Hyperuricemia, the heart, and the kidneys – to treat or not to treat?

Petreski, Tadej; Ekart, Robert; Hojs, Radovan; Bevc, Sebastjan

doi:10.1080/0886022x.2020.1822185

Cited by 43 publications

(31 citation statements)

References 94 publications

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“…Hyperuricemia is defined as a UA concentration higher than 7 mg/dL in men, 6 mg/dL in women, and 5.5 mg/dL in children and teenagers [ 24 ]. Causes of hyperuricemia are rich purine diets, congenital disorders, tumor lysis syndrome, seizures, rhabdomyolysis [ 25 ], hypercatabolic states [ 26 ], or drugs (i.e., acid acetylsalicylic, theophylline, mycophenolate, beta- and alfa- adrenergic antagonists, angiotensin-converting enzyme, cyclosporine) [ 27 ]. Low serum level of UA may be encountered in large volumes of parenteral fluids, psychogenic polydipsia, inappropriate antidiuretic hormone (SIADH), or in some hepatic diseases (i.e., cholangiocarcinoma, viral hepatitis, primary cirrhosis), immunosuppression, or neoplasia.…”

Section: Uric Acid Synthesismentioning

confidence: 99%

Uric Acid and Oxidative Stress—Relationship with Cardiovascular, Metabolic, and Renal Impairment

Gherghina

Peride

Ţigliş

et al. 2022

IJMS

175

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Background: The connection between uric acid (UA) and renal impairment is well known due to the urate capacity to precipitate within the tubules or extra-renal system. Emerging studies allege a new hypothesis concerning UA and renal impairment involving a pro-inflammatory status, endothelial dysfunction, and excessive activation of renin–angiotensin–aldosterone system (RAAS). Additionally, hyperuricemia associated with oxidative stress is incriminated in DNA damage, oxidations, inflammatory cytokine production, and even cell apoptosis. There is also increasing evidence regarding the association of hyperuricemia with chronic kidney disease (CKD), cardiovascular disease, and metabolic syndrome or diabetes mellitus. Conclusions: Important aspects need to be clarified regarding hyperuricemia predisposition to oxidative stress and its effects in order to initiate the proper treatment to determine the optimal maintenance of UA level, improving patients’ long-term prognosis and their quality of life.

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Section: Uric Acid Synthesismentioning

confidence: 99%

Uric Acid and Oxidative Stress—Relationship with Cardiovascular, Metabolic, and Renal Impairment

Gherghina

Peride

Ţigliş

et al. 2022

IJMS

175

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“…However, lifestyle modifications and targeted pharmacological urate-lowering therapy can be beneficial in certain sub-groups of patients and systematic identification of such patients is another big challenge for the clinicians. 25 Limitations of our study was being a single-center study and having a small sample size and limits the generalizability of study findings.…”

Section: Discussionmentioning

confidence: 93%

Prevalence of Hyperuricemia in Thrice Weekly Hemodialysis Patients

Moon

Alam

Yaqoob³

et al. 2022

Pak J Kidney Dis

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Background: Hyperuricemia is a well-established prognostic marker for chronic kidney disease (CKD) patients. Therefore, in this study, our aim was to determine the prevalence of hyperuricemia in thrice-weekly hemodialysis patients at a tertiary care hospital in Karachi, Pakistan. Methods: This was a descriptive cross-sectional study that included consecutive patients diagnosed with end-stage renal disease (ESRD) on maintenance thrice-weekly hemodialysis (HD). Based on serum urate concentrations, hyperuricemia was labeled in male patients with > 7 mg/dL, and in female patients, the threshold value was >6 mg/dL. Results: The study included a total of 73 thrice-weekly hemodialysis patients out of which 64.4% (47) were male and mean age of the study sample was 50.3 ± 12.1 years. Hyperuricemia was observed in 76.7% (56) of the patients. Females (41.1% vs. 17.6%), diabetes (46.4% vs. 23.5%), and glomerulonephritis (5.4% vs. 0%) were relatively more common among patients with hyperuricemia than non- hyperuricemia patients, respectively. Similarly, severe left ventricular (LV) dysfunction (75% vs. 35.3%), severe mitral regurgitation (14.3% vs. 5.9%), and severe tricuspid regurgitation (12.5% vs. 5.9%) were relatively more common among patients with hyperuricemia than non- hyperuricemia patients, respectively. Conclusion: Hyperuricemia was prevalent in more than 3/4th of the thrice-weekly hemodialysis patients. Females, diabetics, glomerulonephritis, severe LV dysfunction with mitral regurgitation (severe) and tricuspid regurgitation (severe) were relatively more common among hyperuricemic patients.

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“…On the other hand, some studies reported no effect of febuxostat on eGFR decline with asymptomatic hyperuricemia in CKD stage 3 patients [ 28 , 29 ]. In addition, recent systematic review has showed evidence that asymptomatic hyperuricemia should be treated under limited conditions: persistent SUA level higher than 13 mg/dL (men) or 10 mg/dL (women) and urinary excretion of uric acid exceeding 1,100 mg daily [ 30 , 31 ]. For individuals of asymptomatic hyperuricemia like our cohort, there have been no sufficient evidence to treat hyperuricemia.…”

Section: Discussionmentioning

confidence: 99%

Alteration of normal level of serum urate may contribute to decrease in estimated glomerular filtration rate decline in healthy Japanese men

et al. 2021

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Introduction Serum uric acid (SUA) levels have a linear relationship with the estimated glomerular filtration rate (eGFR). It is unclear whether further changes, subsequent to normal level of SUA can attenuate eGFR decline in a healthy population, so we aimed to determine the normal level of SUA that can contribute to preventing kidney dysfunction. Methods In this retrospective cohort study from Japan, annual health checkup data from 2009 to 2014 was collected. After propensity score matching (1:1), data from 2,634 individuals with basal SUA ≤7.0 mg/dL (normal; mean age, 39 y; mean eGFR, 80.8 mL/min/1.73 m 2 ) and 1,642 individuals with basal SUA >7.0 mg/dL (elevated; mean age, 42 y; mean eGFR, 75.0 mL/min/1.73 m 2 ) were collected to determine the relationship between followed-up SUA level and the rate of change in eGFR. Results In individuals with normal level SUA at baseline, the elevation of SUA (>7.0 mg/dL) accelerated eGFR decline compared to those with normal SUA levels at 5-year follow-up (−4.1 ± 9.6% vs −9.9 ± 9.0%, p < .0001). Digression of SUA level (≤7.0 mg/dL) reduced eGFR decline compared with persistent SUA level over 7.0 mg/dL (−1.5 ± 11.5% vs −7.0 ± 10.1, p < .0001). In multiple linear regression analysis, there was strong association between the rate of change in SUA and eGFR in individuals with basal SUA ≤7.0 and >7.0 mg/dL (standardized coefficient; −0.3348, p < .001 and −.2523, p < .001, respectively). Conclusion Subsequent to normal level of SUA (under 7.0 mg/dL) may contribute to a decrease in eGFR decline in apparently healthy men.

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Hyperuricemia, the heart, and the kidneys – to treat or not to treat?

Cited by 43 publications

References 94 publications

Uric Acid and Oxidative Stress—Relationship with Cardiovascular, Metabolic, and Renal Impairment

Uric Acid and Oxidative Stress—Relationship with Cardiovascular, Metabolic, and Renal Impairment

Prevalence of Hyperuricemia in Thrice Weekly Hemodialysis Patients

Alteration of normal level of serum urate may contribute to decrease in estimated glomerular filtration rate decline in healthy Japanese men

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