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. 2025 Jan 1;6(1):133-144.
doi: 10.34067/KID.0000000612. Epub 2024 Oct 8.

High Post-Kidney Transplant Serum Uric Acid Levels Are Associated with Detrimental Outcomes

Kian Djamali  1 , Zhongyu Yuan  2   3 , Brad C Astor  2   3 , Kurtis Swanson  2 , Didier Mandelbrot  2 , Sandesh Parajuli  2
Affiliations

High Post-Kidney Transplant Serum Uric Acid Levels Are Associated with Detrimental Outcomes

Kian Djamali et al. Kidney360. .

Abstract

Key Points:

  1. Post-transplant increased serum uric acid levels are associated with congestive heart failure and graft failure for kidney transplant recipients.

  2. kidney transplant recipients age 60 years and older with high serum uric acid are at increased risk for congestive heart failure and death.

  3. Increased serum uric acid are significantly associated with death for female kidney transplant recipients.

Background: The potential effects of post-transplant serum uric acid (SUA) levels and outcomes pose a variety of risks among kidney transplant recipients (KTRs). The association between post-transplant SUA and major detrimental outcomes among KTRs remains uncertain.

Methods: We evaluated all adult KTRs transplanted between January 1, 2000, and December 31, 2019. Recipients were included if they had a functioning allograft without any cardiovascular events (CVEs) before their earliest SUA measurement within 5–13 months post-transplant. Survival analyses were performed regarding CVEs, CVE-related mortality, death-censored graft failure, and uncensored graft failure within 10 years after transplantation.

Results: A total of 3808 eligible KTRs were followed for a median of 7.5 years after transplantation. Recipients with post-transplant SUA >6.8 mg/dl had significantly higher risk of congestive heart failure than those with SUA <6 mg/dl (adjusted hazard ratio [aHR], 1.55; 95% confidence interval [CI], 1.10 to 2.19; P = 0.01), uncensored graft failure (aHR, 1.18; 95% CI, 1.02 to 1.36; P = 0.03), and death-censored graft failure (aHR, 1.28; 95% CI, 1.01 to 1.61; P = 0.04), after adjustment for multiple variables, including kidney graft function. No statistically significant association was found between SUA levels and other CVEs. There was no statistically significant risk for other outcomes of interest when comparing SUA <6 mg/dl versus 6–6.8 mg/dl.

Conclusions: Elevated early post-transplant SUA levels were associated with detrimental post-transplant outcomes, leading to increased morbidity and mortality through congestive heart failure, graft failure, and overall death.

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Conflict of interest statement

Disclosure forms, as provided by each author, are available with the online version of the article at http://links.lww.com/KN9/A730.

Figures

None
Graphical abstract
Figure 1
Figure 1
aHR of overall CVEs on the basis of the SUA levels between 5 and 13 months post-transplant. aHR, adjusted hazard ratio; CVE, cardiovascular event; SUA, serum uric acid.
Figure 2
Figure 2
aHR individual CVEs on the basis of the SUA levels between 5 and 13 months post-transplant for (A) CHF; (B) ischemic heart event; (C) arrhythmia event; (D) ischemic cerebrovascular event. CHF, congestive heart failure.
Figure 3
Figure 3
aHR of (A) DWFG and (B) CVE-related DWFG. DWFG, death with functioning graft.
Figure 4
Figure 4
aHR of (A) overall graft failure and (B) DCGF. DCGF, death-censored graft failure.
Figure 5
Figure 5
aHR of stratified data for CHF by age for (A) KTRs <60 years and (B) KTRs ≥60 years. KTRs, kidney transplant recipients.
Figure 6
Figure 6
aHR of stratified data for DWFG by age for (A) KTRs <60 years and (B) KTRs ≥60 years.
Figure 7
Figure 7
aHR of stratified data for DWFG by sex for (A) women and (B) men.
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