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. 2025 Jan;103(2):582-592.
doi: 10.1177/13872877241303789. Epub 2025 Jan 10.

Effect of serum uric acid to creatinine ratio on cognitive function decline in middle-aged adults: Longitudinal evidence from CHARLS

Xiangjun Zhou  1 , Zhe Wang  1 , Yi Zhu  1 , Shuang Feng  1 , Haijian Wu  1 , Dongliang Zhu  1 , Zheyuan Wu  1 , Qingjun Kao  1
Affiliations

Effect of serum uric acid to creatinine ratio on cognitive function decline in middle-aged adults: Longitudinal evidence from CHARLS

Xiangjun Zhou et al. J Alzheimers Dis. 2025 Jan.

Abstract

Background: Serum uric acid (SUA) was a predictor of cognitive function. The association of SUA/serum creatinine ratio (Scr), which represents renal function-normalized SUA and cognitive function is unknown.

Objective: This study investigated the association of the SUA/Scr with cognitive function and the potential mediation effect of inflammation in the above relationship.

Methods: This study used 1-5 waves of data from the China Health and Retirement Longitudinal Study. 3302 participants aged 45-60 years at baseline were included. Among them, 1129 who attended subsequent 2-3 waves were further included for cumulative exposure calculation to the SUA/Scr ratio. The Cox models were used to evaluate the impact of baseline SUA/Scr ratio and its cumulative exposure on cognitive function decline.

Results: During a median follow-up of 8.6 years, there were 1512 (45.8%) cognitive function declined. After adjustment, the highest quartile of the SUA/SCr ratio was associated with the highest risk of cognitive function decline (Hazard ratio, 1.175; 95% confidence interval, 1.015-1.360). Restricted cubic spline showed a linear association between the SUA/Scr ratio and the risk of cognitive function decline (pnon-linear = 0.514). There were a stronger association of cumulative SUA/Scr ratio and its exposure burden with cognitive function decline [the highest versus lowest quartile: 1.635 (1.006-2.656), the high versus low group: 1.729 (1.212-2.466), respectively]. No significant mediating effect through white blood cell count or C-reactive protein in SUA/Scr ratio-cognitive function decline was found.

Conclusions: The SUA/Scr ratio was associated with a higher risk of cognitive decline, whereas the mechanism mediated by inflammation indicators was not found.

Keywords: Alzheimer's disease; cognitive function; cohort study; inflammation indicators; middle-aged; serum uric acid to serum creatinine ratio.

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Conflict of interest statement

Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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