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Serum uric acid level as a risk factor for acute kidney injury in hospitalized patients: a retrospective database analysis using the integrated medical information system at Kochi Medical School hospital

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Abstract

Background and objectives

Recent studies have shown that both low and high levels of serum uric acid (SUA) before cardiovascular surgery are independent risk factors for postoperative acute kidney injury (AKI). However, these studies were limited by their small sample sizes. Here, we investigated the association between SUA levels and AKI by performing a retrospective database analysis of almost 30 years of data from 81,770 hospitalized patients.

Design, setting, participants, and measurement

Hospitalized patients aged ≥18 years were retrospectively enrolled. AKI was diagnosed according to the Kidney Disease: Improving Global Outcomes 2012 Clinical Practice Guideline (KDIGO) criteria. Multivariate logistic regression analyses were performed to investigate the independent association between SUA levels and the incidence of AKI. SUA levels were treated as categorical variables because the relationship between SUA and the incidence of AKI has been suggested to be J-shaped or U-shaped. In addition to stratified SUA levels, we considered kidney function and related comorbidities, medications, and procedures performed prior to AKI onset as possible confounding risk factors.

Results

The final study cohort included 59,219 adult patients. Adjusted odds ratios of AKI incidence were higher in both the high- and low-SUA strata. Odds ratios tended to become larger in the higher range of SUA levels in women than in men. Additionally, this study showed that AKI risk was elevated in patients with SUA levels ≤7 mg/dL. An SUA level >7 mg/dL is considered the point of initiation of uric acid crystallization.

Conclusions

SUA level could be an independent risk factor for AKI development in hospitalized patients. Additionally, our results might suggest that intervention to lower SUA levels is necessary, even in cases of moderate elevation that does not warrant hyperuricemia treatment. Results also showed that SUA levels that require attention are lower for women than for men.

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Acknowledgments

This work was supported by The Kidney Foundation of Japan and the Kochi Organization for Medical Reformation and Renewal (to Y. T.) and by a grant from the Ministry of Education, Culture, Sports, Science and Technology of Japan (to Y. T. and Y. O.).

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Authors and Affiliations

  1. Center for Innovative and Translational Medicine, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Japan

    Kazunori Otomo & Takeo Miki

  2. Department of Endocrinology, Metabolism and Nephrology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan

    Taro Horino, Tatsuki Matsumoto, Kazu Hamada-Ode, Yoshiko Shimamura, Koji Ogata, Kosuke Inoue, Yoshinori Taniguchi & Yoshio Terada

  3. Center of Medical Information Science, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Japan

    Hiromi Kataoka, Yutaka Hatakeyama & Yoshiyasu Okuhara

Authors
  1. Kazunori Otomo
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  2. Taro Horino
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  3. Takeo Miki
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  4. Hiromi Kataoka
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  5. Yutaka Hatakeyama
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  6. Tatsuki Matsumoto
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  7. Kazu Hamada-Ode
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  8. Yoshiko Shimamura
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  10. Kosuke Inoue
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  11. Yoshinori Taniguchi
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  12. Yoshio Terada
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  13. Yoshiyasu Okuhara
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Corresponding author

Correspondence to Taro Horino.

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The authors have no competing interests to declare.

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Otomo, K., Horino, T., Miki, T. et al. Serum uric acid level as a risk factor for acute kidney injury in hospitalized patients: a retrospective database analysis using the integrated medical information system at Kochi Medical School hospital. Clin Exp Nephrol 20, 235–243 (2016). https://doi.org/10.1007/s10157-015-1156-5

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  • DOI: https://doi.org/10.1007/s10157-015-1156-5

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