Uric Acid Levels May Hint at Faster Kidney Failure, Death

In patients with chronic kidney disease (CKD), elevated serum uric acid (SUA) trajectories are associated with accelerated kidney failure and all-cause mortality, according to a recent study.

From 2003 to 2015, the researchers evaluated data on 5090 patients with CKD aged 20 to 90 years from a 13-year pre-end-stage renal disease (ESRD) care registry.

Patients were categorized by SUA trajectory via trajectory modeling (high, moderate to high, moderate, or low). Multiple Cox regression was used to assess time to ESRD and mortality.

Overall, the researchers recorded 948 ESRD events (incidence rate [IR] 57.9 per 1000 person-years) and 472 deaths (IR 28.7 per 1000 person-years). After accounting for the competing risk of death, the adjusted hazard ratios (HRs) were 1.89 for moderate SUA trajectories, 2.49 for moderate to high trajectories, and 2.84 for high trajectories compared with low trajectories.

For all-cause mortality, corresponding risk estimates were 1.38 for moderate trajectories, 1.95 for moderate to high trajectories, and 4.52 for high trajectories, compared with low trajectories.

The researchers noted a differentially higher unfavorable effect of elevated SUA trajectories on progression to ESRD in CKD patients without the use of urate-lowering agents at baseline.

“Elevated SUA trajectories are associated with accelerated kidney failure and all-cause mortality in CKD patients,” the researchers concluded. “Adequate experimental evidence is urgently needed to inform when and how to optimize SUA in this population.”

—Christina Vogt


Tsai CW, Chiu HT, Huang HC, Ting IW, Yeh HC, Kuo CC. Uric acid predicts adverse outcomes in chronic kidney disease: a novel insight from trajectory analyses. Nephrol Dial Transplantation. 2018;33(2):231-241.