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Hyperuricemia is associated with secondary hyperparathyroidism in patients with chronic kidney disease

  • Nephrology - Original Paper
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Abstract

Purpose

Hyperuricemia is common among patients with chronic kidney disease (CKD). In the general population, hyperuricemia is associated with secondary hyperparathyroidism (SHPT), in a mechanism that involves vitamin D metabolism. Data for patients with CKD, however, are scarce. We aimed to evaluate the relationship between hyperuricemia and mineral and bone metabolism, particularly hyperparathyroidism.

Methods

This is a retrospective study that included 922 adult patients with stages 3, 4, or 5 CKD, not on dialysis. Clinical, demographic, and biochemical data were collected from charts and included uric acid, parathyroid hormone (PTH), 25(OH)-vitamin D, calcium, phosphate, renal function (estimated glomerular filtration rate—eGFR), and medications such as allopurinol, furosemide, and cholecalciferol. SHPT was defined as PTH > 65 pg/ml.

Results

Our patients were mostly Caucasian women, with a mean age of 64 ± 16 years. SHPT and hyperuricemia were observed in 70% and 62.4% of patients, respectively. Patients with SHPT presented higher levels of uric acid (7.2 ± 1.8 vs. 6.6 ± 1.7 mg/dL, p = 0.0001) and a higher frequency of hyperuricemia (66% vs. 33%, p = 0.0001). Patients with hyperuricemia were mostly female, with lower eGFR, higher phosphate, and higher PTH. The risk of hypovitaminosis D was higher among patients with SHPT (69.7% vs. 53.1%, p = 0.0001). Hyperuricemia remained independently associated with hyperparathyroidism, (p = 0.033) even after adjustments for eGFR, calcium, phosphate, hypovitaminosis D, and use of allopurinol, calcitriol, furosemide, and cholecalciferol.

Conclusion

Hyperuricemia seems to be a contributing factor for SHPT in patients with CKD. The mechanisms behind this finding have yet to be elucidated.

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Availability of data and materials

Data are available for reviewers and authors if requested.

Abbreviations

CKD:

Chronic kidney disease

eGFR:

Estimated glomerular filtration rate

FGF-23:

Fibroblast growth factor 23

PTH:

Parathyroid hormone

SHPT:

Secondary hyperparathyroidism

UA:

Uric acid

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Acknowledgements

We would like to thank Fatima Libanio for her support in data collection from the electronic chart.

Funding

The author(s) RMAM and RME disclosed receipt of support from CNPQ (Conselho Nacional de Desenvolvimento Científico e Tecnológico), grant numbers 303545/2020–8 and 305106/2018–0, respectively). This financial support had no role in study design; collection, analysis, and interpretation of data; writing the report; and the decision to submit the report for publication.

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Authors and Affiliations

  1. Division of Nephrology, Department of Medicine, Hospital das Clinicas HCFMUSP, Sao Paulo, (SP), Brazil

    Tiago Emanuel M. Costa, Julia C. Lauar, Mariana L. R. Innecchi, Rosa M. A. Moysés & Rosilene M. Elias

  2. Division of Geriatrics, Department of Medicine, Hospital das Clinicas HCFMUSP, Sao Paulo, (SP), Brazil

    Venceslau A. Coelho

  3. Universidade Nove de Julho (UNINOVE), Sao Paulo, (SP), Brazil

    Rosilene M. Elias

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  1. Tiago Emanuel M. Costa
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  5. Rosa M. A. Moysés
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Contributions

TEC and RME conceived the idea; TEC and JCL collected the data; RMAM and RME supervised the research; TEC, JCL, and VAC give important intellectual contribution; all authors interpreted the data and discussed the results; TEC, RMAM, and RME analyzed the data; TEC and RME drafted the manuscript; all authors read and approved the final version.

Corresponding author

Correspondence to Rosilene M. Elias.

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The authors have no conflicts of interest to declare.

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Ethical approval for this study was obtained from *Comissão de Ética para análise de projetos de pesquisa—CAPpesq (45163715.4.0000.0068).

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Written informed consent was not obtained from subjects since was waived by the Research Ethical Board.

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Costa, T.E.M., Lauar, J.C., Innecchi, M.L.R. et al. Hyperuricemia is associated with secondary hyperparathyroidism in patients with chronic kidney disease. Int Urol Nephrol 54, 2255–2261 (2022). https://doi.org/10.1007/s11255-022-03116-5

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