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Chou H, Wei M, Chen H, Xu Y, Shi L, Duan J, Li L, Yang N, Li Y. The association among uric acid, microalbumin and estimated glomerular filtration rate in hypertensive patients: a case control study. BMC Cardiovasc Disord 2023; 23:68. [PMID: 36740710 PMCID: PMC9899386 DOI: 10.1186/s12872-023-03085-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 01/23/2023] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To estimate the relationship among uric acid (UA), 24-h microalbumin (24 h-MAU) and estimated glomerular filtration rate (eGFR) in hypertensive patients. METHOD The study enrolled adult patients hospitalized in TEDA International Cardiovascular Hospital. The study was used to explore the correlation among UA, 24 h-MAU and eGFR. Univariate analysis was used to compare continuous or categorical data groups according to data type. Multivariate analysis was used to explore the correlation among UA, Log 24 h-MAU and eGFR by linear regression, and the relationship among UA, 24 h-MAU ≥ 30 mg/24 h (increased 24 h-MAU) and eGFR < 90 ml·min-1·1.73 m-2 (mildly decreased eGFR) by logistic regression. Mediation effect analysis was used to explore the mediating effect of increased 24 h-MAU between UA and mildly decreased eGFR. Subgroup analysis was used to investigate the correlation among UA, 24 h-MAU and eGFR in different gender. RESULT Seven hundred and thirty-three inpatients were enrolled in the study, including 257 patients with hyperuricemia. The level of UA was 377.8 ± 99.9 μmol/L in all patients enrolled, and it was about 50.1% higher in hyperuricemia group (482.3 ± 58.8 μmol/L vs. 321.4 ± 63.5 μmol/L, P < 0.001). The prevalence of hyperuricemia was 35.1% (95%CI 31.6-38.5%). The univariate regression analysis showed that UA was significant related to Log 24 h-MAU, increased 24 h-MAU, eGFR and mildly decreased eGFR. After adjusted confounding factors, UA was significant related to Log 24 h-MAU (β = 0.163, P < 0.001), eGFR (β = - 0.196, P < 0.001), increased 24 h-MAU (quantitative analysis: OR = 1.045, 95%CI 1.020-1.071, P < 0.001; qualitative analysis: OR = 2.245, 95%CI 1.410-3.572, P = 0.001), but had no significant relationship with mildly decreased eGFR. Mediating effect analysis showed that increased 24 h-MAU partially mediated the relationship between UA and mildly decreased eGFR (relative indirect effect: 25.0% and 20.3% in quantitative analysis and qualitative analysis respectively). In the subgroup analysis, the results were stable and similar to the analysis for entry patients. CONCLUSION The prevalence of hyperuricemia was higher in hypertensive inpatients. UA was strongly associated with Log 24 h-MAU, eGFR and increased 24 h-MAU, while the correlation with mildly decreased eGFR was affected by multiple factors. And increased 24 h-MAU might be the intermediate factor between UA and mildly decreased eGFR.
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Affiliation(s)
- Hongda Chou
- grid.265021.20000 0000 9792 1228Department of Graduate School, Tianjin Medical University, Tianjin, 300051 China ,grid.478012.8Department of Hypertension, TEDA International Cardiovascular Hospital, Tianjin, 300457 China
| | - Maoti Wei
- grid.478012.8Center for Clinical Epidemiology, TEDA International Cardiovascular Hospital, Tianjin, 300457 China
| | - Hongxia Chen
- grid.478012.8Intensive Care Unit, TEDA International Cardiovascular Hospital, Tianjin, 300457 China
| | - Yuanyuan Xu
- grid.265021.20000 0000 9792 1228Department of Graduate School, Tianjin Medical University, Tianjin, 300051 China ,grid.478012.8Department of Hypertension, TEDA International Cardiovascular Hospital, Tianjin, 300457 China
| | - Leilie Shi
- grid.478012.8Department of Hypertension, TEDA International Cardiovascular Hospital, Tianjin, 300457 China
| | - Jiajia Duan
- grid.478012.8Department of Hypertension, TEDA International Cardiovascular Hospital, Tianjin, 300457 China
| | - Linlin Li
- grid.478012.8Department of Hypertension, TEDA International Cardiovascular Hospital, Tianjin, 300457 China
| | - Ning Yang
- Department of Hypertension, TEDA International Cardiovascular Hospital, Tianjin, 300457, China.
| | - Yuming Li
- Department of Cardiology, TEDA International Cardiovascular Hospital, Tianjin, 300457, China.
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Pagkopoulou E, Soulaidopoulos S, Triantafyllidou E, Malliari A, Kitas GD, Garyfallos A, Dimitroulas T. Association Between Uric Acid and Worsening Peripheral Microangiopathy in Systemic Sclerosis. Front Med (Lausanne) 2022; 8:806925. [PMID: 35004786 PMCID: PMC8739221 DOI: 10.3389/fmed.2021.806925] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 11/15/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: The key element in the pathogenesis of systemic sclerosis (SSc) is microcirculatory changes in several vascular beds. Uric acid is associated with endothelial dysfunction and therefore, microvascular damage. The aim of this study was to examine the association between uric acid (UA) and peripheral microvascular involvement in patients with SSc. Methods: We included consecutive, consenting patients with SSc. Serum UA, urea and creatinine were measured, and glomerular filtration rate (GFR) was calculated with CKD-EPI. All participants underwent nailfold video-capillaroscopy (NVC) to evaluate the microcirculation. Results: A total of 64 patients (95.3% women) were included in the study. UA levels were significantly associated with the number of avascular areas (r = 0.290; p = 0.020), whereas no correlation was shown for the GFR (r = -0.065; p = 0.609). A significant trend of UA in the three capillaroscopic patterns was shown (3.90 ± 1.52 vs. 4.15 ± 0.98 vs. 5.38 ± 2.26; for early, active, and late patterns respectively, p = 0.028). Multivariate analysis showed that male gender (β = 3.049; 95% CI = 0.997-5.101) and UA (β = 0.352; 95% CI = 0.117-0.588) were independently associated with the number of avascular areas. Conclusion: These data suggest that UA levels are significantly associated with the capillaroscopic patterns, reflecting a progressive microvasculopathy.
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Affiliation(s)
- Eleni Pagkopoulou
- Fourth Department of Internal Medicine, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stergios Soulaidopoulos
- First Department of Cardiology, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Eva Triantafyllidou
- Fourth Department of Internal Medicine, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - George D Kitas
- Department of Rheumatology, Dudley Group of Hospitals, NS Foundation Trust, Dudley, United Kingdom.,Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester, United Kingdom
| | - Alexandros Garyfallos
- Fourth Department of Internal Medicine, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Theodoros Dimitroulas
- Fourth Department of Internal Medicine, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Abstract
PURPOSE OF REVIEW Hyperuricemia is highly prevalent, affecting approximately 38 million individuals in the United States. However, the significance of asymptomatic hyperuricemia - hyperuricemia in the absence of gout - continues to be debated. RECENT FINDINGS Asymptomatic hyperuricemia results in monosodium urate crystal deposition in tissues, which may promote chronic inflammation. Intracellularly, hyperuricemia inhibits the master regulator adenosine monophosphate (AMP)-associated protein kinase and may condition innate immune responses through durable epigenetic modifications. At the population level, asymptomatic hyperuricemia is associated with multiple comorbidities, including hypertension, chronic kidney disease, coronary artery disease, and diabetes; limitations of these studies include that most are retrospective and some do not rigorously distinguish between asymptomatic hyperuricemia and gout. Treatment studies suggest that urate lowering may reduce the risk of incidence or progression of some of these comorbidities; unfortunately, many of these treatment studies are small or flawed, and not all study results are consistent. SUMMARY Accumulating evidence suggests that asymptomatic hyperuricemia contributes to the comorbidities with which it associates and that proper asymptomatic hyperuricemia treatment may reduce future risk. Additional prospective trials are needed to definitely establish causality and support decision-making as to whether, and which patients with asymptomatic hyperuricemia would warrant urate-lowering treatment.
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Selcukbiricik F, Ozdogan E, Dagel T, Tanju S, Erus S, Ertuglu LA, Kapdağlı M, Tural D, Bilici A, Dilege S, Mandel NM, Kanbay M. Elevation in serum uric acid levels predicts favourable response to erlotinib treatment in patients with metastatic non-small-cell lung cancer. J Clin Pharm Ther 2019; 45:303-308. [PMID: 31778239 DOI: 10.1111/jcpt.13071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 10/01/2019] [Accepted: 10/18/2019] [Indexed: 12/13/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Erlotinib is a small molecule tyrosine kinase inhibitor which blocks the activation of epidermal growth factor receptor (EGFR), a transmembrane receptor that is upregulated in many cancer types. Inhibition of angiogenesis with consequent impairments in intratumoral microcirculation is one of the mechanisms through which EGFR inhibition halts the progression of cancer. A consequence of impaired microcirculation is intratumoral hypoxia, which results in increases in serum uric acid levels. The goal of this study was to investigate the relationship between serum uric acid levels and response to erlotinib in metastatic non-small-cell lung cancer (NSCLC). METHODS A total of 56 patients with metastatic non-small-cell lung cancer who received erlotinib for a duration of at least 3 months were included in this retrospective cohort study. Demographic characteristics, progression status, baseline serum uric levels and 3-month serum uric acid levels were recorded and analysed. RESULTS AND DISCUSSION Of the study population, 21 (37.5%) were female and 35 (62.5%) were male patients. No significant difference in above demographic characteristics was observed among exitus, survivor with progression and survivor without progression groups. Patients who responded favourably to erlotinib with no progression of their disease had significantly increased uric acid levels at 3-month follow-up (P = .01). Such a correlation was not observed if the patient was exitus (P = .47) or had progressed on erlotinib therapy (P = .19). WHAT IS NEW AND CONCLUSION In conclusion, this study is the first to demonstrate significant increases in serum uric acid levels in patients with metastatic NSCLC who responded favourably to erlotinib and had no progression under erlotinib therapy. Further studies are required to confirm and characterize serum uric acid as a novel biomarker in predicting the outcome in those with metastatic NSCLC.
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Affiliation(s)
- Fatih Selcukbiricik
- Department of Medical Oncology, Faculty of Medicine, Koc University, Istanbul, Turkey
| | - Elif Ozdogan
- Koc University School of Medicine, Istanbul, Turkey
| | - Tuncay Dagel
- Department of Nephrology, Koc University Hospital, Istanbul, Turkey
| | - Serhan Tanju
- Department of Thoracic Surgery, Faculty of Medicine, Koc University, Istanbul, Turkey
| | - Suat Erus
- Department of Thoracic Surgery, Koc University Hospital, Istanbul, Turkey
| | | | - Murat Kapdağlı
- Department of Thoracic Surgery, VKV American Hospital, Istanbul, Turkey
| | - Deniz Tural
- Department of Medical Oncology, Bakırköy Sadi Konuk Education and Training Hospital, Istanbul, Turkey
| | - Ahmet Bilici
- Department of Medical Oncology, Faculty of Medicine, Medipol University, Istanbul, Turkey
| | - Sukru Dilege
- Department of Thoracic Surgery, Faculty of Medicine, Koc University, Istanbul, Turkey
| | - Nil M Mandel
- Department of Medical Oncology, Faculty of Medicine, Koc University, Istanbul, Turkey.,Department of Medical Oncology, VKV American Hospital, Istanbul, Turkey
| | - Mehmet Kanbay
- Department of Nephrology, Faculty of Medicine, Koc University, Istanbul, Turkey
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Kocak MZ, Aktas G, Duman TT, Atak BM, Savli H. Is Uric Acid elevation a random finding or a causative agent of diabetic nephropathy? ACTA ACUST UNITED AC 2019; 65:1155-1160. [PMID: 31618330 DOI: 10.1590/1806-9282.65.9.1156] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 05/02/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE In this study, we aimed to analyze the relationship between serum uric acid (UA) and microalbuminuria as a marker of renal injury in type 2 diabetes mellitus. METHODS A total of 100 patients with type 2 diabetes mellitus were enrolled in the study. Participants were divided into two groups according to the urinary microalbumin/creatinine ratio: diabetic nephropathy and non-nephropathy group. UA and microalbuminuria were compared between the study groups. RESULTS Serum UA levels of diabetic nephropathy patients were significantly higher than those in the non-nephropathy group (UA in patients with diabetic nephropathy groups: 6.3 (1.82) mg/dl, UA in patients of the non-nephropathic group: 4.85 (1.92) mg/dl) (p<0.001). There was a correlation between microalbuminuria and UA (r=0.238). This correlation was statistically significant (p=0.017). CONCLUSION UA levels may be an important predictor of nephropathy in diabetic patients.
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Affiliation(s)
- Mehmet Zahid Kocak
- . Abant Izzet Baysal University Hospital, Department of Internal Medicine, Bolu, Turkey
| | - Gulali Aktas
- . Abant Izzet Baysal University Hospital, Department of Internal Medicine, Bolu, Turkey
| | - Tuba T Duman
- . Abant Izzet Baysal University Hospital, Department of Internal Medicine, Bolu, Turkey
| | - Burcin M Atak
- . Abant Izzet Baysal University Hospital, Department of Internal Medicine, Bolu, Turkey
| | - Haluk Savli
- . Abant Izzet Baysal University Hospital, Department of Internal Medicine, Bolu, Turkey
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Kataoka-Yahiro M, Davis J, Gandhi K, Rhee CM, Page V. Asian Americans & chronic kidney disease in a nationally representative cohort. BMC Nephrol 2019; 20:10. [PMID: 30626357 PMCID: PMC6327460 DOI: 10.1186/s12882-018-1145-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 11/20/2018] [Indexed: 12/27/2022] Open
Abstract
Background There is a paucity of specific data on early stages of chronic kidney disease (CKD) among Asian Americans (AAs). The objective of this study was to examine the independent association of Asian race/ethnicity and socio-demographic and co-morbidity factors with markers of early kidney damage, ascertained by ACR levels, as well as kidney dysfunction, ascertained by eGFR levels in a large cross-sectional sample of AAs enrolled in the National Health and Nutrition Examination Survey (NHANES). Methods Secondary data analyses of the NHANES 2011–2014 data of a nationally representative sample of 5907 participants 18 years and older, US citizens, and of Asian and White race. NHANES data included race (Asian vs. White), as well as other socio-demographic information and comorbidities. Urine albumin-to-creatinine ratio (ACR) categories and estimated glomerular filtration rate (eGFR) were used as indicators for CKD. Descriptive analyses using frequencies, means (standard deviations), and chi-square tests was first conducted, then multivariable logistic regression serial adjustment models were used to examine the associations between race/ethnicity, other socio-demographic factors (age, sex, education), and co-morbidities (obesity, diabetes, hypertension) with elevated ACR levels (A2 & A3 – CKD Stages 3 and 4–5, respectively) as well as reduced eGFR (G3a-G5 and G3b –G5 - CKD Stage 3–5). Results AAs were more likely than White participants to have ACR levels > 300 mg/g (A3) (adjusted OR (aOR) (95% CI) 2.77 (1.55, 4.97), p = 0.001). In contrast, adjusted analyses demonstrated that AAs were less likely to have eGFR levels < 60 ml/min/1.73 m2 (G3a-G5) (aOR (95% CI) 0.50 (0.35, 0.72), p < .001). Conclusions This is one of the first large U.S. population-based studies of AAs that has shown a comparatively higher risk of elevated ACR > 300 mg/g levels (A3) but lower risk of having eGFR levels < 60 ml/min/1.732 m2 (G3a-G5). The findings support the need to address the gaps in knowledge regarding disparities in risk of early stage CKD among AAs. Electronic supplementary material The online version of this article (10.1186/s12882-018-1145-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Merle Kataoka-Yahiro
- Department of Nursing, School of Nursing and Dental Hygiene, University of Hawai'i at Manoa, 2528 McCarthy Mall, Webster Hall 409, Honolulu, HI, 96822, USA.
| | - James Davis
- Office of Biostatistics and Quantitative Health Sciences, John A. Burns School of Medicine, Honolulu, HI, 96813, USA
| | - Krupa Gandhi
- Office of Biostatistics and Quantitative Health Sciences, John A. Burns School of Medicine, Honolulu, HI, 96813, USA
| | - Connie M Rhee
- Division of Nephrology and Hypertension, University of California Irvine School of Medicine, 101 The City Drive South, City Tower, Suite 400, Orange, CA, 92868, USA
| | - Victoria Page
- National Kidney Foundation of Hawaii, Health Innovation Division, 1314 S. King Street #1555, Honolulu, HI, 96814, USA
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7
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Fanning N, Merriman TR, Dalbeth N, Stamp LK. An association of smoking with serum urate and gout: A health paradox. Semin Arthritis Rheum 2017; 47:825-842. [PMID: 29398126 DOI: 10.1016/j.semarthrit.2017.11.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 11/01/2017] [Accepted: 11/16/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND The potential effect of cigarette smoking on levels of serum urate and risk of gout has been considered by a large number of studies, either as the primary variable of interest or as a covariate. METHODS Here we systematically review the published evidence relating to the relationship of smoking with serum urate, hyperuricaemia, and gout. RESULTS Many studies have reported that smoking reduces serum urate, however, the evidence has not been conclusive with other studies pointing to the opposite or no effect. It has also been suggested that smoking reduces the risk of gout, although there is some evidence to contradict this finding. CONCLUSION A consensus has yet to be reached as to the effect of smoking on serum urate levels and the risk of gout.
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Affiliation(s)
- Niamh Fanning
- Department of Medicine, University of Otago, Christchurch, PO Box 4345, Christchurch, New Zealand.
| | - Tony R Merriman
- Department of Biochemistry, University of Otago, Dunedin, New Zealand
| | - Nicola Dalbeth
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Lisa K Stamp
- Department of Medicine, University of Otago, Christchurch, PO Box 4345, Christchurch, New Zealand
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8
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Jung DJ, Lee JH, Kim T, Kim HG, Lee JY, Lee KY. Association Between Hearing Impairment and Albuminuria With or Without Diabetes Mellitus. Clin Exp Otorhinolaryngol 2016; 10:221-227. [PMID: 28002925 PMCID: PMC5545699 DOI: 10.21053/ceo.2016.00787] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 11/05/2016] [Accepted: 11/17/2016] [Indexed: 01/05/2023] Open
Abstract
Objectives Few studies have evaluated the accurate association between hearing loss (HL) and albuminuria in patients with or without diabetes mellitus (DM). The aim of our study was to identify the clinical effects of albuminuria on HL with or without DM. Methods This study included 9,762 patients from the Korean National Health and Nutrition Examination Survey between 2011 and 2013. Participants were divided into 4 groups based on DM and urine albumin/creatinine ratio levels: group 1 included participants with neither DM nor albuminuria, group 2 included participants without DM and with albuminuria, group 3 included patients with DM and without albuminuria, and group 4 included patients with both DM and albuminuria. The low- or mid-frequency and high-frequency, and average hearing threshold values were obtained. Results There were 7,508, 545, 1,325, and 384 participants in groups 1, 2, 3, and 4, respectively. Univariate and multivariate analyses showed that the 3 hearing thresholds in group 1 were the lowest and those in group 4 were the highest among the 4 groups. No significant differences were observed in those thresholds between groups 2 and 3. Group 4 was associated with HL compared with the other groups, but moderate to severe HL was not associated with DM or albuminuria. Conclusion The presence of albuminuria was associated with a modest effect on hearing thresholds regardless of presence of DM.
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Affiliation(s)
- Da Jung Jung
- Department of Otorhinolaryngology-Head and Neck Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea
| | - Jae Ho Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea
| | - Taehoon Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea
| | - Hak-Geon Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea
| | - Jae Young Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea
| | - Kyu-Yup Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea
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Lin F, Zhang H, Huang F, Chen H, Lin C, Zhu P. Influence of changes in serum uric acid levels on renal function in elderly patients with hypertension: a retrospective cohort study with 3.5-year follow-up. BMC Geriatr 2016; 16:35. [PMID: 26842652 PMCID: PMC4739318 DOI: 10.1186/s12877-016-0209-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 01/26/2016] [Indexed: 02/07/2023] Open
Abstract
Background Hyperuricemia is closely related to renal diseases. Therefore, the aim of this study was to explore the relationship between the longitudinal changes in serum uric acid and the estimated glomerular filtration rate (eGFR) in a cohort of elderly hypertensive patients. Methods Eighty hundred and thirty-seven re-hospitalized patients with hypertension were included in this retrospective cohort study. Multiple regression analysis was used to investigate the relationship between changes in serum uric acid and renal function after 3.5 years follow-up. Results The average age at baseline was 69.0+/-10.0 years, and the average follow-up duration was 3.5 years. Multiple linear regression analysis showed that the baseline uric acid levels had a linearly negative correlation with baseline eGFR (P < 0.01), after adjustment for age, gender, blood pressure, and body mass index, et al. An increase of 100 μmol/L baseline uric acid level resulted in a decrease of 5.684 ml/min/1.73 m2 in eGFR [95 % confidence interval (CI): 7.735-3.633]. Patients with increased uric acid levels had higher risk of renal function decline over the follow-up period, with an adjusted odds ratio of 1.639 (95 % CI: 1.129-2.378, P = 0.009) , whereas eGFR was remained unchanged in patients with hyperuricemia at baseline and with normal uric acid level 3.5-year later. Conclusions Longitudinal changes in uric acid levels were independently associated with the renal function decline in elderly patients with hypertension. Uric acid level should be considered in hypertension management in the elderly.
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Affiliation(s)
- Fan Lin
- Department of Geriatric Medicine, Fujian Provincial Hospital, Fujian Institute of Clinical Geriatrics, Fuzhou, 350001, China.,Fujian Medical University, Fuzhou, 350001, China
| | - Hailin Zhang
- Fujian Medical University, Fuzhou, 350001, China
| | - Feng Huang
- Department of Geriatric Medicine, Fujian Provincial Hospital, Fujian Institute of Clinical Geriatrics, Fuzhou, 350001, China.,Fujian Medical University, Fuzhou, 350001, China
| | - Hui Chen
- Department of Cardiology, Fujian Provincial Hospital, Fuzhou, 350001, China.,Fujian Medical University, Fuzhou, 350001, China
| | - Chunjin Lin
- Department of Geriatric Medicine, Fujian Provincial Hospital, Fujian Institute of Clinical Geriatrics, Fuzhou, 350001, China.,Fujian Medical University, Fuzhou, 350001, China
| | - Pengli Zhu
- Department of Geriatric Medicine, Fujian Provincial Hospital, Fujian Institute of Clinical Geriatrics, Fuzhou, 350001, China. .,Fujian Medical University, Fuzhou, 350001, China.
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10
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Liu P, Chen Y, Wang B, Zhang F, Wang D, Wang Y. Allopurinol treatment improves renal function in patients with type 2 diabetes and asymptomatic hyperuricemia: 3-year randomized parallel-controlled study. Clin Endocrinol (Oxf) 2015; 83:475-82. [PMID: 25400252 DOI: 10.1111/cen.12673] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Revised: 09/05/2014] [Accepted: 11/12/2014] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To investigate the effects of long-term effective control of serum uric acid on renal function in patients with type 2 diabetes and asymptomatic hyperuricemia. METHODS Application of randomized open parallel-controlled methods, a total of 176 patients with type 2 diabetes and asymptomatic hyperuricemia were selected, and was randomly divided into two groups for allopurinol or conventional treatments, respectively. Changes in urinary albumin excretion rate (UAER), the levels of serum creatinine and glomerular filtration rate (GFR) and the incidence of new-onset diabetic nephropathy (DN) and hypertension in patients before and after 3 years of treatment were measured and compared between groups. RESULTS There were no statistically significant difference in the baseline clinical characteristics of study participants between two treatment groups (P > 0·05 for all). After 3 years of treatment, compared to the conventional treatment, the allopurinol treatment was more effective in reducing serum uric acid, UAER, serum creatinine (P < 0·01 for all) and increasing GFR (P < 0·01). The intention-to-treat (ITT) analysis indicated that the incidence of new-onset DN and hypertension in the allopurinol group showed a declining trend compared to that in the conventional treatment group, despite a lack of significant difference (P > 0·05). CONCLUSION Long-term effective control of serum uric acid can decrease UAER and serum creatinine, increase GFR and may exert kidney protection effects in patients with type 2 diabetes and asymptomatic hyperuricemia.
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Affiliation(s)
- Peng Liu
- Department of Endocrinology, Laiwu Hospital Affiliated to Taishan Medical College, Laiwu, China
| | - Yingying Chen
- Department of Endocrinology, Laiwu Hospital Affiliated to Taishan Medical College, Laiwu, China
| | - Bin Wang
- Department of Endocrinology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Fengmei Zhang
- Department of Endocrinology, Laiwu Hospital Affiliated to Taishan Medical College, Laiwu, China
| | - Debao Wang
- Department of Endocrinology, Laiwu Hospital Affiliated to Taishan Medical College, Laiwu, China
| | - Yangang Wang
- Department of Endocrinology, The Affiliated Hospital of Qingdao University, Qingdao, China
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De Cosmo S, Viazzi F, Pacilli A, Giorda C, Ceriello A, Gentile S, Russo G, Rossi MC, Nicolucci A, Guida P, Feig D, Johnson RJ, Pontremoli R. Serum Uric Acid and Risk of CKD in Type 2 Diabetes. Clin J Am Soc Nephrol 2015; 10:1921-9. [PMID: 26342044 DOI: 10.2215/cjn.03140315] [Citation(s) in RCA: 121] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 07/20/2015] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND OBJECTIVE Serum uric acid may predict the onset and progression of kidney disease, but it is unclear whether uric acid is an independent risk factor for diabetic nephropathy. Our aim was to study the relationship between uric acid levels and the development of CKD components in patients with type 2 diabetes. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Longitudinal study of a cohort of patients with type 2 diabetes from the database of the Italian Association of Clinical Diabetologists network. From a total of 62,830 patients attending the diabetes centers between January 1, 2004, and June 30, 2008, we considered those with baseline eGFR values ≥60 ml/min per 1.73 m2 and normal albumin excretion (n=20,142). Urinary albumin excretion, GFR, and serum uric acid were available in 13,964 patients. We assessed the association of serum uric acid quintiles with onset of CKD components by multinomial logistic regression model adjusting for potential confounders. We calculated the relative risk ratios (RRRs) for eGFR <60 ml/min per 1.73 m2, albuminuria, and their combination at 4 years. RESULTS At 4-year follow-up, 1109 (7.9%) patients developed GFR <60 ml/min per 1.73 m2 with normoalbuminuria, 1968 (14.1%) had albuminuria with eGFR ≥60 ml/min per 1.73 m2, and 286 (2.0%) had albuminuria with eGFR <60 ml/min per 1.73 m2. The incidence of eGFR <60 ml/min per 1.73 m2 increased in parallel with uric acid quintiles: Compared with the lowest quintile, RRRs were 1.46 (95% confidence interval [CI], 1.14 to 1.88; P=0.003), 1.44 (95% CI, 1.11 to 1.87; P=0.006), 1.95 (95% CI, 1.48 to 2.58; P<0.001), and 2.61 (95% CI, 1.98 to 3.42; P<0.001) for second, third, fourth, and fifth quintiles, respectively. Serum uric acid was significantly associated with albuminuria only in presence of eGFR <60 ml/min per 1.73 m2. CONCLUSIONS Mild hyperuricemia is strongly associated with the risk of CKD in patients with type 2 diabetes.
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Affiliation(s)
- Salvatore De Cosmo
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material.
| | - Francesca Viazzi
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Antonio Pacilli
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Carlo Giorda
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Antonio Ceriello
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Sandro Gentile
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Giuseppina Russo
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Maria C Rossi
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Antonio Nicolucci
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Pietro Guida
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Daniel Feig
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Richard J Johnson
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Roberto Pontremoli
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
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Does skin microcirculation represent a faithful mirror of uric acid alterations? J Hypertens 2015; 33:1531-2. [DOI: 10.1097/hjh.0000000000000623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Nacak H, van Diepen M, Qureshi AR, Carrero JJ, Stijnen T, Dekker FW, Evans M. Uric acid is not associated with decline in renal function or time to renal replacement therapy initiation in a referred cohort of patients with Stage III, IV and V chronic kidney disease. Nephrol Dial Transplant 2015; 30:2039-45. [PMID: 26185050 DOI: 10.1093/ndt/gfv225] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Accepted: 04/24/2015] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Although many studies have suggested an association between higher uric acid (UA) and both development of chronic kidney disease (CKD) and faster decline in renal function in Stage I and II CKD, it is not clear whether this effect is consistent throughout higher CKD stages. The aim of this study was to investigate the association between baseline UA and renal outcomes in patients with established CKD (Stages III-V). METHODS We analysed data in the Swedish Renal Registry-Chronic Kidney Disease (SRR-CKD), which is a nationwide registry of referred CKD patients. Patients with a visit between January 1(st), 2005 and December 31(st), 2011 were followed until initiation of renal replacement therapy (RRT), death, referral to primary care or end of follow-up. Decline in renal function was assessed with a linear mixed model using all estimated glomerular filtration rate (eGFR) assessments recorded during median 28 months of follow-up, adjusting for important confounders such as demographic factors, primary renal disease, age, sex, relevant medication, diet, blood pressure and body mass index. RESULTS There were 2466 patients with a baseline UA measurement {mean [standard deviation (SD)] of 7.81 [1.98] mg/dL}. The mean decline in renal function was -1.48 (95% CI -1.65; -1.31) mL/min/1.73 m(2) per year. The overall adjusted change in decline in renal function per unit increase in baseline UA was 0.08 (95% CI -0.01; 0.17) mL/min/1.73 m(2) per year indicating no association between higher UA levels and decline in renal function. In Stage III, IV and V CKD patients, the mean decline in renal function was -1.52 (95% CI -1.96; -1.08), -1.52 (95% CI -1.72; -1.32) and -1.19 (95% CI -1.75; -0.64) mL/min/1.73 m(2) per year, respectively. The adjusted change in the decline in renal function per unit increase in baseline UA was -0.09 (95% CI -0.30; 0.13) in Stage III CKD, 0.16 (95% CI 0.04; 0.28) in Stage IV CKD and 0.18 (95% CI -0.09; 0.45) in Stage V CKD. The overall adjusted hazard ratio for start of RRT was 0.97 (95% CI 0.93-1.02). For Stage III, IV and V CKD, it was 0.99 (95% CI 0.73-1.34), 0.97 (95% CI 0.91-1.03) and 0.99 (95% CI 0.91-1.07), respectively. CONCLUSION UA is not associated with the rate of decline in renal function or time to start of RRT in Stage III, IV and/or V CKD patients.
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Affiliation(s)
- Hakan Nacak
- The Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Merel van Diepen
- The Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Abdul R Qureshi
- Renal Medicine, CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - Juan J Carrero
- Renal Medicine, CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - Theo Stijnen
- The Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, The Netherlands
| | - Friedo W Dekker
- The Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marie Evans
- Renal Medicine, CLINTEC, Karolinska Institutet, Stockholm, Sweden
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Abstract
BACKGROUND Many epidemiological, clinical, and experimental reports have demonstrated an association between serum uric acid concentration and a variety of cardiovascular and renal diseases, particularly in hypertension. At present, there seems to be no resolution to the question whether this relationship is causal or coincidental. SUMMARY This discussion examines a number of biological, pathophysiological, fundamental, and clinical relationships between serum uric acid concentration and several of these disorders. To this end, discussion and review provide some specific insight conclusions and recommendations related to their clinical relevance. KEY MESSAGES We suggest that, in most instances (especially in patients with essential hypertension), the increase in serum uric acid concentration is coincidental, serving as a useful biomarker that relates the magnitude of circulating plasma uric acid concentration with the extent of impaired cardiovascular and renal function. Moreover, the value of certain pharmaceutical agents affecting the serum uric acid level should be considered carefully by taking into consideration the associated pathophysiological derangements.
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Affiliation(s)
| | - Edward D. Frohlich
- Hypertension Research Laboratory, Ochsner Clinic Foundation, New Orleans, La., USA
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A global proteome approach in uric acid stimulated human aortic endothelial cells revealed regulation of multiple major cellular pathways. Int J Cardiol 2014; 176:746-52. [DOI: 10.1016/j.ijcard.2014.07.102] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 07/01/2014] [Accepted: 07/26/2014] [Indexed: 12/13/2022]
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Abstract
PURPOSE OF REVIEW To discuss the evolving data regarding uric acid as a potential cause of hypertension and progressive renal dysfunction and its clinical and research implications. RECENT FINDINGS The potential mechanisms by which uric acid could cause vasoconstriction and a progressive ateriolopathy were established in animal models between 1999 and 2004. Since then, there has been a growing interest in the topic and numerous retrospective and prospective observational studies. The preponderance of data support the hypothesis that serum uric acid is a cause or exacerbating factor of hypertension and progressive kidney disease. Over the last couple of years clinical intervention trials, including randomized controlled trials in the young have supported this mechanistic role. SUMMARY Current evidence supports the role of uric acid as marker and mediator of risk for both hypertension and progressive decline in renal function. Data on the impact of xanthine oxidase inhibitors or uricosurics on clinical hypertension and chronic kidney disease are suggestive but inconclusive. Considerably, more data will be required to determine if uric acid lowering therapy will become a mainstay of management in diseases other than gout and tumor lysis syndrome.
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