Elevated Uric Acid Correlates With High Risk of Acute Kidney Injury

Wisit Cheungpasitporn, MD Nephrology Fellow Departments of Nephrology and Hypertension Mayo Clinic, Rochester, MMedicalResearch.com Interview with:
Wisit Cheungpasitporn, MD
Nephrology Fellow
Departments of Nephrology and Hypertension
Mayo Clinic, Rochester, MN
Program director: Suzanne Norby, MD
Co-authors: Charat Thongprayoon, MD, Andrew M. Harrison, BS and Stephen B. Erickson, MD
Project mentors: Stephen B. Erickson, MD Departments of Nephrology and Hypertension
Mayo Clinic, Rochester, MN

 

Medical Research: What is the background for this study?

Dr. Cheungpasitporn: Uric acid has been linked to acute kidney injury (AKI) through crystal-dependent pathways and crystal-independent mechanisms, including reduced renal blood flow and glomerular filtration rate. Serum uric acid measurement has recently been examined as a marker for early AKI detection, especially in the setting of postoperative AKI following cardiovascular surgery. The effect of admission serum uric acid levels on the risk of in-hospital AKI in the general hospitalized patients, however, was unclear. Thus, we conducted a study to assess the risk of AKI in all hospitalized patients across different serum uric acid levels. The findings of our study data were recently published in Clinical Kidney Journal.

Medical Research: What are the main findings?

Dr. Cheungpasitporn: We reviewed all 1,435 hospitalized adult patients who had available serum uric acid levels at the time of admission between the year of 2011 and 2013. According to the findings of our study, we demonstrate that the admission serum uric acid level is correlated with the incidence o facute kidney injury and the need for renal replacement therapy during hospitalization. Also, there is a positive correlation between admission serum uric acid level and the risk of developing acute kidney injury (AKI), with the highest risk in the admission serum uric acid >9.4 mg/dL patient group. The lowest risk group was admission serum uric acid <3.4 mg/dL. After adjusting for potential confounders, we found that serum uric acid >9.4 mg/dL was associated with a higher risk of developing AKI, with odds ratio (OR) of 1.79 [95% CI 1.13–2.82] using the most common serum uric acid level range (5.8–7.6 mg/dL) as the reference group. On the other hand, admission serum uric acid <3.4 and 3.4–4.5 mg/dL were associated with a lower AKI risk, with ORs of 0.38 (95% CI 0.17–0.75) and 0.50 (95% CI 0.28–0.87), respectively.

Medical Research: What should clinicians and patients take away from your report?

Dr. Cheungpasitporn: Our study found a positive linear correlation between admission serum uric acid level and the risk of developing AKI in hospitalized patients. Also, the findings of our study show a prognostic effect of admission serum uric acid level on the acute kidney injury development. These findings may help improve clinicians’ ability to identify patients at high risk for AKI, ultimately to improve the quality of care and outcomes.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Cheungpasitporn: Since patients who had available admission serum uric acid measurements may have had different clinical characteristics from others who did not, a prospective study is required. In addition, future studies of forecasting models to predict acute kidney injury including admission serum uric acid levels are suggested.

Citation:

Wisit Cheungpasitporn, Charat Thongprayoon, Andrew M. Harrison,and Stephen B. Erickson

Admission hyperuricemia increases the risk of acute kidney injury in hospitalized patientsClin Kidney J first published online September 9, 2015 doi:10.1093/ckj/sfv086

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Wisit Cheungpasitporn, MD (2015). Elevated Uric Acid Correlates With High Risk of Acute Kidney Injury