The survival curve before enter ESRD in individuals diagnosed at (A) stage 3, (B) stage 4, (C) stage 5, stratified by average annual decline rate.

<p>The survival curve before enter ESRD in individuals diagnosed at (A) stage 3, (B) stage 4, (C) stage 5, stratified by average annual decline rate.</p

Serum Uric Acid and Progression of Kidney Disease: A Longitudinal Analysis and Mini-Review

<div><p>Background</p><p>Increasing evidence supports the association between hyperuricemia and incident chronic kidney disease (CKD); however, there are conflicting data regarding the role of hyperuricemia in the progression of CKD. This study retrospectively assessed the longitudinal association between uric acid (UA) level and CKD progression in a Chinese population lived in Taiwan.</p><p>Methods</p><p>Patients with physician diagnosis of hyperuricemia or receiving urate-lowering therapy between 2003 and 2005 were identified in the electronic medical records (EMR) of a tertiary medical center and were followed up until December 31, 2011. Patients were divided into four UA categories at the cut-off 6, 8, and 10 mg/dL. CKD progression was estimated by the change of estimated glomerular filtration rate (eGFR) in the linear mixed models. Kidney failure was defined as an eGFR less than 15 mL/min/1.73 m² or requiring renal replacement therapy.</p><p>Results</p><p>A total of 739 patients were analyzed. In the full-adjusted model, patients with a baseline UA level ≥6 mg/dL had greater decline in eGFR ((<i>β</i> = -9.6, 95% CI -16.1, -3.1), comparing to those with a UA level less than 6 mg/dL. When stratifying patients into four UA categories, all three hyperuricemia categories (UA6-8, 8–10, ≥10 mg/dL) associated with a greater decline in eGFR over the follow-up period with an increasing dose-response, comparing to the lowest UA category. The risk of progression to renal failure increased 7% (hazard ratio 1.07, 95% CI 1.00, 1.14) for each 1mg/dL increase in baseline UA level. The influences of hyperuricemia on eGFR decline and the risk of kidney failure were more prominent in patients without proteinuria than those with proteinuria.</p><p>Conclusion</p><p>Our study showed a higher uric acid level is associated with a significant rapid decline in eGFR and a higher risk of kidney failure, particularly in patients without proteinuria. Our findings suggest hyperuricemia is a potential modifiable factor of CKD progression.</p></div

Studies of serum uric acid level in the progression of kidney function and the development of kidney failure.

<p>Studies of serum uric acid level in the progression of kidney function and the development of kidney failure.</p

The risk of CKD progression to kidney failure (eGFR <15 ml/min) for each 1 mg/dL increase in uric acid level.

<p>The risk of CKD progression to kidney failure (eGFR <15 ml/min) for each 1 mg/dL increase in uric acid level.</p

The eGFR annual decline rate by subgroups.

<p>The eGFR annual decline rate by subgroups.</p

Characteristics of hyperuricemic patients stratified by baseline serum uric acid categories^*.

<p>Characteristics of hyperuricemic patients stratified by baseline serum uric acid categories^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0170393#t001fn001" target="_blank">*</a>}.</p

Average annual eGFR decline rate by age and CKD stage.

<p>Average annual eGFR decline rate by age and CKD stage.</p

The distribution of the proportion of baseline hyperuricemic status (by cut-off values of 6, 8, and 10mg/dL) across CKD stages.

<p>The distribution of the proportion of baseline hyperuricemic status (by cut-off values of 6, 8, and 10mg/dL) across CKD stages.</p

The odds ratio for rapid CKD progression [rapid progression (eGFR-ADR >3 ml/min/1.73m²) vs. non-progression (eGFR-ADR <1 ml/min/1.73m²)] of different matrices of kidney function in multiple logistic regression.

<p>The odds ratio for rapid CKD progression [rapid progression (eGFR-ADR >3 ml/min/1.73m²) vs. non-progression (eGFR-ADR <1 ml/min/1.73m²)] of different matrices of kidney function in multiple logistic regression.</p

Regression coefficients between the eGFR annual decline rate and the common risk factors in the multiple linear regression modeling.

<p>Regression coefficients between the eGFR annual decline rate and the common risk factors in the multiple linear regression modeling.</p