ASN's Mission

ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005


The Latest on Twitter

Kidney Week

Abstract: FR-PO303

Relationship of Uric Acid with Cardiovascular Mortality: A Systematic Review and Meta-Analysis

Session Information

Category: CKD (Non-Dialysis)

  • 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention


  • Browne, Leonard, University Of Limerick, Limerick, Ireland
  • Quinn, Eoghain, University Of Limerick, Limerick, Ireland
  • O'Ceallaigh, Oisin, University Of Limerick, Limerick, Ireland
  • Johnson, Richard J., University of Colorado Denver, Aurora, Colorado, United States
  • Stack, Austin G., University Of Limerick, Limerick, Ireland

Uric acid (UA) levels predict cardiovascular (CV) and all-cause mortality, but uncertainty remains regarding optimal threshold values for intervention. The aim of this systematic review and meta-analysis was to investigate risk thresholds for UA on CV mortality in four distinct populations: general population, cardiovascular disease (CVD), chronic kidney disease (CKD) and end stage kidney disease (ESKD).


We searched electronic databases up to 1 July 2018 for observational studies reporting associations for three or more groups of UA with all-cause and CV mortality in the four distinct populations:general, CVD, CKD and ESKD. Study-specific associations between UA and adjusted relative risks (RR) were estimated using restricted cubic splines with three knots at 10th, 75th and 90th percentile of the UA distribution and a generalised least squares method before pooling study estimates with a multivariate random-effects meta-analysis.


We included 1,665,013 participants from 37 cohorts with 25,334 CV deaths. The overall pattern of association between serum UA and CV-mortality was non-linear (p-value, non-linearity < 0.001). Mortality risks increased beyond UA of 6.0 mg/dL [RR: 1.03 (1.01-1.05)], with an almost linear increase in risk for higher concentrations (7.0 mg/dL, [RR: 1.13 (1.08- 1.18)]) compared to a referent of 5.5 mg/dL. There was evidence of heterogeneity across studies (I2=63.5). The shape of the UA-mortality association was similar for participants in the general, CKD, and CVD populations but differed significantly from ESKD (p<0.001). In ESKD, the pattern was completely reversed, with a reduced mortality for UA values above 5.5 mg/dL.


Uric acid exhibits a J-shaped association with CV mortality with increasing risk above 5.5 mg/dL in the general and CVD populations. This relationship was attenuated in CKD and completely reversed in ESKD. Large randomised clinical trials of urate-lowering therapy should test whether targeting this threshold will confer cardioprotection.

Nonlinear dose-response analyses of UA and risk of CV mortality by population type


  • Government Support - Non-U.S.