Serum uric acid and risk of incident chronic kidney disease: a national cohort study and updated meta-analysis

Abstract

Background: We prospectively examined the association between serum uric acid (SUA) levels and chronic kidney disease (CKD) in China and updated the evidence through a comprehensive meta-analysis of prospective studies worldwide.

Methods: Our original analyses were based on data from the China Health and Retirement Longitudinal Study. The primary exposure of interest was SUA at baseline, and the main outcome was incident CKD. Logistic regression models were used to examine the association between SUA levels and incident CKD. A meta-analysis was performed to pool our effect estimate and those from other cohort studies.

Results: During a 4-year follow-up, 180 participants developed incident CKD. Participants in the highest SUA quartile were 2.73 times as likely to develop incident CKD compared to those in the lowest quartile (multivariable-adjusted OR, 2.73; 95% CI, 1.65-4.50). Each 1 mg/dL increment in the SUA levels was associated with a 49% increased risk of incident CKD (multivariable-adjusted OR, 1.49; 95% CI, 1.28-1.74). In the meta-analysis of 30 cohort studies (including the current study), pooled relative risks (95% CIs) of incident CKD were 1.15 (1.10-1.21) for SUA each 1 mg/dL increment, 1.22 (1.14-1.30) for the highest versus lowest SUA group, and 1.17 (1.12-1.23) for hyperuricemia versus no hyperuricemia.

Conclusions: Baseline SUA levels were associated with higher risk of incident CKD in middle-aged and elderly Chinese adults, and this positive association was confirmed in the meta-analysis of multiple cohort studies. Our findings may imply that SUA levels need to be routinely monitored for future CKD risk.

Keywords: Chinese; Chronic kidney disease; Cohort study; Meta-analysis; Serum uric acid.

Fig. 1

Meta-analysis of the association between SUA and incident CKD

Fig. 2

Subgroup analyses for the association between SUA and incident CKD