Skip to main content

Advertisement

SpringerLink
Log in

The association between elevated serum uric acid level and an increased risk of renal function decline in a health checkup cohort in China

  • Nephrology - Original Paper
  • Published:
International Urology and Nephrology Aims and scope Submit manuscript

Abstract

Purpose

To investigate whether an elevated serum uric acid (SUA) level is an independent risk factor for rapid decline in renal function or new-onset chronic kidney disease (CKD) in a Chinese health checkup population.

Methods

A cohort study of 6495 Chinese individuals who underwent health checkups with normal estimated glomerular filtration rate (eGFR) at baseline was carried out from May 2011 to April 2016. Examinations included a questionnaire, physical measurements, and blood sampling. The gender-specific quartiles of blood uric acid were used to present baseline descriptive data. Rapid decline of renal function was defined as eGFR loss of > 3 mL/min/1.73 m2/year. New-onset CKD was defined as follow-up eGFR < 60 mL/min/1.73 m2 or positive proteinuria. Multivariable logistic regression was used to assess the relationship between serum uric acid and the following outcomes: rapid decline of renal function, incident CKD, and combined renal outcomes.

Results

During mean follow-up of 52.8 months, 1608 (24.8%) individuals reached combined renal events. Rapid decline in renal function developed in 1506 (23.2%) individuals, and incident CKD was documented in 372 (5.7%) individuals. In a multivariate model adjusted for age, BMI, diabetes, hypertension, alcohol drinking, SBP, total cholesterol, and eGFR, the odds ratio for rapid decline of renal function increased across quartiles of serum uric acid level, reaching a 1.32 (95% CI 1.02–2.97) for the top quartile compared to the lowest quartile (P for trend < 0.001). Meanwhile, higher SUA was also associated with incident CKD in all models. Furthermore, an increased risk of reaching renal outcomes across increasing quartiles of SUA levels appeared to be similar among subgroups stratified according to age, eGFR, and SBP (P < 0.05 in all).

Conclusions

These findings suggest that higher SUA may predict progressive renal damage and dysfunction in a health checkup population in China.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Dunkler D, Kohl M, Heinze G, Teo KK, Rosengren A, Pogue J, Gao P, Gerstein H, Yusuf S, Oberbauer R, Mann JF (2015) Modifiable lifestyle and social factors affect chronic kidney disease in high-risk individuals with type 2 diabetes mellitus. Kidney Int 87(4):784–791. https://doi.org/10.1038/ki.2014.370

    Article  CAS  PubMed  Google Scholar 

  2. Sharma SK, Ghimire A, Carminati S, Remuzzi G, Perico N (2014) Management of chronic kidney disease and its risk factors in eastern Nepal. Lancet Glob Health 2(9):e506–e507. https://doi.org/10.1016/S2214-109X(14)70281-5

    Article  PubMed  Google Scholar 

  3. Dunkler D, Kohl M, Teo KK, Heinze G, Dehghan M, Clase CM, Gao P, Yusuf S, Mann JF, Oberbauer R (2015) Dietary risk factors for incidence or progression of chronic kidney disease in individuals with type 2 diabetes in the European Union. Nephrol Dial Transplant 30(Suppl 4):iv76–iv85. https://doi.org/10.1093/ndt/gfv086

    Article  PubMed  Google Scholar 

  4. Zammit AR, Katz MJ, Derby C, Bitzer M, Lipton RB (2015) Chronic kidney disease in non-diabetic older adults: associated roles of the metabolic syndrome, inflammation, and insulin resistance. PLoS ONE 10(10):e0139369. https://doi.org/10.1371/journal.pone.0139369

    Article  PubMed  PubMed Central  Google Scholar 

  5. Sakurai M, Kobayashi J, Takeda Y, Nagasawa SY, Yamakawa J, Moriya J, Mabuchi H, Nakagawa H (2016) sex differences in associations among obesity, metabolic abnormalities, and chronic kidney disease in Japanese men and women. J Epidemiol. https://doi.org/10.2188/jea.JE20150208

    Google Scholar 

  6. Isaka Y, Takabatake Y, Takahashi A, Saitoh T, Yoshimori T (2016) Hyperuricemia-induced inflammasome and kidney diseases. Nephrol Dial Transplant 31(6):890–896. https://doi.org/10.1093/ndt/gfv024

    Article  CAS  PubMed  Google Scholar 

  7. Li L, Yang C, Zhao Y, Zeng X, Liu F, Fu P (2014) Is hyperuricemia an independent risk factor for new-onset chronic kidney disease?: a systematic review and meta-analysis based on observational cohort studies. BMC Nephrol 15:122. https://doi.org/10.1186/1471-2369-15-122

    Article  PubMed  PubMed Central  Google Scholar 

  8. Hisatome I, Kuwabara M (2016) Hyperuricemia plays pivotal role in progression of kidney disease. Circ J 80(8):1710–1711. https://doi.org/10.1253/circj.CJ-16-0605

    Article  PubMed  Google Scholar 

  9. Liu H, Zhang XM, Wang YL, Liu BC (2014) Prevalence of hyperuricemia among Chinese adults: a national cross-sectional survey using multistage, stratified sampling. J Nephrol 27(6):653–658. https://doi.org/10.1007/s40620-014-0082-z

    Article  CAS  PubMed  Google Scholar 

  10. Perloff D, Grim C, Flack J, Frohlich ED, Hill M, McDonald M, Morgenstern BZ (1993) Human blood pressure determination by sphygmomanometry. Circulation 88(5 Pt 1):2460–2470

    Article  CAS  PubMed  Google Scholar 

  11. Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, Kusek JW, Eggers P, Van Lente F, Greene T, Coresh J (2009) A new equation to estimate glomerular filtration rate. Ann Intern Med 150(9):604–612

    Article  PubMed  PubMed Central  Google Scholar 

  12. Cheng HT, Huang JW, Chiang CK, Yen CJ, Hung KY, Wu KD (2012) Metabolic syndrome and insulin resistance as risk factors for development of chronic kidney disease and rapid decline in renal function in elderly. J Clin Endocrinol Metab 97(4):1268–1276. https://doi.org/10.1210/jc.2011-2658

    Article  CAS  PubMed  Google Scholar 

  13. Shlipak MG, Katz R, Kestenbaum B, Siscovick D, Fried L, Newman A, Rifkin D, Sarnak MJ (2009) Rapid decline of kidney function increases cardiovascular risk in the elderly. J Am Soc Nephrol 20(12):2625–2630. https://doi.org/10.1681/ASN.2009050546

    Article  PubMed  PubMed Central  Google Scholar 

  14. Madero M, Peralta C, Katz R, Canada R, Fried L, Najjar S, Shlipak M, Simonsick E, Lakatta E, Patel K, Rifkin D, Hawkins M, Newman A, Sarnak M (2013) Association of arterial rigidity with incident kidney disease and kidney function decline: the Health ABC study. Clin J Am Soc Nephrol 8(3):424–433. https://doi.org/10.2215/CJN.07900812

    Article  PubMed  Google Scholar 

  15. Krishnan E (2014) Interaction of inflammation, hyperuricemia, and the prevalence of hypertension among adults free of metabolic syndrome: NHANES 2009-2010. J Am Heart Assoc 3(2):e000157. https://doi.org/10.1161/JAHA.113.000157

    Article  PubMed  PubMed Central  Google Scholar 

  16. Whelton A (2012) Hyperuricemia and hypertension: a confluence of concepts. Hypertension 60(5):1112–1113. https://doi.org/10.1161/HYPERTENSIONAHA.112.198341

    Article  CAS  PubMed  Google Scholar 

  17. Krishnan E, Pandya BJ, Chung L, Hariri A, Dabbous O (2012) Hyperuricemia in young adults and risk of insulin resistance, prediabetes, and diabetes: a 15-year follow-up study. Am J Epidemiol 176(2):108–116. https://doi.org/10.1093/aje/kws002

    Article  PubMed  Google Scholar 

  18. Rodenbach KE, Schneider MF, Furth SL, Moxey-Mims MM, Mitsnefes MM, Weaver DJ, Warady BA, Schwartz GJ (2015) Hyperuricemia and progression of CKD in children and adolescents: the chronic kidney disease in children (CKiD) cohort study. Am J Kidney Dis 66(6):984–992. https://doi.org/10.1053/j.ajkd.2015.06.015

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Hsu CY, Iribarren C, McCulloch CE, Darbinian J, Go AS (2009) Risk factors for end-stage renal disease: 25-year follow-up. Arch Intern Med 169(4):342–350. https://doi.org/10.1001/archinternmed.2008.605

    Article  PubMed  PubMed Central  Google Scholar 

  20. Zhu P, Liu Y, Han L, Xu G, Ran JM (2014) Serum uric acid is associated with incident chronic kidney disease in middle-aged populations: a meta-analysis of 15 cohort studies. PLoS ONE 9(6):e100801. https://doi.org/10.1371/journal.pone.0100801

    Article  PubMed  PubMed Central  Google Scholar 

  21. Kim WJ, Kim SS, Bae MJ, Yi YS, Jeon YK, Kim BH, Song SH, Kim IJ, Kim YK (2014) High-normal serum uric acid predicts the development of chronic kidney disease in patients with type 2 diabetes mellitus and preserved kidney function. J Diabetes Complicat 28(2):130–134. https://doi.org/10.1016/j.jdiacomp.2013.11.006

    Article  PubMed  Google Scholar 

  22. Chonchol M, Shlipak MG, Katz R, Sarnak MJ, Newman AB, Siscovick DS, Kestenbaum B, Carney JK, Fried LF (2007) Relationship of uric acid with progression of kidney disease. Am J Kidney Dis 50(2):239–247. https://doi.org/10.1053/j.ajkd.2007.05.013

    Article  CAS  PubMed  Google Scholar 

  23. Kawashima M, Wada K, Ohta H, Terawaki H, Aizawa Y (2011) Association between asymptomatic hyperuricemia and new-onset chronic kidney disease in Japanese male workers: a long-term retrospective cohort study. BMC Nephrol 12:31. https://doi.org/10.1186/1471-2369-12-31

    Article  PubMed  PubMed Central  Google Scholar 

  24. Soltani Z, Rasheed K, Kapusta DR, Reisin E (2013) Potential role of uric acid in metabolic syndrome, hypertension, kidney injury, and cardiovascular diseases: is it time for reappraisal? Curr Hypertens Rep 15(3):175–181. https://doi.org/10.1007/s11906-013-0344-5

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Ryu ES, Kim MJ, Shin HS, Jang YH, Choi HS, Jo I, Johnson RJ, Kang DH (2013) Uric acid-induced phenotypic transition of renal tubular cells as a novel mechanism of chronic kidney disease. Am J Physiol Renal Physiol 304(5):F471–F480. https://doi.org/10.1152/ajprenal.00560.2012

    Article  CAS  PubMed  Google Scholar 

  26. Moynihan J, Moore H (2010) Endocrine system dynamics and MS epidemiology. Med Hypotheses 74(5):814–817. https://doi.org/10.1016/j.mehy.2009.12.008

    Article  CAS  PubMed  Google Scholar 

  27. Wang Y, Bao X (2013) Effects of uric acid on endothelial dysfunction in early chronic kidney disease and its mechanisms. Eur J Med Res 18:26. https://doi.org/10.1186/2047-783X-18-26

    Article  PubMed  PubMed Central  Google Scholar 

  28. Moe OW (2010) Posing the question again: does chronic uric acid nephropathy exist? J Am Soc Nephrol 21(3):395–397. https://doi.org/10.1681/ASN.2008101115

    Article  PubMed  PubMed Central  Google Scholar 

  29. Nagahama K, Inoue T, Kohagura K, Kinjo K, Ohya Y (2015) Associations between serum uric acid levels and the incidence of hypertension and metabolic syndrome: a 4-year follow-up study of a large screened cohort in Okinawa, Japan. Hypertens Res 38(3):213–218. https://doi.org/10.1038/hr.2014.161

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

This work was supported in part by a grant from the Natural Science Foundation of Hunan Province, China (2017JJ3470). We thank Chang Liu, for his help in programming and statistical analyses as well as all participants for their contribution.

Author information

Authors and Affiliations

  1. Department of Health Management, Health Management Research Center of Central South University, The Third Xiangya Hospital, Central South University, Tongzipo Road 138, Changsha, 410013, Hunan Province, China

    Xia Cao & Zhiheng Chen

  2. Zhongguancun Xinzhiyuan Health Management Institute, Beijing, China, 100011

    Liuxin Wu

Authors
  1. Xia Cao
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Liuxin Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Zhiheng Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Zhiheng Chen.

Ethics declarations

Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee at which the studies conducted (IRB Approval Number: 2017S102).

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 15 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cao, X., Wu, L. & Chen, Z. The association between elevated serum uric acid level and an increased risk of renal function decline in a health checkup cohort in China. Int Urol Nephrol 50, 517–525 (2018). https://doi.org/10.1007/s11255-017-1732-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11255-017-1732-6

Keywords

Search

Navigation