Abstract: FR-PO381

Uric Acid Predicts Adverse Outcomes in CKD: A Novel Insight from Trajectory Analyses

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 301 CKD: Risk Factors for Incidence and Progression

Authors

  • Kuo, Chin-Chi, China Medical University Hospital, Taichung City, Taiwan
  • Tsai, Ching-Wei, China Medical University Hospital, Taichung, Taiwan

Group or Team Name

  • CMUH Kidney Research Group
Background

Very little is known about longitudinal trajectories of serum uric acid (SUA) over the course of chronic kidney disease (CKD). We aimed to determine whether longitudinal SUA trajectories are associated with the risk of end-stage renal disease (ESRD) and all-cause mortality among CKD patients.

Methods

We conducted a prospective cohort study from a 13-year multidisciplinary pre-ESRD care registry. The final study population consisted of 5,090 CKD patients aged 20-90 years between 2003-2015. Individual’s SUA trajectory was defined by group-based trajectory modeling in four distinct patterns: high-rising, moderate-high, moderate-low and stable-low. Time to ESRD and death was analyzed by multiple Cox regression.

Results

A total of 948 ESRD events and 472 deaths occurred with incidence rates of 57.9 and 28.7 per 1,000 person-years, respectively. Compared to those with a stable-low SUA trajectory, the adjusted hazard ratio (HR) of patients for incident ESRD was in a dose-response manner as follows: moderate-low: 1.89 (95% CI, 1.35-2.64); moderate-high: 2.74 (1.90-3.95), and high-rising: 3.24 (2.04-5.13), after considering the competing risk of death. For all-cause mortality, the corresponding risk estimate of the same SUA trajectory was 1.43 (95% CI, 0.93-2.21), 2.16 (1.35-3.44), and 5.18 (2.82-9.49), respectively.

Conclusion

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

Kaplan-Meier curves of (A) dialysis-free survival and (B) overall survival by serum uric acid (SUA) trajectories based on group-based trajectory modelling (GBTM) (N = 5,090).