Journal of the Formosan Medical Association
Volume 108, Issue 12 , Pages 921-928, December 2009

Hyperuricemia Associated With Rapid Renal Function Decline in Elderly Taiwanese Subjects

  • Chung-Jen Yen

      Affiliations

    • Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
    • Corresponding Author InformationCorrespondence to: Dr Chung-Jen Yen, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, 7 Chung-Shan South Road, Taipei 10006, Taiwan
    • Chung-Jen Yen and Chih-Kang Chiang contributed equally to this work.
    • ,
  • Chih-Kang Chiang

      Affiliations

    • Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
    • Department of Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, Taipei, Taiwan
    • Chung-Jen Yen and Chih-Kang Chiang contributed equally to this work.
    • ,
  • Li-Chun Ho

      Affiliations

    • Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
    • Division of Nephrology, Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan
    • ,
  • Sandy Huey-Jen Hsu

      Affiliations

    • Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan
    • ,
  • Kuan-Yu Hung

      Affiliations

    • Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
    • ,
  • Kwan-Dun Wu

      Affiliations

    • Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
    • ,
  • Tun-Jun Tsai

      Affiliations

    • Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan

Received 17 February 2009; received in revised form 18 March 2009; accepted 1 May 2009.

Article Outline

Background/Purpose

Hyperuricemia is encountered frequently in patients with chronic kidney disease (CKD). We tested the hypothesis that uric acid influences glomerular filtration rate (GFR) and is associated with renal function decline in elderly Taiwanese subjects.

Methods

We enrolled 800 elderly Taiwanese subjects for a health checkup. Estimated GFR (eGFR) was measured using the Modification of Diet in Renal Disease Study equation. eGFR < 60 mL/min/1.73 m2 was used to analyze the prevalence and incidence of CKD. Significant renal function decline was defined as a decrease in eGFR of ≥ 3 mL/min/1.73 m2 per year.

Results

The prevalence of CKD was 18.0% in the elderly subjects. Mean serum uric acid level was 6.6 mg/dL in male and 5.6 mg/dL in female subjects, and eGFR was 71.7 mL/min/1.73 m2. Uric acid levels were associated independently and negatively with eGFR after adjusting for conventional factors of renal function decline. One hundred and sixty-two individuals (31.2%) had a significant decline in renal function. As uric acid level increased by 1 mg/dL, the odds of a significant eGFR decline increased by 1.208.

Conclusion

Serum uric acid level was associated with eGFR and decline in renal function in elderly Taiwanese subjects. Whether hypouricemic therapy could retard the progression of CKD deserves further in-depth study.

Key Words:  aged , chronic kidney disease , glomerular filtration rate , hyperuricemia , Taiwan

No full text is available. To read the body of this article, please view the PDF online.

 

Back to Article Outline

References 

  1. Reungjui S , Roncal CA , Mu W , et al.   Thiazide diuretics exacerbate fructose-induced metabolic syndrome . J Am Soc Nephrol . 2007;18:2724–2731
  2. Kang DH , Han L , Ouyang X , et al.   Uric acid causes vascular smooth muscle cell proliferation by entering cells via a functional urate transporter . Am J Nephrol . 2005;25:425–433
  3. Kang DH , Park SK , Lee IK , et al.   Uric acid-induced C-reactive protein expression: implication on cell proliferation and nitric oxide production of human vascular cells . J Am Soc Nephrol . 2005;16:3553–3562
  4. Kanellis J , Watanabe S , Li JH , et al.   Uric acid stimulates monocyte chemoattractant protein-1 production in vascular smooth muscle cells via mitogen-activated protein kinase and cyclooxygenase-2 . Hypertension . 2003;41:1287–1293
  5. Ford ES , Li C , Cook S , et al.   Serum concentrations of uric acid and the metabolic syndrome among US children and adolescents . Circulation . 2007;115:2526–2532
  6. Iseki K , Ikemiya Y , Inoue T , et al.   Significance of hyperuricemia as a risk factor for developing ESRD in a screened cohort . Am J Kidney Dis . 2004;44:642–650
  7. Iseki K , Oshiro S , Tozawa M , et al.   Significance of hyperuricemia on the early detection of renal failure in a cohort of screened subjects . Hypertens Res . 2001;24:691–697
  8. Mazzali M , Kim YG , Suga S , et al.   Hyperuricemia exacerbates chronic cyclosporine nephropathy . Transplantation . 2001;71:900–905
  9. Myllymaki J , Honkanen T , Syrjanen J , et al.   Uric acid correlates with the severity of histopathological parameters in IgA nephropathy . Nephrol Dial Transplant . 2005;20:89–95
  10. Kang DH , Nakagawa T , Feng L , et al.   A role for uric acid in the progression of renal disease . J Am Soc Nephrol . 2002;13:2888–2897
  11. Ohno I , Hosoya T , Gomi H , et al.   Serum uric acid and renal prognosis in patients with IgA nephropathy . Nephron . 2001;87:333–339
  12. Fessel WJ . Renal outcomes of gout and hyperuricemia . Am J Med . 1979;67:74–82
  13. Yu TF , Berger L . Impaired renal function gout: its association with hypertensive vascular disease and intrinsic renal disease . Am J Med . 1982;72:95–100
  14. Siu YP , Leung KT , Tong MK , et al.   Use of allopurinol in slowing the progression of renal disease through its ability to lower serum uric acid level . Am J Kidney Dis . 2006;47:51–59
  15. Obermayr RP , Temml C , Gutjahr G , et al.   Elevated uric acid increases the risk for kidney disease . J Am Soc Nephrol . 2008;19:2407–2413
  16. Chonchol M , Shlipak MG , Katz R , et al.   Relationship of uric acid with progression of kidney disease . Am J Kidney Dis . 2007;50:239–247
  17. Weiner DE , Tighiouart H , Elsayed EF , et al.   Uric acid and incident kidney disease in the community . J Am Soc Nephrol . 2008;19:1204–1211
  18. Levey AS , Coresh J , Balk E , et al.   National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification . Ann Intern Med . 2003;139:137–147
  19. National Kidney Foundation  . K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification . Am J Kidney Dis . 2002;39(2 Suppl 1):S1–S266
  20. Fried L , Solomon C , Shlipak M , et al.   Inflammatory and prothrombotic markers and the progression of renal disease in elderly individuals . J Am Soc Nephrol . 2004;15:3184–3191
  21. Klein R , Klein BE , Moss SE , et al.   The 10-year incidence of renal insufficiency in people with type 1 diabetes . Diabetes Care . 1999;22:743–751
  22. Rao GN , Corson MA , Berk BC . Uric acid stimulates vascular smooth muscle cell proliferation by increasing platelet-derived growth factor A-chain expression . J Biol Chem . 1991;266:8604–8608
  23. Umekawa T , Chegini N , Khan SR . Increased expression of monocyte chemoattractant protein-1 (MCP-1) by renal epithelial cells in culture on exposure to calcium oxalate, phosphate and uric acid crystals . Nephrol Dial Transplant . 2003;18:664–669
  24. Mazzali M , Kanellis J , Han L , et al.   Hyperuricemia induces a primary renal arteriolopathy in rats by a blood pressure-independent mechanism . Am J Physiol Renal Physiol . 2002;282:F991–F997
  25. Mazzali M , Hughes J , Kim YG , et al.   Elevated uric acid increases blood pressure in the rat by a novel crystal-independent mechanism . Hypertension . 2001;38:1101–1106
  26. Nakagawa T , Mazzali M , Kang DH , et al.   Hyperuricemia causes glomerular hypertrophy in the rat . Am J Nephrol . 2003;23:2–7
  27. Chien KL , Hsu HC , Sung FC , et al.   Hyperuricemia as a risk factor on cardiovascular events in Taiwan: the Chin-Shan Community Cardiovascular Cohort Study . Atherosclerosis . 2005;183:147–155
  28. Johnson RJ , Kivlighn SD , Kim YG , et al.   Reappraisal of the pathogenesis and consequences of hyperuricemia in hypertension, cardiovascular disease, and renal disease . Am J Kidney Dis . 1999;33:225–234
  29. Jankowska EA , Ponikowska B , Majda J , et al.   Hyperuricaemia predicts poor outcome in patients with mild to moderate chronic heart failure . Int J Cardiol . 2007;115:151–155
  30. Culleton BF , Larson MG , Kannel WB , et al.   Serum uric acid and risk for cardiovascular disease and death: the Framingham Heart Study . Ann Intern Med . 1999;131:7–13
  31. Nagahama K , Inoue T , Iseki K , et al.   Hyperuricemia as a predictor of hypertension in a screened cohort in Okinawa, Japan . Hypertens Res . 2004;27:835–841
  32. Syrjanen J , Mustonen J , Pasternack A . Hypertriglyceridaemia and hyperuricaemia are risk factors for progression of IgA nephropathy . Nephrol Dial Transplant . 2000;15:34–42

PII: S0929-6646(10)60004-6

doi:10.1016/S0929-6646(10)60004-6

Journal of the Formosan Medical Association
Volume 108, Issue 12 , Pages 921-928, December 2009

Article Tools