The effect of baseline serum uric acid on chronic kidney disease in normotensive, normoglycemic, and non-obese individuals: A health checkup cohort study

Abstract

Introduction: The independent role of serum uric acid (SUA) on kidney disease is controversial due to its association with metabolic syndrome. The objective of this study was to investigate the association of baseline SUA with development of chronic kidney disease and eGFR decline in normotensive, normoglycemic and non-obese individuals during follow up period.

Materials and methods: We included non-hypertensitive, non-diabetic, and non-obese 13,133 adults with estimated glomerular filtration rate (eGFR) ≥ 60ml/min/1.73m2 who had a voluntary health check-up during 2004-2017.

Results: SUA was positively related to adjusted means of systolic blood pressure (SBP), triglyceride, body mass index, and body fat percent. SUA was inversely associated with high density lipoprotein HDL (P for trend ≤0.001). SUA was an independent risk factor for the development of diabetes, hypertension, and obesity. During 45.0 [24.0-76.0] months of median follow up, the highest quartiles of SUA showed significant risks of 30% eGFR decline compared than the lowest quartile (RR:3.701; 95% CI: 1.504-9.108). The highest quartile had a 2.2 fold (95% CI: 1.182-4.177) increase in risk for incident chronic kidney disease (CKD).

Conclusions: SUA is an independent risk factor for the development of diabetes, hypertension, and obesity in the healthy population. High SUA is associated with increased risk of CKD development and eGFR decline in participants with intact renal function.

Fig 1. Selection of study population.

Fig 2. Association of Serum Uric Acid (SUA) with metabolic disorders.

A. The highest quartile had significantly higher of systolic blood pressure (SBP) than the lowest quartile (P = 0.003). B. The 3^rd and the highest quartiles had significantly higher triglyceride (TG) than the lowest quartile (P< 0.001). C. The 2^nd, 3^rd, and the highest quartiles had significantly higher high density lipoprotein (HDL) than the lowest quartile (P< 0.001). D. The 2^nd, 3^rd, and the highest quartiles had significantly higher BMI than the lowest quartile (P ≤0.024). E. The 2^nd, 3^rd, and the highest quartiles had significantly higher body fat percent than the lowest quartile (P ≤0.009). Body fat percent was measured in 3,682 participants. F. FBS was not associated with SUA (P >0.05). *P < 0.05 vs. the lowest uric acid quartile. SBP, TG, HDL, BMI, body fat percent, and FBS were adjusted by age, hemoglobin, white blood cell count, estimated glomerular filtration rate, serum albumin, aspartate aminotransferase, alanine aminotransferase, total cholesterol, and low density lipoprotein. Adjusted means and 95% confidence intervals (95% CIs) of SBP, TG, HDL, BMI, body fat percent and FBS were calculated using analysis of covariance to adjust independent factors related to SUA.