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      Association of uric acid in serum and urine with subclinical renal damage: Hanzhong Adolescent Hypertension Study

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          Abstract

          Background and objectives

          The aim of the study was to examine the associations of uric acid (UA) in blood and urine with subclinical renal damage (SRD) and its progression in a Chinese cohort.

          Methods

          1) 2342 participants from our previously established cohort who were followed up in 2017 were included. Cross-sectional analysis was used to examine the relationships between serum and urinary UA and the risk of SRD. 2) A total of 266 participants were recruited from the same cohort in 2013, and followed up in 2017. Longitudinal analysis was used to determine the relationships of serum and urinary UA with progression of SRD, which was defined as urinary albumin-to-creatinine ratio (uACR) progression or estimated glomerular filtration rate (eGFR) decline.

          Results

          In cross-sectional analysis, higher levels of uACR were associated with higher levels of serum uric acid (SUA) and urinary uric acid/creatinine ratio (uUA/Cre). Lower eGFR was associated with higher levels of SUA and fractional excretion of uric acid (FEUA) but lower uUA/Cre levels in all subjects. In addition, the multivariate-adjusted odds ratios for SRD compared with non-SRD were 3.574 (2.255–5.664) for uUA/Cre. Increasing uUA/Cre levels were associated with higher risk of SRD. In longitudinal analysis, 4-year changes of uUA/Cre and SUA were significantly associated with eGFR decline.

          Conclusions

          This study suggested that urinary UA excretion was significantly associated with the risk of SRD in Chinese adults. Furthermore, 4-year changes of serum and urinary UA were associated with SRD progression. These findings suggest that UA, especially urinary UA, may be used as a simple, noninvasive marker for early detection of decreased renal function in otherwise healthy subjects.

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          Most cited references35

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          Chronic kidney disease as a risk factor for cardiovascular disease and all-cause mortality: a pooled analysis of community-based studies.

          Chronic kidney disease (CKD) is a major public health problem. Conflicting evidence exists among community-based studies as to whether CKD is an independent risk factor for adverse cardiovascular outcomes. After subjects with a baseline history of cardiovascular disease were excluded, data from four publicly available, community-based longitudinal studies were pooled: Atherosclerosis Risk in Communities Study, Cardiovascular Health Study, Framingham Heart Study, and Framingham Offspring Study. Serum creatinine levels were indirectly calibrated across studies. CKD was defined by a GFR between 15 and 60 ml/min per 1.73 m(2). A composite of myocardial infarction, fatal coronary heart disease, stroke, and death was the primary study outcome. Cox proportional hazards models were used to adjust for study, demographic variables, educational status, and other cardiovascular risk factors. The total population included 22,634 subjects; 18.4% of the population was black, and 7.4% had CKD. There were 3262 events. In adjusted analyses, CKD was an independent risk factor for the composite study outcome (hazard ratio [HR], 1.19; 95% confidence interval [CI], 1.07-1.32), and there was a significant interaction between kidney function and race. Black individuals with CKD had an adjusted HR of 1.76 (95% CI, 1.35-2.31), whereas whites had an adjusted HR of 1.13 (95% CI, 1.02-1.26). CKD is a risk factor for the composite outcome of all-cause mortality and cardiovascular disease in the general population and a more pronounced risk factor in blacks than in whites. It is hypothesized that this effect may be due to more frequent or more severe subclinical vascular disease secondary to hypertension or diabetes in black individuals.
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            Chronic renal diseases as a public health problem: epidemiology, social, and economic implications.

            The impact of chronic kidney disease (CKD) on the global burden of diseases is probably underestimated by current methods of evaluation. However, CKD are emerging as a major health problem. First, the costs of renal replacement therapy are excedingly high and are consuming a significant proportion of health care budgets of developed countries, while in developing countries are out of reach. Second, complex interaction are clearly emerging between chronic kidney, cardiovascular disease, and diabetes.
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              Serum Uric Acid and Risk of CKD in Type 2 Diabetes.

              Serum uric acid may predict the onset and progression of kidney disease, but it is unclear whether uric acid is an independent risk factor for diabetic nephropathy. Our aim was to study the relationship between uric acid levels and the development of CKD components in patients with type 2 diabetes.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: SoftwareRole: Writing – original draft
                Role: Data curationRole: Formal analysisRole: SoftwareRole: Writing – original draft
                Role: Data curationRole: Formal analysisRole: Investigation
                Role: Investigation
                Role: Investigation
                Role: Investigation
                Role: Investigation
                Role: Investigation
                Role: Investigation
                Role: Methodology
                Role: Methodology
                Role: Supervision
                Role: Investigation
                Role: Supervision
                Role: Supervision
                Role: Investigation
                Role: Resources
                Role: Resources
                Role: ConceptualizationRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                15 November 2019
                2019
                : 14
                : 11
                : e0224680
                Affiliations
                [1 ] Department of Cardiovascular Medicine, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
                [2 ] Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi’an, China
                [3 ] Department of Cardiology, Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
                [4 ] Department of Cardiology, Xi’an Fourth People’s Hospital, Xi’an, China
                [5 ] Institute of Cardiovascular Sciences, Hanzhong People’s Hospital, Hanzhong, China
                Universita degli Studi di Perugia, ITALY
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0002-0335-3528
                Article
                PONE-D-19-09294
                10.1371/journal.pone.0224680
                6857911
                31730636
                44604a96-623d-4ed0-b9eb-4fff38496489
                © 2019 Wang et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 22 April 2019
                : 18 October 2019
                Page count
                Figures: 1, Tables: 7, Pages: 15
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/501100001809, National Natural Science Foundation of China;
                Award ID: 81600327
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/501100001809, National Natural Science Foundation of China;
                Award ID: 81570381, 81870319
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/501100001809, National Natural Science Foundation of China;
                Award ID: 81700368
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/501100010031, Postdoctoral Research Foundation of China;
                Award ID: 2018T111075
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/501100010031, Postdoctoral Research Foundation of China;
                Award ID: 2018M631177
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/501100012226, Fundamental Research Funds for the Central Universities;
                Award ID: xjj2018103
                Award Recipient :
                Funded by: the Clinical Research Award of the First Affiliated Hospital of Xi’an Jiaotong University
                Award ID: XJTU1AF-CRF-2017-021
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/501100013076, National Major Science and Technology Projects of China;
                Award ID: 2016YFC1300104 and 2017YFC1307604
                Award Recipient :
                Funded by: Key Research Project of Shaanxi Province
                Award ID: 2017ZDXM-SF-107
                Award Recipient :
                This work was supported by the National Natural Science Foundation of China No. 81600327 (Y.W.), No. 81870319, 81570381 (J.-J.M.) and No. 81700368 (C.C.), the Grants from China Postdoctoral Science Foundation No. 2018T111075 and 2018M631177 (Y.W.), Fundamental Research Funds for the Central Universities No. xjj2018103 (Y.W.), the Special Financial Grant from the Shaanxi Postdoctoral Science Foundation (Y.W.), the Clinical Research Award of the First Affiliated Hospital of Xi’an Jiaotong University No. XJTU1AF-CRF-2017-021 (Y.W.), Grants 2016YFC1300104 and 2017YFC1307604 (J.-J.M.) from the Major Chronic Non-communicable Disease Prevention and Control Research Key Project of the Ministry of Science and Technology of China, and Grant 2017ZDXM-SF-107 (J.-J.M.) from the Key Research Project of Shaanxi Province. The funders had no role in study design, data collection and analysis, or preparation of the manuscript.
                Categories
                Research Article
                Biology and Life Sciences
                Physiology
                Physiological Processes
                Excretion
                Medicine and Health Sciences
                Physiology
                Physiological Processes
                Excretion
                Physical Sciences
                Chemistry
                Chemical Compounds
                Acids
                Uric Acid
                Medicine and Health Sciences
                Vascular Medicine
                Blood Pressure
                Hypertension
                Biology and Life Sciences
                Physiology
                Renal Physiology
                Glomerular Filtration Rate
                Medicine and Health Sciences
                Physiology
                Renal Physiology
                Glomerular Filtration Rate
                Biology and Life Sciences
                Anatomy
                Body Fluids
                Urine
                Medicine and Health Sciences
                Anatomy
                Body Fluids
                Urine
                Biology and Life Sciences
                Physiology
                Body Fluids
                Urine
                Medicine and Health Sciences
                Physiology
                Body Fluids
                Urine
                Medicine and Health Sciences
                Endocrinology
                Endocrine Disorders
                Diabetes Mellitus
                Medicine and Health Sciences
                Metabolic Disorders
                Diabetes Mellitus
                Biology and Life Sciences
                Biochemistry
                Lipids
                Cholesterol
                Biology and Life Sciences
                Biochemistry
                Biomarkers
                Creatinine
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                All relevant data are within the manuscript and its Supporting Information files.

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