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Survival impact of serum uric acid levels in children and adolescents

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Abstract

Evidence is limited on the association between hyperuricaemia and mortality in children and adolescents. This study was to investigate this association in the paediatric population. The study included children and adolescents who had undergone serum uric acid (SUA) measurement at the Chang Gung Memorial Hospital between 1997 and 2008. The survival status and cause of death of the included were ascertained by examining the National Death Registry of Taiwan. Hyperuricaemia was defined as a SUA level greater than 7.0 mg/dL. We included 13,241 patients (male, n = 7,454; female, n = 5,787) of mean age 14.3 ± 4.9 years. During the 82,800 person-years of follow-up, 455 deaths were identified, which corresponded to a crude mortality rate of 5.50 deaths per 1,000 person-years. Compared with individuals with a SUA <6.0 mg/dL, those with a SUA of 6.0–8.9, 9.0–11.9 and ≥12 mg/dL had an age- and sex-adjusted HR (95 % CI) of 1.02 (0.82–1.26), 1.48 (1.08–2.02) and 4.73 (2.67–8.37). After adjustment for age, sex and history of diabetes mellitus and hypertension, hyperuricaemia was found to be associated with a HR (95 % CI) of 1.38 (1.13–1.69; p < 0.001) for all-cause mortality. Hyperuricaemia was associated with an increased risk of mortality due to cardiovascular diseases (HR, 5.0; 95 % CI 1.79–13.94; p = 0.001) and kidney diseases (11.71; 3.13–43.78; p < 0.001). Paediatric patients with hyperuricaemia were at increased risk of mortality, especially due to kidney and cardiovascular diseases.

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References

  1. Fang J, Alderman MH (2000) Serum uric acid and cardiovascular mortality the NHANES I epidemiologic follow-up study, 1971–1992. National Health and Nutrition Examination Survey. JAMA 283(18):2404–2410. doi:10.1001/jama.283.18.2404

    Article  PubMed  CAS  Google Scholar 

  2. Alper AB Jr, Chen W, Yau L, Srinivasan SR, Berenson GS, Hamm LL (2005) Childhood uric acid predicts adult blood pressure: the Bogalusa Heart Study. Hypertension 45(1):34–38. doi:10.1161/01.HYP.0000150783.79172.bb

    Article  PubMed  CAS  Google Scholar 

  3. Feig DI, Johnson RJ (2003) Hyperuricemia in childhood primary hypertension. Hypertension 42(3):247–252. doi:10.1161/01.HYP.0000085858.66548.59

    Article  PubMed  CAS  Google Scholar 

  4. Ford ES, Li C, Cook S, Choi HK (2007) Serum concentrations of uric acid and the metabolic syndrome among US children and adolescents. Circulation 115(19):2526–2532. doi:10.1161/CIRCULATIONAHA.106.657627

    Article  PubMed  CAS  Google Scholar 

  5. Syrjanen J, Mustonen J, Pasternack A (2000) Hypertriglyceridaemia and hyperuricaemia are risk factors for progression of IgA nephropathy. Nephrol Dial Transplant 15(1):34–42. doi:10.1093/ndt/15.1.34

    Article  PubMed  CAS  Google Scholar 

  6. Van Albada ME, Loot FG, Fokkema R, Roofthooft MT, Berger RM (2008) Biological serum markers in the management of pediatric pulmonary arterial hypertension. Pediatr Res 63(3):321–327. doi:10.1203/PDR.0b013e318163a2e7

    Article  PubMed  Google Scholar 

  7. Kedar A, Grow W, Neiberger RE (1995) Clinical versus laboratory tumor lysis syndrome in children with acute leukemia. Pediatr Hematol Oncol 12(2):129–134. doi:10.3109/08880019509029545

    Article  PubMed  CAS  Google Scholar 

  8. Baker JF, Krishnan E, Chen L, Schumacher HR (2005) Serum uric acid and cardiovascular disease: recent developments, and where do they leave us? Am J Med 118(8):816–826. doi:10.1016/j.amjmed.2005.03.043

    Article  PubMed  CAS  Google Scholar 

  9. Loeb JN (1972) The influence of temperature on the solubility of monosodium urate. Arthritis Rheum 15(2):189–192. doi:10.1002/art.1780150209

    Article  PubMed  CAS  Google Scholar 

  10. Lu TH, Shau WY, Shih TP, Lee MC, Chou MC, Lin CK (2001) Factors associated with errors in death certificate completion. A national study in Taiwan. J Clin Epidemiol 54(3):232–238. doi:10.1016/S0895-4356(00)00299-7

    Article  PubMed  CAS  Google Scholar 

  11. Brodov Y, Behar S, Boyko V, Chouraqui P (2010) Effect of the metabolic syndrome and hyperuricemia on outcome in patients with coronary artery disease (from the Bezafibrate Infarction Prevention Study). Am J Cardiol 106(12):1717–1720. doi:10.1016/j.amjcard.2010.07.046

    Article  PubMed  CAS  Google Scholar 

  12. Panero F, Gruden G, Perotto M et al (2012) Uric acid is not an independent predictor of cardiovascular mortality in type 2 diabetes: a population-based study. Atherosclerosis 221(1):183–188. doi:10.1016/j.atherosclerosis.2011.11.042

    Article  PubMed  CAS  Google Scholar 

  13. Jones DP, Richey PA, Alpert BS, Li R (2008) Serum uric acid and ambulatory blood pressure in children with primary hypertension. Pediatr Res 64(5):556–561. doi:10.1203/PDR.0b013e318183fd7c

    Article  PubMed  CAS  Google Scholar 

  14. Baldree LA, Stapleton FB (1990) Uric acid metabolism in children. Pediatr Clin North Am 37(2):391–418

    PubMed  CAS  Google Scholar 

  15. Chang HY, Pan WH, Yeh WT, Tsai KS (2001) Hyperuricemia and gout in Taiwan: results from the Nutritional and Health Survey in Taiwan (1993–96). J Rheumatol 28(7):1640–1646

    PubMed  CAS  Google Scholar 

  16. Lee MS, Wahlqvist ML, Yu HL, Pan WH (2007) Hyperuricemia and metabolic syndrome in Taiwanese children. Asia Pac J Clin Nutr 16(Suppl 2):594–600

    PubMed  CAS  Google Scholar 

  17. Darmawan J, Valkenburg HA, Muirden KD, Wigley RD (1992) The epidemiology of gout and hyperuricemia in a rural population of Java. J Rheumatol 19(10):1595–1599

    PubMed  CAS  Google Scholar 

  18. Chang FT, Chang SJ, Wu YY, Wang TN, Ko YC (1995) Body mass index and hyperuricemia differences between aboriginal and non-aboriginal children in Taiwan. Gaoxiong Yi Xue Ke Xue Za Zhi 11(6):315–321

    PubMed  CAS  Google Scholar 

  19. Nicholls A, Snaith ML, Scott JT (1973) Effect of oestrogen therapy on plasma and urinary levels of uric acid. BMJ 1(5851):449–451

    Article  PubMed  CAS  Google Scholar 

  20. Adamopoulos D, Vlassopoulos C, Seitanides B, Contoyiannis P, Vassilopoulos P (1977) The relationship of sex steroids to uric acid levels in plasma and urine. Acta Endocrinol (Copenh) 85(1):198–208. doi:10.1530/acta.0.0850198

    CAS  Google Scholar 

  21. Garbagnati E (1996) Urate changes in lean and obese boys during pubertal development. Metabolism 45(2):203–205. doi:10.1016/S0026-0495(96)90054-2

    Article  PubMed  CAS  Google Scholar 

  22. Khosla UM, Zharikov S, Finch JL et al (2005) Hyperuricemia induces endothelial dysfunction. Kidney Int 67(5):1739–1742. doi:10.1111/j.1523-1755.2005.00273.x

    Article  PubMed  Google Scholar 

  23. Johnson RJ, Kang DH, Feig D et al (2003) Is there a pathogenetic role for uric acid in hypertension and cardiovascular and renal disease? Hypertension 41(6):1183–1190. doi:10.1161/01.HYP.0000069700.62727.C5

    Article  PubMed  CAS  Google Scholar 

  24. Zhou X, Matavelli L, Frohlich ED (2006) Uric acid: its relationship to renal hemodynamics and the renal renin-angiotensin system. Curr Hypertens Rep 8(2):120–124. doi:10.1007/s11906-006-0007-x

    Article  PubMed  CAS  Google Scholar 

  25. Kuo CF, Yu KH, Luo SF et al (2010) Role of uric acid in the link between arterial stiffness and cardiac hypertrophy: a cross-sectional study. Rheumatology 49(6):1189–1196. doi:10.1093/rheumatology/keq095

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

The authors would like to thank the Ministry of Education of Taiwan and Chang Gung Memorial Hospital for their financial support of this research, and the Graduate Institute of Clinical Medical Sciences, Chang Gung University, for methodological assistance. This study is based on data from the National Death Registry, provided by the Bureau of Health Promotion, Department of Health, Taiwan. The conclusions herein do not represent the opinions of the Bureau.

Conflict of interest

The authors have no conflict of interest to declare.

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Authors and Affiliations

  1. Division of Paediatric Critical Care, Chang Gung Children’s Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan

    Shao-Hsuan Hsia

  2. Division of Paediatric General Medicine, Chang Gung Children’s Hospital, Chang Gung University College of Medicine, No.5, Fuxing Street, Guishan Township, Taoyuan, 333, Taiwan

    I-Jun Chou & Chang-Teng Wu

  3. Division of Paediatric Neurology, Chang Gung Children’s Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan

    I-Jun Chou, Kuang-Lin Lin & Huei-Shyong Wang

  4. Division of Rheumatology Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan

    Chang-Fu Kuo, Kuang-Hui Yu & Shue-Fen Luo

  5. Department of Public Health, Biostatistics Consulting Centre, College of Medicine, Chang Gung University, Taoyuan, Taiwan

    Lai-Chu See

  6. Biostatistics Core Laboratory, Molecular Medicine Research Centre, Chang Gung University, Taoyuan, Taiwan

    Lai-Chu See

  7. Division of Allergy, Asthma and Rheumatology, Department of Paediatrics, Chang Gung Children’s Hospital, Chang Gung University, Taoyuan, Taiwan

    Jing-Long Huang

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  1. Shao-Hsuan Hsia
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  10. Huei-Shyong Wang
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Correspondence to I-Jun Chou.

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Hsia, SH., Chou, IJ., Kuo, CF. et al. Survival impact of serum uric acid levels in children and adolescents. Rheumatol Int 33, 2797–2802 (2013). https://doi.org/10.1007/s00296-013-2808-y

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  • DOI: https://doi.org/10.1007/s00296-013-2808-y

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