J Korean Med Sci.  2020 Jul;35(28):e254. 10.3346/jkms.2020.35.e254.

Association between Serum Uric Acid Level and ESRD or Death in a Korean Population

• Kim K
• Go S
• Son HE
• Ryu JY
• Lee H
• Heo NJ
• Chin HJ
• Park JH

• KMID: 2504365
• DOI: http://doi.org/10.3346/jkms.2020.35.e254

Abstract

Background
Serum uric acid (SUA) is recognized as a risk factor for chronic kidney disease (CKD) and mortality. However, there is controversy as to whether a high or low level of SUA is related to the risk of CKD progression or death, and whether it differs between males and females.
Methods
We included 143,762 adults who underwent voluntary health screening between 1995 and 2009 in Korea. For each sex, we divided participants into sex-specific quintiles according to SUA levels and compared end-stage renal disease (ESRD) incidence and mortality between the groups with low and high SUA levels and those with middle SUA levels. Sex-specific Cox proportional hazard analyses were performed for ESRD and all-cause mortality.
Results
Among the 143,762 participants, 0.2% (n = 272) developed ESRD. The hazard ratio (HR) of ESRD was higher in the highest (adjusted HR, 2.13; 95% confidence interval [CI], 1.18–3.84) and lowest (adjusted HR, 1.90; 95% CI, 1.02–3.51) SUA quintiles than in the middle SUA quintile in males and the highest SUA quintile in females (adjusted HR, 2.31; 95% CI, 1.10–4.84). Four-point three percent (n = 6,215) of participants died during a mean follow-up period of 157 months. The hazard ratio (HR) of all-cause mortality was higher in the highest SUA quintile than in the middle SUA quintile in males (adjusted HR, 1.15; 95% CI, 1.03–1.28) and females (adjusted HR, 1.17; 95% CI, 1.01–1.35).
Conclusion
Elevated levels of SUA are associated with increased risk for ESRD and all-cause mortality in both sexes. Low levels of SUA might be related to ESRD and death only in males, showing U-shaped associations. Our findings suggest sex-specific associations between SUA levels and ESRD development and mortality.

Keyword

Hyperuricemia; Uric Acid; Risk Factors; Chronic Kidney Disease

Figure

• 

  Fig. 1 Kaplan-Meier curves for ESRD and all-cause mortality. (A) Male, ESRD, (B) Female, ESRD, (C) Male, all-cause mortality, (D) Female, all-cause mortality. Each uric acid group represents quintiles. P values are for log-rank test and adjusted for multiple comparisons.ESRD = end-stage renal disease.

• 

  Fig. 2 Restricted cubic spline curves illustrating the association between serum uric acid levels and the risk of ESRD and all-cause mortality. The median value of uric acid levels was set as a reference. (A) ESRD, (B) All-cause mortality. Blue line: male, yellow line: female. The shaded area represents the 95% confidence interval.ESRD = end-stage renal disease.

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