Longitudinal uric acid has nonlinear association with kidney failure and mortality in chronic kidney disease

Mathilde Prezelin-Reydit (1, 2, 3) , Christian Combe (4, 5) , Denis Fouque (6, 7) , Luc Frimat (8, 9) , Christian Jacquelinet (10, 11) , Maurice Laville (6, 12) , Ziad Massy (11, 13) , Céline Lange (11) , Carole Ayav (14, 8) , Roberto Pecoits-Filho (15, 16) , Sophie Liabeuf (17, 18, 11) , Bénédicte Stengel (11) , Jérôme Harambat (1, 3, 19) , Karen Leffondré (20, 1)

1 BPH - Bordeaux population health
2 AURAD Aquitaine
3 CIC Bordeaux
4 BIOTIS - Bioingénierie tissulaire
5 CHU Bordeaux
6 CarMeN - Cardiovasculaire, métabolisme, diabétologie et nutrition
7 CHLS - Centre Hospitalier Lyon Sud [CHU - HCL]
8 CHRU Nancy - Centre Hospitalier Régional Universitaire de Nancy
9 APEMAC - Adaptation, mesure et évaluation en santé. Approches interdisciplinaires
10 Agence de la biomédecine [Saint-Denis la Plaine]
11 CESP - Centre de recherche en épidémiologie et santé des populations
12 AURAL - Association pour l'Utilisation du Rein Artificiel Région Lyonnaise
13 Hôpital Ambroise Paré [AP-HP]
14 CIC - Centre d'investigation clinique [Nancy]
15 PUCPR - Pontifícia Universidade Católica do Paraná [Curitiba, Brasil] = Pontifical Catholic University of Paraná [Curitiba, Brazil] = Université catholique pontificale du Paraná [Curitiba, Brésil]
16 Arbor Research Collaborative for Health
17 MP3CV - Mécanismes physiopathologiques et conséquences des calcifications vasculaires - UR UPJV 7517
18 CHU Amiens-Picardie
19 Hôpital Pellegrin
20 ISPED - Institut de Santé Publique, d'Epidémiologie et de Développement

Abstract We investigated the shape of the relationship between longitudinal uric acid (UA) and the hazard of kidney failure and death in chronic kidney disease (CKD) patients, and attempted to identify thresholds associated with increased hazards. We included CKD stage 3–5 patients from the CKD-REIN cohort with one serum UA measurement at cohort entry. We used cause-specific multivariate Cox models including a spline function of current values of UA (cUA), estimated from a separate linear mixed model. We followed 2781 patients (66% men, median age, 69 years) for a median of 3.2 years with a median of five longitudinal UA measures per patient. The hazard of kidney failure increased with increasing cUA, with a plateau between 6 and 10 mg/dl and a sharp increase above 11 mg/dl. The hazard of death had a U-shape relationship with cUA, with a hazard twice higher for 3 or 11 mg/dl, compared to 5 mg/dl. In CKD patients, our results indicate that UA above 10 mg/dl is a strong risk marker for kidney failure and death and that low UA levels below 5 mg/dl are associated with death before kidney failure.

Domaines: Médecine humaine et pathologie

Mathilde Prezelin-Reydit, Christian Combe, Denis Fouque, Luc Frimat, Christian Jacquelinet, et al.. Longitudinal uric acid has nonlinear association with kidney failure and mortality in chronic kidney disease. Scientific Reports, 2023, 13 (1), pp.3952. ⟨10.1038/s41598-023-30902-7⟩. ⟨hal-04032437⟩