Predictors of Hyperuricemia after Kidney Transplantation: Association with Graft Function

Abstract

Background and objectives: In kidney transplant recipients (KTR), hyperuricemia (HU) is a commonly-observed phenomenon, due to calcineurin inhibitors and reduced kidney graft function. Factors predicting HU, and its association with graft function, remains equivocal. Materials and Methods: We conducted a retrospective longitudinal study to assess factors associated with HU in KTR, and to determine risk factors associated with graft function, measured as glomerular filtration rate (GFR). Moreover, GFR > 60 mL/min/1.73 m2 was considered normal. HU was defined as a serum uric acid level of > 416 μmol/L (4.70 mg/dL) in men and >357 μmol/L (4.04 mg/dL) in women, or xanthine-oxidase inhibitor use. We built multiple logistic regression models to assess predictors of HU in KTR, as well as the association of demographic, clinical, and biochemical parameters of patients with normal GFR after a three-year follow-up. We investigated the effect modification of this association with HU. Results: There were 144 patients (mean age 46.6 ± 13.9), with 42.4% of them having HU. Predictors of HU in KTR were the presence of cystic diseases (OR = 9.68 (3.13; 29.9)), the use of diuretics (OR = 4.23 (1.51; 11.9)), and the male gender (OR = 2.45 (1.07; 5.56)). Being a younger age, of female gender, with a normal BMI, and the absence of diuretic medications increased the possibility of normal GFR. HU was the effect modifier of the association between demographic, clinical, and biochemical factors and a normal GFR. Conclusions: Factors associated with HU in KTR: Presence of cystic diseases, diuretic use, and male gender. HU was the effect modifier of the association of demographic, clinical, and biochemical factors to GFR.

Prevalence of Musculoskeletal Manifestations in Adult Kidney Transplant’s Recipients: A Systematic Review

“…Recently, Inese Folkmane et al, in 2020, reported that the prevalence of HU in KTxR was 42.36% and its predictors included the presence of cystic diseases, the use of diuretics, and the male gender. Therefore, being a younger, female, with a normal BMI increased the possibility of normal GFR [ 41 ].…”

Risk factors and management of hyperuricemia after renal transplantation

“…Malheiro et al found that hyperuricemic patients were overwhelmingly male of 302 renal transplant patients ( 22 ). This gender bias could be explained by the fact that estrogenic compounds enhance renal urate excretion in women, possibly reducing the active renal urate transporters resulting in less tubular UA reabsorption ( 7 , 23 ).…”

“…Since, there is not much evidence to prove that the use of beta blockers is a risk factor for HUA after renal transplantation, a detailed mechanism needs further investigation. Multiple studies have reported that diuretics were directly related to a higher risk for HUA after renal transplantation ( 7 , 8 , 32 ). Among these, thiazide diuretics and loop diuretics can interact with renal OAT; they enter the proximal tubular cells from the blood by OAT1 and OAT3, which could probably compete with UA, causing the reduced secretion of UA ( 30 , 44 , 45 ).…”

Saphenous Vein Graft between Brachial Artery and Cephalic Vein in Antebrachial Arteriovenous Anastomosis – Simulation of the Procedure

“…This study has several limitations. First, we cannot exclude, that in some patients' body the native vein graft will be rejected or vasodilation will occur faster, than using the prosthetic graft, which will depend on individual reaction to the new structure in the forearm compartment, hypoxia, nutrition, different growth factor (plateletderived growth factor, vascular endothelial growth factor) activity, the presence or lack of everyday physical activity, changes in body temperature, hypotension et cetera [9,10,12]. A second limitation, we had no possibility to perform the procedure clinically on the patient due to the limited access to the hospital and lack of the researches, in which the great saphenous vein was used as arteriovenous anastomosis connective structure, except cardiovascular surgery researches with the saphenous vein in coronary bypass surgery [1].…”