Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Oct;64(4):550-7.
doi: 10.1053/j.ajkd.2014.04.024. Epub 2014 Jun 4.

Uric acid levels, kidney function, and cardiovascular mortality in US adults: National Health and Nutrition Examination Survey (NHANES) 1988-1994 and 1999-2002

Michelle C Odden  1 , Abdul-Razak Amadu  2 , Ellen Smit  2 , Lowell Lo  3 , Carmen A Peralta  3
Affiliations

Uric acid levels, kidney function, and cardiovascular mortality in US adults: National Health and Nutrition Examination Survey (NHANES) 1988-1994 and 1999-2002

Michelle C Odden et al. Am J Kidney Dis. 2014 Oct.

Abstract

Background: Chronic kidney disease (CKD) and hyperuricemia often coexist, and both conditions are increasing in prevalence in the United States. However, their shared role in cardiovascular risk remains highly debated.

Study design: Cross-sectional and longitudinal.

Setting & participants: Participants in the National Health and Nutrition Examination Survey (NHANES) from 1988 to 2002 (n = 10,956); data were linked to mortality data from the National Death Index through December 31, 2006.

Predictors: Serum uric acid concentration, categorized as the sex-specific lowest (< 25th), middle (25th- < 75th), and highest (≥ 75th) percentiles; and kidney function assessed by estimated glomerular filtration rate (eGFR) based on the CKD-EPI (CKD Epidemiology Collaboration) creatinine-cystatin C equation and urinary albumin-creatinine ratio (ACR).

Outcomes: Cardiovascular death and all-cause mortality.

Results: Uric acid levels were correlated with eGFR(cr-cys) (r = -0.29; P < 0.001) and were correlated only slightly with ACR (r = 0.04; P < 0.001). There were 2,203 deaths up until December 31, 2006, of which 981 were due to cardiovascular causes. Overall, there was a U-shaped association between uric acid levels and cardiovascular mortality in both women and men, although the lowest risk of cardiovascular mortality occurred at a lower level of uric acid for women compared with men. There was an association between the highest quartile of uric acid level and cardiovascular mortality even after adjustment for potential confounders (HR, 1.48; 95% CI, 1.13-1.96), although this association was attenuated after adjustment for ACR and eGFR(cr-cys) (HR, 1.25; 95% CI, 0.89-1.75). The pattern of association between uric acid levels and all-cause mortality was similar.

Limitations: GFR not measured; mediating events were not observed.

Conclusions: High uric acid level is associated with cardiovascular and all-cause mortality, although this relationship was no longer statistically significant after accounting for kidney function.

Keywords: Uric acid; albuminuria; cardiovascular mortality; chronic kidney disease (CKD); hyperuricemia; kidney function; risk factor.

PubMed Disclaimer

Figures

Fig 1
Fig 1
Age-adjusted mean (standard error) of uric acid levels (mg/dL) by level of kidney function in women. * Small cell size
Fig 2
Fig 2
Age-adjusted mean (standard error) of uric acid levels (mg/dL) by level of kidney function in men. * Small cell size
Figure 3
Figure 3
There is a U-shaped association of uric acid level and cardiovascular mortality in women (solid line) and men (dotted line), based on weighted fractional polynomials regression adjusted for age.
See this image and copyright information in PMC

References

    1. Coresh J, Selvin E, Stevens LA, et al. Prevalence of chronic kidney disease in the United States. JAMA : the journal of the American Medical Association. 2007 Nov 7;298(17):2038–2047. - PubMed
    1. Rho YH, Zhu Y, Choi HK. The epidemiology of uric acid and fructose. Seminars in nephrology. 2011 Sep;31(5):410–419. - PMC - PubMed
    1. Goicoechea M, de Vinuesa SG, Verdalles U, et al. Effect of allopurinol in chronic kidney disease progression and cardiovascular risk. Clinical journal of the American Society of Nephrology : CJASN. 2010 Aug;5(8):1388–1393. - PMC - PubMed
    1. Siu YP, Leung KT, Tong MK, Kwan TH. Use of allopurinol in slowing the progression of renal disease through its ability to lower serum uric acid level. American journal of kidney diseases : the official journal of the National Kidney Foundation. 2006 Jan;47(1):51–59. - PubMed
    1. Liu WC, Hung CC, Chen SC, et al. Association of hyperuricemia with renal outcomes, cardiovascular disease, and mortality. Clinical journal of the American Society of Nephrology : CJASN. 2012 Apr;7(4):541–548. - PubMed

Publication types

MeSH terms