The physiology of uric acid and the impact of end‐stage kidney disease and dialysis

Murea, Mariana; Tucker, Bryan M.

doi:10.1111/sdi.12735

Cited by 43 publications

(64 citation statements)

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“…Thus, the risk of high mortality due to low UA levels might be because of bad nutritional status associated with hypoalbuminemia, and heavier comorbidities led to higher risk of death. Secondly, it could also be that excessive oxidative stress caused by low UA levels, and by inducing endothelial dysfunction, indirectly led to a higher risk of death [31,32].…”

Section: Discussionmentioning

confidence: 99%

Association of Serum Uric Acid Concentration and Its Change with Cardiovascular Death and All-Cause Mortality

Dong

Tian

et al. 2020

Disease Markers

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Objective. There is no consensus on the role of abnormal uric acid (UA) levels in the prognosis of patients undergoing hemodialysis. We therefore aimed to investigate the effects of changes in UA concentration on the risk of all-cause death and cardiac death in such patients. Method. In this retrospective cohort study, patients admitted to two hemodialysis centers performing maintenance hemodialysis (MHD) in Wuhan First Hospital and Fourth Hospital Hemodialysis Center from January 1, 2007, to October 31, 2017, were included. Results. In all, 325 patients undergoing MHD aged 59.7±14.7 years, including 195 men (60%), were enrolled, with a median follow-up of 37 months. Serum UA (p<0.001) was significantly higher in the surviving group than in the death group. No significant difference was found in UA variability (p=0.193) between the two groups. Patients were assigned Quartile 1-Quartile 4 (from lowest to highest) based on serum UA levels. A total of 45 of 81 (55.6%) patients in Quartile 1 experienced all-cause death; 19 of 82 (23.2%) in Quartile 4 had all-cause mortality (OR, 0.2; 95% confidence interval, 0.1 to 0.5; p for trend<0.001). 25 of 81 (30.9%) in Quartile 1 had cardiac death; and 11 of 82 (13.4%) in Quartile 4 had cardiac death (OR, 0.3; 95% confidence interval, 0.2 to 0.8; p for trend=0.003). After adjusting for age, primary renal disease, vascular access, serum albumin, and UA variability, the OR values and 95% CI for all-cause death and cardiac death were 0.3 and 0.1-0.7 (p=0.001) and 0.6 and 0.2-1.4 (p=0.101), respectively. Additionally, the receiver operating characteristic curve showed that UA concentration and its changes combined with age had a good predictive value for all-cause mortality in patients undergoing MHD (AUC=0.7517, 95% CI: 0.6677-0.811, p=0.0245). However, the predictive value of cardiac death was not improved (AUC=0.7394, 95% CI: 0.6677-0.811, p=0.2194). Conclusion. Low UA levels were closely related to all-cause mortality in patients undergoing MHD. Although UA levels had no significant effect on cardiac death, they had a good predictive value for long-term prognosis in patients on MHD.

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Section: Discussionmentioning

confidence: 99%

Association of Serum Uric Acid Concentration and Its Change with Cardiovascular Death and All-Cause Mortality

Dong

Tian

et al. 2020

Disease Markers

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“…Notably, UA is considered as a double-edged sword in the context of human health, as it has both anti-and pro-oxidant properties depending on the surrounding environment [47][48][49]. In a physiological milieu, UA serves as an antioxidant, and when homeostasis is perturbed, divergent effects are observed depending on the clinical context [50]. Moreover, the effect of reducing hydroxyl and superoxide radicals is concentration-dependent, such that increasing serum concentrations of UA intensi es scavenging of reactive oxygen species (ROS) [51][52][53].…”

Section: Discussionmentioning

confidence: 99%

The Negative Association Between Non-alcoholic Fatty Liver Disease Severity and Gouty Nephropathy in a Non-diabetic Gouty Population: A Cross-Sectional Study

Zhou¹,

Wang²,

Chi³

et al. 2020

Preprint

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Background: Nonalcoholic fatty liver (NAFLD) and chronic kidney disease (CKD) share common pathogenic mechanisms and risk factors, but the specific relationship between NAFLD and gouty nephropathy has not been well understood. We aim to evaluate the association between NAFLD and gouty nephropathy in a non-diabetic gouty population.Methods: The retrospective cross‑sectional study was performed on 1049 non-diabetic gouty participants, who were hospitalized between 2014 and 2020, across 4 districts in Shandong, China. Demographic and clinical characteristics of the study population were collected. The odds ratios (OR) and corresponding 95% confidence intervals (CI) in relation to the NAFLD severity determined by ultrasonography were obtained by multiple logistic regression analysis. Results: An unexpectedly inverse relationship was found between NAFLD severity and the risk of gout nephropathy. Multivariate logistic regression analysis demonstrated that higher degree of NAFLD severity is independently associated with lower risk of gouty nephropathy, after adjusted for age, sex, smoking, gout duration, and metabolic risk factors including obesity, hypertension, hyperglycemia, hyperuriacemia and dyslipidemia, with OR 0.392 (95 % CI 0.248–0.619, P < 0.001), 0.379 (95 % CI 0.233–0.616, P < 0.001) and 0.148 (95 % CI 0.043–0.512, P = 0.003) in participants with mild, moderate, and severe NAFLD, respectively, compared to those without NAFLD. We also observed a weakened association of serum uric acid (SUA) with metabolic risk factors and NAFLD under circumstances of gouty nephropathy (r = -0.054, P = 0.466). Conclusions: The presence and severity of NAFLD was negatively associated with the risk of gouty nephropathy in the non-diabetic gouty populations. Further investigation of NAFLD will provide insights into the pathogenesis of gouty nephropathy.Trials registration: Chinese Clinical Trials Registry ChiCTR2000035185. Registered 2 August 2020.

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“…Сечова кислота (СК) є кінцевим продуктом катаболізму екзогенних (дієтичних) та ендогенних (нуклеїнових кислот) пуринів, які складають дві третини від загальної кількості СК в організмі [1,2]. Загалом в організмі здорової людини міститься близько 1100 мг СК, 2/3 якої виводиться з сечею [1][2][3]. Фізіологічною вважають концентрацію СК у сироватці крові 270-420 мкмоль/л для чоловіків та 180-340 мкмоль/л для жінок [1,2,4].…”

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“…Загалом в організмі здорової людини міститься близько 1100 мг СК, 2/3 якої виводиться з сечею [1][2][3]. Фізіологічною вважають концентрацію СК у сироватці крові 270-420 мкмоль/л для чоловіків та 180-340 мкмоль/л для жінок [1,2,4].…”

unclassified

“…В організмі людини СК виконує дві основні функції: разом з аміаком і сечовиною СК відіграє важливу роль у виведенні азотистих сполук [1,2,4] та є потужним антиоксидантом, який забезпечує нейтралізацію більше половини вільних радикалів сироватки крові [4]. Разом з тим, незважаючи на свої корисні функції, гіперурикемія асоційована з запаленням, ендотеліальною дисфункцією та оксидативним стресом, що може бути причиною несприятливих клінічних подій у пацієнтів з хронічною хворобою нирок (ХХН) [5].…”

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Uric acid and the risk of kidney failure in primary glomerulonephritis patients with nephrotic syndrome: preliminary results of an ongoing single-center prospective study

Kolesnyk

Stepanova

Snisar

et al. 2020

Ukr. J. Nephrol. and Dial.

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The current study aimed to evaluate whether serum uric acid (SUA) level is associated with the risk of kidney failure in primary glomerulonephritis patients (PGN) with nephrotic syndrome. Methods. During 2019, 38 patients with newly-diagnosed PGN and the nephrotic syndrome were prospectively considered for the study which is a fragment of the ongoing study "To evaluate the effect of oxalates and urates metabolism on the evolution of renal diseases". In addition to routine clinical and laboratory examination, the concentration of serum (SUA) and urine uric acid was determined. According to the CKD-EPI formula, the glomerular filtration rate (GFR) was calculated. Hyperuricemia was considered to be a uric acid concentration ≥420 μmol / l (7 mg/dl) in men and ≥360 μmol / l (6 mg/dl) in women. All patients enrolled in the study underwent a lifetime renal biopsy under ultrasound. Results. There were 26/38 (68.4%) men and 12/38 (31.6%) women. The patients' age ranged from 18 to 69 years and averaged 37 years. The CKD duration at the time of hospitalization and carrying out the kidney biopsy was 11.0 [5,4] months. Hyperuricemia was defined in 14/38 (37%) patients. SUA had an inverse correlation with the patients' GFR (r = -0.44; p = 0.003). Uraturia level was associated with the chronic changes' gradе on the kidney biopsy specimens (r = 0.66; p < 0.00013). A multivariate logistic analysis (adjustment for albumin, serum creatinine, total blood protein, daily proteinuria, patient age, and hypertension) SUA had an effect on the GFR level (OR 19.2 (95% CI 1.8; 209.5), χ 2 = 8.4; p = 0.003). Conclusions. Hyperuricemia was observed in 37% of PGN patients with nephrotic syndrome and was an independent risk factor for CKD progression. Recruitment of patients continues to complete the statistical analysis and confirm our hypothesis. Patient recruitment is still ongoing to finalize the statistical analyses and to confirm our hypothesis.

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The physiology of uric acid and the impact of end‐stage kidney disease and dialysis

Cited by 43 publications

References 90 publications

Association of Serum Uric Acid Concentration and Its Change with Cardiovascular Death and All-Cause Mortality

Association of Serum Uric Acid Concentration and Its Change with Cardiovascular Death and All-Cause Mortality

The Negative Association Between Non-alcoholic Fatty Liver Disease Severity and Gouty Nephropathy in a Non-diabetic Gouty Population: A Cross-Sectional Study

Uric acid and the risk of kidney failure in primary glomerulonephritis patients with nephrotic syndrome: preliminary results of an ongoing single-center prospective study

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