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Shi Y, Tao M, Ma X, Hu Y, Huang G, Qiu A, Zhuang S, Liu N. Delayed treatment with an autophagy inhibitor 3-MA alleviates the progression of hyperuricemic nephropathy. Cell Death Dis 2020; 11:467. [PMID: 32555189 PMCID: PMC7298642 DOI: 10.1038/s41419-020-2673-z] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 05/29/2020] [Accepted: 06/03/2020] [Indexed: 02/06/2023]
Abstract
Autophagy is a cell self-renewal process that relies on the degradation of the cytoplasmic proteins or organelles of lysosomes and is associated with development of numerous diseases. However, the therapeutic effect of autophagy inhibition on hyperuricemic nephropathy (HN) and the underlying mechanisms are still unknown. Here, we investigated the effect of delayed treatment with 3-methyladenine (3-MA), a specific autophagy inhibitor, on the development of HN in a rat model. Administration of 3-MA at 21 days following after uric acid injury protected kidney from hyperuricemic-related injuries, as demonstrated by improving renal dysfunction and architecture damage, blocking Beclin-1 and LC3II/I and decreasing the number of autophagic vacuoles. Late treatment with 3-MA was also effective in attenuating renal fibrosis as evidenced by reducing ECM protein deposition, blocking epithelial-to-mesenchymal transition (EMT) and decreasing the number of renal epithelial cells arrested at the G2/M phase of cell cycle. Injury to the kidney resulted in increased expression of TGFβ receptor I, and phosphorylation of Smad3, 3-MA significantly abrogated all these responses. Moreover, inhibition of autophagy suppressed mitochondrial fission, downregulated the expression of Dynamin-related protein 1 (Drp-1), Cofilin and F-actin, and alleviated cell apoptosis. Finally, 3-MA effectively blocked STAT3 and NF-κB phosphorylation and suppressed infiltration of macrophages and lymphocytes as well as release of multiple profibrogenic cytokines/chemokines in the injured kidney. Taken together, these findings indicate that hyperuricemia-induced autophagy is critically involved in the activation of renal fibroblasts, EMT, mitochondrial fission and apoptosis of tubular epithelial cells and development of renal fibrosis. Thus, this study provides evidence for autophagy inhibitors as the treatment of HN patients.
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Affiliation(s)
- Yingfeng Shi
- Department of Nephrology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Min Tao
- Department of Nephrology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiaoyan Ma
- Department of Nephrology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yan Hu
- Department of Nephrology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Guansen Huang
- Department of Nephrology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Andong Qiu
- School of Life Science and Technology, Advanced Institute of Translational Medicine, Tongji University, Shanghai, China
| | - Shougang Zhuang
- Department of Nephrology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.,Department of Medicine, Rhode Island Hospital and Alpert Medical School, Brown University, Providence, RI, USA
| | - Na Liu
- Department of Nephrology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.
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Hyperuricemia is associated with a lower glomerular filtration rate in pediatric sickle cell disease patients. Pediatr Nephrol 2020; 35:883-889. [PMID: 31960140 DOI: 10.1007/s00467-019-04432-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 11/12/2019] [Accepted: 11/19/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Sickle cell nephropathy (SCN) is a progressive disease that contributes significant morbidity and mortality in sickle cell disease (SCD), yet it remains poorly understood. Hyperuricemia negatively impacts renal function in the non-sickle cell population but is understudied in SCD. METHODS We performed a cross-sectional analysis of the first 78 pediatric SCD patients enrolled in a cohort study. The mechanism of development of hyperuricemia (defined, serum uric acid (UA) ≥ 5.5 mg/dL) was characterized as a result of either UA overproduction or inefficient renal excretion by the Simkin index and fractional clearance of urate (FCU) equations. Associations between hyperuricemia and albuminuria or estimated glomerular filtration rate (eGFR) were determined by linear regression. RESULTS The prevalence of hyperuricemia in this young population (mean age 11.6 ± 3.77 years) was 34.2%. Only 1 hyperuricemic participant overproduced UA by Simkin index, while 62.5% were inefficient renal excretors of UA (FCU < 4%). Hyperuricemia was associated with a significant decrease in average eGFR, -27 ml/min/1.73m2 below normouricemia (mean eGFR 151.6 ± 40.32), p = 0.0122. Notably, the previously accepted association between decline of eGFR with age is significantly modified by hyperuricemia stratification, where hyperuricemia explains 44% of the variance in eGFR by age (R2 = 0.44, p = 0.0004) and is nonsignificant in normouricemia (R2 = 0.07, p = 0.0775). CONCLUSION These findings indicate that hyperuricemia may be associated with early eGFR decline in SCN. This association must be further characterized in prospective cohort studies in SCN, and hyperuricemia must be investigated as a potential therapeutic target for SCN.
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Li S, Cui L, Cheng J, Shu R, Chen S, Nguyen US, Misra D, Wu S, Gao X. Repeated measurements of serum urate and mortality: a prospective cohort study of 152,358 individuals over 8 years of follow-up. Arthritis Res Ther 2020; 22:84. [PMID: 32295651 PMCID: PMC7160947 DOI: 10.1186/s13075-020-02173-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 03/31/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Longitudinal evidence on change of serum urate level with mortality risk is limited as prior studies have a measurement of serum urate at a single time point. Further, the combined effect of serum urate and systemic inflammation on mortality is unknown. METHODS We conducted a prospective cohort study of 152,358 participants (122,045 men and 30,313 women) with repeated measurements of serum urate in 2006, 2008, 2010, and 2012 (107,751 participants had all four measurements of serum urate). We used the Cox proportional hazard model to examine the association between cumulative average and changes in serum urate with mortality. The combined effect of serum urate and systemic inflammation was determined by testing the interaction of serum urate and high-sensitive C-reactive protein (hs-CRP) in relation to mortality risk. RESULTS During a median follow-up of 8.7 (interquartile range 6.3-9.2) years, we identified 7564 all-cause deaths, 1763 CVD deaths, 1706 cancer deaths, and 1572 other deaths. We observed U-shaped relationships of cumulative average serum urate with all-cause mortality, cardiovascular mortality, and other mortalities. Compared with participants with stable serum urate, those with greater increases in serum urate had a 1.7-fold elevated mortality (hazard ratio (HR) = 1.66, 95% confidence interval (CI) = 1.49-1.84), and those with decreased serum urate had a 2-fold elevated mortality risk (HR = 2.14, 95% CI 1.93-2.37). Participants with both hyperuricemia and hs-CRP had 1.6 times higher mortality, compared with those with low serum urate and hs-CRP levels (HR = 1.56, 95% CI 1.37-1.76). CONCLUSIONS We observed a U-shaped relationship of long-term cumulative average serum urate with all-cause mortality, cardiovascular mortality, and other mortalities. Compared with participants with relatively stable serum urate levels, a greater increase or decrease in serum urate was associated with elevated mortality. Participants with both hyperuricemia and high systemic inflammation had the greatest mortality risk compared with those with low serum urate and low hs-CRP levels.
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Affiliation(s)
- Shanshan Li
- Slone Epidemiology Center, Boston University, Boston University Medical Campus, 72 East Concord Street, L-7, Boston, MA, 02118, USA.
| | - Liufu Cui
- Department of Rheumatology and Immunology, Kailuan General Hospital, Tangshan, China
| | - Jin Cheng
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, USA
| | - Rong Shu
- Health Care Center of Kailuan Group, Tangshan, China
| | - Shuohua Chen
- Health Care Center of Kailuan Group, Tangshan, China
| | - Uyen-Sa Nguyen
- Department of Biostatistics and Epidemiology, University of North Texas Health Science Center School of Public Health, Fort Worth, TX, USA
| | - Devyani Misra
- Geriatrics and Rheumatology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Shouling Wu
- Health Care Center of Kailuan Group, Tangshan, China.
- Department of Cardiology, Kailuan General Hospital, 57 Xinhua East Rd., Tangshan, 063000, China.
| | - Xiang Gao
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, USA
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Kang EH, Choi HK, Shin A, Lee YJ, Lee EB, Song YW, Kim SC. Comparative cardiovascular risk of allopurinol versus febuxostat in patients with gout: a nation-wide cohort study. Rheumatology (Oxford) 2020; 58:2122-2129. [PMID: 31098635 DOI: 10.1093/rheumatology/kez189] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 04/14/2019] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To compare cardiovascular (CV) risk among gout patients initiating allopurinol vs febuxostat. METHODS Using 2002-2015 Korean National Health Insurance Service data for the entire Korean population, we conducted a cohort study on gout patients initiating allopurinol or febuxostat. The primary outcome was a composite CV end point of myocardial infarction, stroke/transient ischaemic attack, or coronary revascularization. Secondary outcomes were individual components of the primary outcome, and all-cause mortality. We used propensity score-matching with a 4:1 ratio for allopurinol and febuxostat initiators to control for confounding. Competing risk analyses were done for non-fatal outcomes accounting for deaths. RESULTS We included 39 640 allopurinol initiators propensity score-matched on 9910 febuxostat initiators. The mean age was 59.1 years and 78.4% were male. The incidence rate per 100 person-years for the primary outcome was 1.89 for allopurinol and 1.84 for febuxostat initiators. The corresponding hazard ratio comparing allopurinol vs febuxostat initiators was 1.09 (95% CI: 0.90, 1.32). No significant difference was found for the secondary outcomes, including all-cause mortality (hazard ratio 0.96; 95% CI: 0.79, 1.16). Subgroup analyses limited to those at high CV risk and to equipotent-dose initiators (i.e. allopurinol ⩾300 mg/day vs febuxostat ⩾40 mg/day) showed similar results. CONCLUSION Overall, this large Korean population-based study suggests no difference in the risk of non-fatal CV events and all-cause mortality between allopurinol and febuxostat initiators. These findings are consistent with the recent US Medicare population study, although the current study population consisted of younger Asians.
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Affiliation(s)
- Eun Ha Kang
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyon K Choi
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Anna Shin
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yun Jong Lee
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Eun Bong Lee
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Yeong Wook Song
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Seoyoung C Kim
- Division of Pharmacoepidemiology & Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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42
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Dissanayake LV, Spires DR, Palygin O, Staruschenko A. Effects of uric acid dysregulation on the kidney. Am J Physiol Renal Physiol 2020; 318:F1252-F1257. [PMID: 32223309 DOI: 10.1152/ajprenal.00066.2020] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Recently, research has redirected its interests in uric acid (UA) from gout, an inflammatory disease in joints, to groups of closely interrelated pathologies associated with cardiovascular and kidney dysfunction. Many epidemiological, clinical, and experimental studies have shown that UA may play a role in the pathophysiology of the cardiorenal syndrome continuum; however, it is still unclear if it is a risk factor or a causal role. Hyperuricemia has been well studied in the past two decades, revealing mechanistic insights into UA homeostasis. Likewise, some epidemiological and experimental evidence suggests that hypouricemia can lead to cardiorenal pathologies. The goal of this review is to highlight why studying both hyperuricemia and hypouricemia is warranted as well as to summarize the relevance of UA to kidney function.
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Affiliation(s)
| | - Denisha R Spires
- Department of Physiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Oleg Palygin
- Department of Physiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Alexander Staruschenko
- Department of Physiology, Medical College of Wisconsin, Milwaukee, Wisconsin.,Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin
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43
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Li L, Zhu JX, Hou XH, Ma YH, Xu W, Tan CC, Sun FR, Li HQ, Dong Q, Tan L, Yu JT. Serum Uric Acid Levels and Risk of Intracranial Atherosclerotic Stenosis: A Cross-Sectional Study. Neurotox Res 2020; 37:936-943. [PMID: 32034694 DOI: 10.1007/s12640-020-00171-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 01/20/2020] [Accepted: 01/22/2020] [Indexed: 01/07/2023]
Abstract
Elevated serum uric acid (SUA) has been reported to be associated with an increased risk of cardiovascular diseases, but the role of SUA in intracranial atherosclerosis remains unclear. To investigate the association between SUA and intracranial atherosclerotic stenosis (ICAS), we evaluated 1522 subjects (305 with ICAS, 1217 without ICAS) with magnetic resonance angiography (MRA). Subjects were classified into ten groups according to the deciles of the SUA level. The rate of ICAS reached a minimum in the seventh decile (6.0-6.3 mg/dL; reference group). After adjusting for confounding factors, multivariate logistic regression analysis demonstrated that both low SUA level (≤ 3.8 mg/dL; OR, 2.34; 95% CI, 1.29-4.39; p = 0.006) and high SUA level (≥ 7.8 mg/dL; OR, 2.10; 95% CI, 1.15-3.92; p = 0.017) conferred greater risk for ICAS. In multivariable analysis with a quadratic model which used SUA as a continuous variable, a U-shaped association between SUA and the rate of ICAS was confirmed (α > 0; p < 0.001). The estimated SUA level associated with the lowest rate of ICAS was 6.2 mg/dL. In conclusion, our findings suggest a U-shaped association between ICAS and SUA.
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Affiliation(s)
- Lin Li
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, 266071, China
| | - Jun-Xia Zhu
- Department of Prevention and Health Protection, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xiao-He Hou
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, 266071, China
| | - Ya-Hui Ma
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, 266071, China
| | - Wei Xu
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, 266071, China
| | - Chen-Chen Tan
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, 266071, China
| | - Fu-Rong Sun
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, 266071, China
| | - Hong-Qi Li
- Department of Neurology and Institute of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, 12th Wulumuqi Zhong Road, Shanghai, 200040, China
| | - Qiang Dong
- Department of Neurology and Institute of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, 12th Wulumuqi Zhong Road, Shanghai, 200040, China.
| | - Lan Tan
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, 266071, China.
| | - Jin-Tai Yu
- Department of Neurology and Institute of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, 12th Wulumuqi Zhong Road, Shanghai, 200040, China.
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Joosten LAB, Crişan TO, Bjornstad P, Johnson RJ. Asymptomatic hyperuricaemia: a silent activator of the innate immune system. Nat Rev Rheumatol 2020; 16:75-86. [PMID: 31822862 PMCID: PMC7075706 DOI: 10.1038/s41584-019-0334-3] [Citation(s) in RCA: 131] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2019] [Indexed: 12/22/2022]
Abstract
Asymptomatic hyperuricaemia affects ~20% of the general population in the USA, with variable rates in other countries. Historically, asymptomatic hyperuricaemia was considered a benign laboratory finding with little clinical importance in the absence of gout or kidney stones. Yet, increasing evidence suggests that asymptomatic hyperuricaemia can predict the development of hypertension, obesity, diabetes mellitus and chronic kidney disease and might contribute to disease by stimulating inflammation. Although urate has been classically viewed as an antioxidant with beneficial effects, new data suggest that both crystalline and soluble urate activate various pro-inflammatory pathways. This Review summarizes what is known about the role of urate in the inflammatory response. Further research is needed to define the role of asymptomatic hyperuricaemia in these pro-inflammatory pathways.
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Affiliation(s)
- Leo A B Joosten
- Department of Medical Genetics, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
- Department of Internal Medicine and Radboud Institute of Molecular Life Sciences (RIMLS), Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Tania O Crişan
- Department of Medical Genetics, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Petter Bjornstad
- Department of Medicine of the University of Colorado School of Medicine of the University Hospital, Aurora, CO, USA
| | - Richard J Johnson
- Department of Medicine of the University of Colorado School of Medicine of the University Hospital, Aurora, CO, USA.
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45
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Association of Serum Uric Acid Concentration and Its Change with Cardiovascular Death and All-Cause Mortality. DISEASE MARKERS 2020; 2020:7646384. [PMID: 32076464 PMCID: PMC7008257 DOI: 10.1155/2020/7646384] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 11/29/2019] [Accepted: 12/23/2019] [Indexed: 02/07/2023]
Abstract
Objective There is no consensus on the role of abnormal uric acid (UA) levels in the prognosis of patients undergoing hemodialysis. We therefore aimed to investigate the effects of changes in UA concentration on the risk of all-cause death and cardiac death in such patients. Method In this retrospective cohort study, patients admitted to two hemodialysis centers performing maintenance hemodialysis (MHD) in Wuhan First Hospital and Fourth Hospital Hemodialysis Center from January 1, 2007, to October 31, 2017, were included. Results In all, 325 patients undergoing MHD aged 59.7 ± 14.7 years, including 195 men (60%), were enrolled, with a median follow-up of 37 months. Serum UA (p < 0.001) was significantly higher in the surviving group than in the death group. No significant difference was found in UA variability (p < 0.001) was significantly higher in the surviving group than in the death group. No significant difference was found in UA variability (p < 0.001) was significantly higher in the surviving group than in the death group. No significant difference was found in UA variability (p < 0.001) was significantly higher in the surviving group than in the death group. No significant difference was found in UA variability (p < 0.001) was significantly higher in the surviving group than in the death group. No significant difference was found in UA variability (p < 0.001) was significantly higher in the surviving group than in the death group. No significant difference was found in UA variability (p < 0.001) was significantly higher in the surviving group than in the death group. No significant difference was found in UA variability (p < 0.001) was significantly higher in the surviving group than in the death group. No significant difference was found in UA variability ( Conclusion Low UA levels were closely related to all-cause mortality in patients undergoing MHD. Although UA levels had no significant effect on cardiac death, they had a good predictive value for long-term prognosis in patients on MHD.
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Selim G, Stojceva-Taneva O, Tozija L, Zafirova-Ivanovska B, Spasovski G, Gerasimovska V, Petronijevic Z, Trajceska L, Dzekova-Vidimliski P, Gjorgjievski N, Pavleska-Kuzmanovska S, Kabova A, Georgievska-Ismail L. Uric acid and left ventricular hypertrophy: another relationship in hemodialysis patients. Clin Kidney J 2019; 14:578-585. [PMID: 33623682 PMCID: PMC7886584 DOI: 10.1093/ckj/sfz172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 11/12/2019] [Indexed: 12/28/2022] Open
Abstract
Background The impact of serum uric acid (UA) on morbidity and mortality in hemodialysis (HD) patients is quite controversial in relation to the general population. The aim of this study was to evaluate the association of serum UA with both mortality and left ventricular hypertrophy (LVH) in HD patients. Methods This longitudinal study enrolled 225 prevalent HD patients who were classified into three groups according to their follow-up-averaged UA (FA-UA) levels: low FA-UA (FA-UA <400 µmol/L), intermediate/reference FA-UA (FA-UA between 400 and 450 µmol/L) and high FA-UA (FA-UA >450 µmol/L). Echocardiography was performed on a nondialysis day and the presence of LVH was defined based on a left ventricular mass index (LVMI) >131 and >100 g/m2 for men and women, respectively. The patients were followed during a 60-month period. Results The mean FA-UA level was 425 ± 59 µmol/L (range 294–620). There was a consistent association of higher FA-UA with better nutritional status (higher body mass index, normalized protein catabolic rate, creatinine, albumin and phosphorus), higher hemoglobin, but lower C-reactive protein and LVMI. During the 5-year follow-up, 81 patients died (36%) and the main causes of death were cardiovascular (CV) related (70%). When compared with the reference group, the hazard ratio for all-cause mortality was 1.75 [95% confidence interval (CI) 1.02–2.98; P = 0.041] in the low FA-UA group, but there was no significant association with the high FA-UA group. In contrast, FA-UA did not show an association with CV mortality neither with the lower nor with the high FA-UA group. The unadjusted odds ratio (OR) of LVH risk in the low FA-UA compared with the reference FA-UA group was 3.11 (95% CI 1.38–7.05; P = 0.006), and after adjustment for age, gender, diabetes and CV disease, ORs for LVH persisted significantly only in the low FA-UA group [OR 2.82 (95% CI 1.16–6.88,); P = 0.002]. Conclusions Low serum UA is a mortality risk factor and is associated with LVH in HD patients. These results are in contrast with the association of UA in the general population and should be the subject of further research.
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Affiliation(s)
- Gjulsen Selim
- University Clinic of Nephrology, Ss. Cyril and Methodius University Skopje, Republic of North Macedonia
| | - Olivera Stojceva-Taneva
- University Clinic of Nephrology, Ss. Cyril and Methodius University Skopje, Republic of North Macedonia
| | - Liljana Tozija
- University Clinic of Nephrology, Ss. Cyril and Methodius University Skopje, Republic of North Macedonia
| | - Beti Zafirova-Ivanovska
- Institute of Epidemiology and Biostatistics, Ss. Cyril and Methodius University Skopje, Republic of North Macedonia
| | - Goce Spasovski
- University Clinic of Nephrology, Ss. Cyril and Methodius University Skopje, Republic of North Macedonia
| | - Vesna Gerasimovska
- University Clinic of Nephrology, Ss. Cyril and Methodius University Skopje, Republic of North Macedonia
| | - Zvezdana Petronijevic
- University Clinic of Nephrology, Ss. Cyril and Methodius University Skopje, Republic of North Macedonia
| | - Lada Trajceska
- University Clinic of Nephrology, Ss. Cyril and Methodius University Skopje, Republic of North Macedonia
| | | | - Nikola Gjorgjievski
- University Clinic of Nephrology, Ss. Cyril and Methodius University Skopje, Republic of North Macedonia
| | | | - Angela Kabova
- University Clinic of Nephrology, Ss. Cyril and Methodius University Skopje, Republic of North Macedonia
| | - Ljubica Georgievska-Ismail
- University Institute for Heart Diseases, Ss. Cyril and Methodius University Skopje, Republic of North Macedonia
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47
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Hsu YSO, Wu IW, Chang SH, Lee CC, Tsai CY, Lin CY, Lin WT, Huang YT, Wu CY, Kuo G, Hsiao CY, Lin HL, Yang CC, Yen TH, Chen YC, Hung CC, Tian YC, Kuo CF, Yang CW, Anderson GF, Yang HY. Comparative Renoprotective Effect of Febuxostat and Allopurinol in Predialysis Stage 5 Chronic Kidney Disease Patients: A Nationwide Database Analysis. Clin Pharmacol Ther 2019; 107:1159-1169. [PMID: 31628864 PMCID: PMC7232862 DOI: 10.1002/cpt.1697] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 09/19/2019] [Indexed: 12/11/2022]
Abstract
Hyperuricemia has been associated with chronic kidney disease (CKD) progression. The antihyperuricemic febuxostat's potential renoprotective effect has been demonstrated in stage 1–3 CKD. Large‐scale studies comparing the renoprotective potential of febuxostat and allopurinol in advanced CKD are lacking. We exclusively selected 6,057 eligible patients with predialysis stage 5 CKD prescribed either febuxostat or allopurinol using the National Health Insurance Research Database in Taiwan during 2012–2015. There were 69.57% of allopurinol users and 42.01% febuxostat users who required long‐term dialysis (P < 0.0001). The adjusted hazard ratio (HR) of 0.65 (95% confidence interval (CI) 0.60–0.70) indicated near 35% lower hazards of long‐term dialysis with febuxostat use. The renal benefit of febuxostat was consistent across most patient subgroups and/or using the propensity score‐matched cohort. The adjusted HR was 0.66 (95% CI, 0.61–0.70) for long‐term dialysis or death. In conclusion, lower risk of progression to dialysis was observed in predialysis stage 5 CKD febuxostat users without compromising survival.
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Affiliation(s)
- Yun-Shiuan O Hsu
- Kidney Research Institute, Nephrology Department, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - I-Wen Wu
- Nephrology Department, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Shang-Hung Chang
- Cardiovascular Department, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Cheng-Chia Lee
- Kidney Research Institute, Nephrology Department, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chung-Ying Tsai
- Kidney Research Institute, Nephrology Department, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chan-Yu Lin
- Kidney Research Institute, Nephrology Department, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wan-Ting Lin
- Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yu-Tung Huang
- Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chao-Yi Wu
- Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - George Kuo
- Kidney Research Institute, Nephrology Department, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Yen Hsiao
- Division of Nephrology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi County, Taiwan
| | - Hsing-Lin Lin
- Division of Critical Care Surgery, Department of Critical Care Medicine, Veterans General Hospital, Kaohsiung, Taiwan
| | - Chih-Chao Yang
- Nephrology Department, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Tzung-Hai Yen
- Kidney Research Institute, Nephrology Department, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yung-Chang Chen
- Kidney Research Institute, Nephrology Department, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Cheng-Chieh Hung
- Kidney Research Institute, Nephrology Department, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ya-Chong Tian
- Kidney Research Institute, Nephrology Department, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chang-Fu Kuo
- Division of Rheumatology, Allergy, and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chih-Wei Yang
- Kidney Research Institute, Nephrology Department, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Gerard F Anderson
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Huang-Yu Yang
- Kidney Research Institute, Nephrology Department, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Han X, Xiao Y, Tang Y, Zheng X, Anwar M, Qin W. Clinical and pathological features of immunoglobulin A nephropathy patients with nephrotic syndrome. Clin Exp Med 2019; 19:479-486. [PMID: 31542837 DOI: 10.1007/s10238-019-00580-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 09/16/2019] [Indexed: 02/05/2023]
Abstract
IgA nephropathy (IgAN) is the most common glomerulonephritis worldwide. The classic manifestation of IgAN is episodic hematuria and proteinuria. Nephrotic syndrome (NS) is not very common in IgAN, reported to occur in only 5-10% of IgAN patients. However, the clinical and pathological characteristics and long-term outcomes of patients with NS-IgAN at onset remain unknown. A retrospective study was conducted, enrolling 1165 patients with biopsy-proven IgAN from West China Hospital in 2008-2015. Patients with renal biopsy of minimal change disease with mesangial IgA deposits were excluded. The renal endpoint was defined as 50% decrease in eGFR or progressing into end-stage renal disease (ESRD). A total of 1165 patients were enrolled with average age of 34.58, and 171 (14.7%) patients were presented with NS. Comparing NS and non-NS groups, significance differences were shown in hypertension (HTN), 24-h urine protein, serum albumin, serum creatine, eGFR and uric acid. NS group had severe pathological changes such as endocapillary hypercellularity, tubular atrophy or interstitial fibrosis and crescent, but less segmental glomerulosclerosis or adhesion and global sclerosis. During the average follow-up of 44.27 months, 29.8% (51/171) NS patients and 15.8% (157/994) non-NS patients progressed to the renal endpoint. 5-year renal survival rates were 73.1% and 87.8% (P < 0.001) in NS and non-NS groups, respectively. This study demonstrated that IgAN patients with NS had higher serum creatine, lower eGFR, lower uric acid, more acute lesions and poor prognosis. NS was an independent risk factor for progression to the renal endpoint.
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Affiliation(s)
- Xin Han
- Division of Nephrology, West China Hospital of Sichuan University, 37th Guoxuexiang Road, Chengdu, 610041, China
| | - Yi Xiao
- West China School of Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Yi Tang
- Division of Nephrology, West China Hospital of Sichuan University, 37th Guoxuexiang Road, Chengdu, 610041, China
| | - Xiaonan Zheng
- West China School of Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Mawluda Anwar
- West China School of Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Wei Qin
- Division of Nephrology, West China Hospital of Sichuan University, 37th Guoxuexiang Road, Chengdu, 610041, China.
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Roumeliotis S, Roumeliotis A, Dounousi E, Eleftheriadis T, Liakopoulos V. Dietary Antioxidant Supplements and Uric Acid in Chronic Kidney Disease: A Review. Nutrients 2019; 11:nu11081911. [PMID: 31443225 PMCID: PMC6723425 DOI: 10.3390/nu11081911] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 08/10/2019] [Accepted: 08/12/2019] [Indexed: 02/07/2023] Open
Abstract
Increased serum levels of uric acid have been associated with the onset and development of chronic kidney disease (CKD), cardiovascular disease, and mortality, through several molecular pathogenetic mechanisms, such as inflammation and oxidative stress. Oxidative stress is present even in the early stages of CKD, progresses parallelly with the deterioration of kidney function, and is even more exacerbated in end-stage renal disease patients undergoing maintenance hemodialysis. Although acting in the plasma as an antioxidant, once uric acid enters the intracellular environment; it behaves as a powerful pro-oxidant. Exogenous intake of antioxidants has been repeatedly shown to prevent inflammation, atherosclerosis and oxidative stress in CKD patients. Moreover, certain antioxidants have been proposed to exert uric acid-lowering properties. This review aims to present the available data regarding the effects of antioxidant supplements on both oxidative stress and uric acid serum levels, in a population particularly susceptible to oxidative damage such as CKD patients.
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Affiliation(s)
- Stefanos Roumeliotis
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki 54636, Greece
| | - Athanasios Roumeliotis
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki 54636, Greece
| | - Evangelia Dounousi
- Department of Nephrology, School of Medicine, University of Ioannina, Ioannina 45110, Greece
| | | | - Vassilios Liakopoulos
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki 54636, Greece.
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Yin W, Zhou QL, OuYang SX, Chen Y, Gong YT, Liang YM. Uric acid regulates NLRP3/IL-1β signaling pathway and further induces vascular endothelial cells injury in early CKD through ROS activation and K + efflux. BMC Nephrol 2019; 20:319. [PMID: 31412804 PMCID: PMC6694569 DOI: 10.1186/s12882-019-1506-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 07/31/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) has been considered as a major health problem in the world. Increasing uric acid (UA) could induce vascular endothelial injury, which is closely related to microinflammation, oxidative stress, and disorders of lipids metabolism. However, the specific mechanism that UA induces vascular endothelial cells injury in early CKD remains unknown. METHODS Human umbilical vein endothelial cells (HUVECs) were cultured and subjected to different concentrations of UA for different periods. Early CKD rat model with elevated serum UA was established. Western blotting and quantitative real-time PCR (qPCR) were applied for measuring protein and mRNA expression of different cytokines. The animals were sacrificed and blood samples were collected for measurement of creatinine, UA, IL-1β, TNF-α, and ICAM-1. Renal tissues were pathologically examined by periodic acid-Schiff (PAS) or hematoxylin-eosin (HE) staining. RESULTS The expression of IL-1β, ICAM-1, NLRP3 complexes, and activation of NLRP3 inflammasome could be induced by UA, but the changes induced by UA were partially reversed by siRNA NLRP3 or caspase 1 inhibitor. Furthermore, we identified that UA regulated the activation of NLRP3 inflammasome by activating ROS and K+ efflux. In vivo results showed that UA caused the vascular endothelial injury by activating NLRP3/IL-1β pathway. While allopurinol could reduce UA level and may have protective effects on cardiovascular system. CONCLUSIONS UA could regulate NLRP3/IL-1β signaling pathway through ROS activation and K+ efflux and further induce vascular endothelial cells injury in early stages of CKD.
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Affiliation(s)
- Wei Yin
- Department of Nephrology, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, No.61, West Jiefang Road, Changsha, 410005, Hunan Province, People's Republic of China
| | - Qiao-Ling Zhou
- Department of Nephrology, Xiangya Hospital, Central South University, Changsha, 410008, People's Republic of China
| | - Sha-Xi OuYang
- Department of Nephrology, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, No.61, West Jiefang Road, Changsha, 410005, Hunan Province, People's Republic of China
| | - Ying Chen
- Department of Nephrology, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, No.61, West Jiefang Road, Changsha, 410005, Hunan Province, People's Republic of China
| | - Yu-Ting Gong
- Department of Nephrology, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, No.61, West Jiefang Road, Changsha, 410005, Hunan Province, People's Republic of China
| | - Yu-Mei Liang
- Department of Nephrology, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, No.61, West Jiefang Road, Changsha, 410005, Hunan Province, People's Republic of China.
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