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. 2022 Mar 7:9:853917.
doi: 10.3389/fcvm.2022.853917. eCollection 2022.

Effect Modification of Hyperuricemia, Cardiovascular Risk, and Age on Chronic Kidney Disease in China: A Cross-Sectional Study Based on the China Health and Nutrition Survey Cohort

Yang Li  1   2   3 , Bowen Zhu  1   2   3 , Yeqing Xie  1   2   3 , Shi Jin  1   2   3 , Weiran Zhou  1   2   3 , Yi Fang  1   2   3 , Xiaoqiang Ding  1   2   3
Affiliations

Effect Modification of Hyperuricemia, Cardiovascular Risk, and Age on Chronic Kidney Disease in China: A Cross-Sectional Study Based on the China Health and Nutrition Survey Cohort

Yang Li et al. Front Cardiovasc Med. .

Abstract

Introduction: The question of whether the increased burden of chronic kidney disease (CKD) is caused by the interaction of hyperuricemia and cardiovascular disease (CVD) risk factors or is accelerated by aging remains unresolved. The purpose of this study is to better understand the effect modification of hyperuricemia, cardiovascular risk, and age on CKD among the Chinese population.

Methods: This cross-sectional study of 8243 participants was derived from the China Health and Nutrition Survey (CHNS) in 2009. Inclusion criteria included age ≥18 years, non-pregnancy, and no history of high-protein diet prior to blood test. Demographics, comorbidities, health-related behaviors, and serum biomarkers were collected. Interaction association of hyperuricemia, CVD risk and age with CKD were analyzed using Logistic regression.

Results: CKD was detected in 359 (27.2%, 95% CI 24.8∼29.7%) of 1321 participants with hyperuricemia and 680 (9.8%, 95% CI 9.1∼10.5%) of 6,922 participants without hyperuricemia, and these patterns remained significant after controlling for age, gender, and Framingham risk score (adjusted odds ratio [aOR] 3.82, 95% CI 3.20∼4.57). We found a negative multiplicative interaction between hyperuricemia and CVD risk on CKD. The aOR in low-CVD risk groups was 5.51 (95% CI 4.03∼7.52), followed by medium-CVD risk groups (aOR: 3.64, 95% CI 2.61∼5.09) and high-CVD risk groups (aOR: 2.89, 95% CI 2.12∼3.96). CVD risk was less associated with CKD in hyperuricemia group (aOR: 0.92, 95% CI 0.68∼1.22) than in non-hyperuricemia group (aOR: 1.43, 95% CI 1.21∼1.70). Furthermore, hyperuricemia and age had a significant additive effect on CKD, with a synergy index of 2.26 (95% CI 1.45∼3.52). Coexisting with older age and hyperuricemia, the likelihood of developing CKD was higher than the sum of the two alone.

Conclusion: The link between hyperuricemia and CKD begins at a young age and becomes stronger in the low CVD risk group. For young adults, early detection of hyperuricemia, routine CVD risk assessment, and timely intervention of modifiable factors are warranted.

Keywords: China health and nutrition survey; cardiovascular disease risk; chronic kidney disease; hyperuricemia; interaction analysis.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Flow diagram for selecting participants.
FIGURE 2
FIGURE 2
Mean eGFR (SD) and median CVD risk (interquartile range) across age groups in participants with and without hyperuricemia.
FIGURE 3
FIGURE 3
Multiplicative interaction models examining the relationships between hyperuricemia and kidney dysfunction across CVD risk and age groups (A) CKD (eGFR <60 mL/min/1.73 m2). (B) eGFR as a continuous variable.
FIGURE 4
FIGURE 4
Multiplicative interaction models examining the relationships between CVD risk and kidney dysfunction across hyperuricemia and age groups (A) CKD (eGFR <60 mL/min/1.73 m2). (B) eGFR as a continuous variable.
FIGURE 5
FIGURE 5
Synergistic effect of the interaction between hyperuricemia, CVD risk, and age on CKD. (A) Additive model of hyperuricemia (HUA) + age on CKD. (B) Additive model of hyperuricemia (HUA) + CVD risk on CKD.
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