Evre 3-5 Kronik Böbrek Hastalarında Serum Ürik Asit Seviyesi ve Kardiyovasküler Hastalık Gelişim Riski

Abstract

Amaç: Kronik böbrek hastalığı (KBH) olanlarda kardiyovasküler hastalık (KVH) riski genel popülasyondan daha yüksektir ve bu risk ileri KBH evrelerinde artmaktadır. Evre 3-5 KBH hastalarında KVH ve ürik asit seviyesi arasındaki ilişki hakkındaki veriler literatürde sınırlıdır. Bu çalışmanın amacı, KBH hastalarında ürik asit düzeyinin kardiyovasküler olaylar ve mortalite ile ilişkili olup olmadığının incelenmesidir. Gereç ve Yöntemler: Haziran 2014 ve Aralık 2019 tarihleri arasında evre 3-5 KBH tanısı ile takip edilen hastalar geriye dönük olarak değerlendirildi. On sekiz yaş üstü 100 evre 3-5 KBH olgusu çalışmaya dahil edildi. Hastalar ortalama serum ürik asit düzeylerine göre <7 mg/dL ve ≥7 mg/dL olmak üzere iki gruba ayrıldı. Doğrulanmış inme, miyokard enfarktüsü, koroner kalp hastalığı veya kalp yetmezliği tanısı olması KVH öyküsü için pozitif kabul edildi. Bulgular: On beş hastada kardiyovasküler olay gelişimi, 1 hastada mortalite izlendi. Grup 1'deki 10 (%21,3) hastada ve grup 2'deki 5 (%9,4) hastada KVH görüldü. Grup 1’de kardiyovasküler olaylar daha fazla görülmesine rağmen, bu fark istatistiksel olarak anlamlı değildi (p=0.098). Sonuç: Bu çalışmada, düşük ürik asit (<7 mg/dL) grubunda KVH daha yüksek görülmekle birlikte, evre 3-5 KBH hastalarında serum ürik asit düzeyi ile KVH gelişimi arasında anlamlı bir ilişki bulunamamıştır. Daha fazla örneklem büyüklükleri ile ileriye dönük çalışmalar, olası ilişki hakkında daha iyi kanıt sağlayabilir.

Keywords

• Hiperürisemi
• kronik böbrek hastalığı
• kardiyovasküler hastalık

Serum Uric Acid Level and Cardiovascular Disease Development Risk in Stage 3-5 Chronic Kidney Disease Patients

Abstract

Aim: The patients with chronic kidney disease (CKD) have higher risk of cardiovascular disease (CVD) than the general population and this risk increases in advanced CKD stages. The data about the association between CVD and uric acid level in stage 3-5 CKD patients are limited in the literature. The aim of this study is to investigate whether uric acid levels are associated with cardiovascular events and mortality in the CKD patients. Material and Methods: Patients who were followed up with the diagnosis of stage 3-5 CKD between June 2014 and December 2019 were evaluated retrospectively. A hundred stage 3-5 CKD cases above the age of eighteen were included in the study. The patients were divided into two groups according to average serum uric acid levels; <7 mg/dL and ≥7 mg/dL. Any confirmed diagnosis of stroke, myocardial infarction, coronary heart disease or heart failure was accepted positive for the history of CVD. Results: Cardiovascular event development was observed in 15 patients and mortality in 1 patient. CVD were seen in 10 (21.3%) patients in group 1 while 5 (9.4%) patients in group 2. Although the cardiovascular events were seen more in the group 1, this difference was not statistically significant (p=0.098). Conclusion: Although CVD is seen higher in the low uric acid (<7 mg/dL) group, no significant association was found between serum uric acid level and development of CVD in stage 3-5 CKD patients, in this study. Prospective studies with larger sample sizes may provide better evidence regarding possible relationship.

Keywords

• hyperuricemia
• chronic kidney disease
• cardiovascular disease

References

1. Kasahara M, Kuwabara Y, Moriyama T, Tanabe K, Satoh-Asahara N, Katsuya T, et al. Intensive uric acid-lowering therapy in CKD patients: the protocol for a randomized controlled trial. Clin Exp Nephrol. 2020;24(3):235-41.
2. Tanaka K, Watanabe T, Takeuchi A, Ohashi Y, Nitta K, Akizawa T, et al. Cardiovascular events and death in Japanese patients with chronic kidney disease. Kidney Int. 2017;91(1):227-34.
3. Vásquez-Vivar J, Santos AM, Junqueira VB, Augusto O. Peroxynitrite-mediated formation of free radicals in human plasma: EPR detection of ascorbyl, albumin-thiyl and uric acid-derived free radicals. Biochem J. 1996;314(Pt 3):869-76.
4. Emmerson BT. Atherosclerosis and urate metabolism. Aust N Z J Med. 1979;9(4):451-4.
5. Ginsberg MH, Kozin F, O’Malley M, McCarty DJ. Release of platelet constituents by monosodium urate crystals. J Clin Invest. 1977;60(5):999-1007.
6. Leyva F, Anker S, Swan JW, Godsland IF, Wingrove CS, Chua TP, et al. Serum uric acid as an index of impaired oxidative metabolism in chronic heart failure. Eur Heart J. 1997;18(5):858-65.
7. Liese AD, Hense HW, Löwel H, Döring A, Tietze M, Keil U. Association of serum uric acid with all-cause and cardiovascular disease mortality and incident myocardial infarction in the MONICA Augsburg cohort. World Health Organization Monitoring Trends and Determinants in Cardiovascular Diseases. Epidemiology 1999;10(4):391-7.
8. Bengtsson C, Lapidus L, Stendahl C, Waldenström J. Hyperuricaemia and risk of cardiovascular disease and overall death. A 12-year follow-up of participants in the population study of women in Gothenburg, Sweden. Acta Med Scand 1988;224(6):549-55.

9. Fang J, Alderman MH. Serum uric acid and cardiovascular mortality the NHANES I epidemiologic follow-up study, 1971-1992. National Health and Nutrition Examination Survey. JAMA. 2000;283(18):2404-10.
10. Casiglia E, Spolaore P, Ginocchio G, Colangeli G, Di Menza G, Marchioro M, et al. Predictors of mortality in very old subjects aged 80 years or over. Eur J Epidemiol 1993;9(6):577-86.
11. Wannamethee SG, Shaper AG, Whincup PH. Serum urate and the risk of major coronary heart disease events. Heart. 1997;78(2):147-53.
12. Moriarity JT, Folsom AR, Iribarren C, Nieto FJ, Rosamond WD. Serum uric acid and risk of coronary heart disease: Atherosclerosis Risk in Communities (ARIC) Study. Ann Epidemiol. 2000;10(3):136-43.
13. Culleton BF, Larson MG, Kannel WB, Levy D. Serum uric acid and risk for cardiovascular disease and death: the Framingham Heart Study. Ann Intern Med. 1999;131(1):7-13.
14. Reunanen A, Takkunen H, Knekt P, Aromaa A. Hyperuricemia as a risk factor for cardiovascular mortality. Acta Med Scand Suppl. 1982;668:49-59.
15. Gerber Y, Tanne D, Medalie JH, Goldbourt U. Serum uric acid and long-term mortality from stroke, coronary heart disease and all causes. Eur J Cardiovasc Prev Rehabil. 2006;13(2):193-8.
16. Zhao G, Huang L, Song M, Song Y. Baseline serum uric acid level as a predictor of cardiovascular disease related mortality and all-cause mortality: A meta-analysis of prospective studies. Atherosclerosis. 2013;231(1):61-8.
17. Edwards NL. The role of hyperuricemia and gout in kidney and cardiovascular disease. Clev Clin J Med. 2008;75(Suppl 5):S13-6.
18. Weiner DE, Tighiouart H, Elsayed EF, Griffith JL, Salem DN, Levey AS, et al. The relationship between nontraditional risk factors and outcomes in individuals with stage 3 to 4 CKD. Am J Kidney Dis. 2008;51(2):212-23.
19. Madero M, Sarnak MJ, Wang X, Greene T, Beck GJ, Kusek JW, et al. Uric acid and long-term outcomes in CKD. Am J Kidney Dis. 2009;53(5):796-803.
20. Suliman ME, Johnson RJ, García-López E, Qureshi AR, Molinaei H, Carrero JJ, et al. J-shaped mortality relationship for uric acid in CKD. Am J Kidney Dis. 2006;48(5):761-71.
21. Levey AS, Coresh J, Greene T, Stevens LA, Zhang YL, Hendriksen S, et al. Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate. Ann Intern Med. 2006;145(4):247-54.
22. Chapter 3: Management of progression and complications of CKD. Kidney Int Suppl. 2013;3(1):73-90.
23. Niskanen LK, Laaksonen DE, Nyyssönen K, Alfthan G, Lakka HM, Lakka TA, et al. Uric acid level as a risk factor for cardiovascular and all-cause mortality in middle-aged men: a prospective cohort study. Arch Intern Med. 2004;164(14):1546-51.
24. Li M, Ye ZC, Li CM, Zhao WB, Tang H, Liu X, et al. Low serum uric acid levels increase the risk of all-cause death and cardiovascular death in hemodialysis patients. Ren Fail. 2020;42(1):315-22.
25. Dong ZX, Tian M, Li H, Wu Y, Du XG, Dong JW, et al. Association of serum uric acid concentration and its change with cardiovascular death and all-cause mortality. Dis Markers. 2020;2020:7646384.
26. Aker Karagöz Y, Şahin İ, Karagöz F, Şit D. Evaluation of relationship between uric acid and CRP, RDW, and MPV as cardiovascular risk factors in patients with hypertension. Bezmialem Science. 2017;5(1):16-21.
27. Shao, Shao H, Sawhney MS, Shi L. Serum uric acid as a risk factor of all-cause mortality and cardiovascular events among type 2 diabetes population: Meta analysis of correlational evidence. J Diabetes Complications 2019;33(10):107409.