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Kidney Week

Abstract: PO1174

Associations Between Prelude eGFR Category and Trajectories of Uric Acid and eGFR Prior to Dialysis Transition Among US Veterans

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Cuvelier, Nicholas, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
  • Wenziger, Cachet, VA Long Beach Healthcare System, Long Beach, California, United States
  • Hsiung, Jui-Ting, VA Long Beach Healthcare System, Long Beach, California, United States
  • Hanna, Ramy Magdy, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
  • Tantisattamo, Ekamol, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
  • Rhee, Connie, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
  • Kovesdy, Csaba P., Memphis VA Medical Center, Memphis, Tennessee, United States
  • Kalantar-Zadeh, Kamyar, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
  • Streja, Elani, VA Long Beach Healthcare System, Long Beach, California, United States
Background

Prior studies have demonstrated that elevated uric acid is associated with declining kidney function. However, how uric acid and estimated glomerular filtration rate (eGFR) levels change with progression towards end stage renal disease have not yet been fully characterized. We sought to examine trajectories of eGFR and uric acid 1 year prior to ESRD transition across strata of eGFR 5 quarters prior to transition.

Methods

From a cohort of US veterans who transitioned to dialysis between 10/2007-03/2015, we identified 15,725 patients with a pre-dialysis eGFR measurement 5 quarters prelude (15 months) before transitioning to ESRD and at least 1 uric acid measurement prior to ESRD. Trajectories were modeled across eGFR strata using mixed effects model with random slope and random intercept.

Results

The mean age of the cohort was 67±11 years old and included 2% females and 35% African American. In addition, the mean prelude quarter 5 uric acid level was 8±2 mg/dL and the median eGFR was 21 ml/min/1.73m2. While the trajectories of uric acid were relatively stable for most strata, eGFR steadily declined across all strata. However, in the final 3 months prior to ESRD transition (PQ2 to PQ1), those in the highest PQ5 eGFR category (>=45 ml/min/1.73m2) showed a sharp decrease in eGFR and corresponding sharp increase in uric acid, while there were less notable trends for other strata. [Figure]

Conclusion

Patients with the most rapid renal function decline also had a sharp increase in uric acid 3 months prior to transition to ESRD. The mechanism behind this relationship is currently unknown, and should be investigated in future studies. Future studies should also examine the clinical implications of elevated uric acid in patients transitioning to dialysis earlier due to a rapid renal function decline.