Kidney Week

Abstract: FR-PO0264

Proteinuria Modifies the Association Between Serum Uric Acid and Subsequent Decline in eGFR: Community-Based Cohort

Session Information

• CKD: Omics, Systemic Stressors, and Targeted Pharmacotherapy
  October 23, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2201 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

• Noda, Seiya, Iwate Ika Daigaku, Shiwa District, Iwate Prefecture, Japan

Seiya Noda, MD

• Tanaka, Fumitaka, Nara Kyoiku Daigaku, Nara, Nara Prefecture, Japan

Fumitaka Tanaka

• Kikuchi, Yawara, Iwate Ika Daigaku, Shiwa District, Iwate Prefecture, Japan

Yawara Kikuchi

• Kawashima, Eri, Iwate Ika Daigaku, Shiwa District, Iwate Prefecture, Japan

Eri Kawashima, MD, PhD

• Yoshikawa, Kazuhiro, Iwate Ika Daigaku, Shiwa District, Iwate Prefecture, Japan

Kazuhiro Yoshikawa, MD, PhD

• Shimoda, Haruki, Iwate Ika Daigaku, Shiwa District, Iwate Prefecture, Japan

Haruki Shimoda, PhD

• Sakata, Kiyomi, Iwate Ika Daigaku, Shiwa District, Iwate Prefecture, Japan

Kiyomi Sakata, MD, PhD

• Asahi, Koichi, Iwate Ika Daigaku, Shiwa District, Iwate Prefecture, Japan

Koichi Asahi, MD, PhD

Background

Hyperuricemia and proteinuria are independent risk factors for kidney function decline, but whether proteinuria modifies the association between serum uric acid (SUA) and renal decline is unclear.

Methods

We studied 8,266 adults aged ≥20 years in a Japanese community cohort after excluding participants with prior cardiovascular disease, gout, urate-lowering therapy, and no follow-up eGFR measurements. Proteinuria was defined as trace or greater by dipstick at baseline. Annual eGFR slope was analyzed using linear mixed-effects models with random intercepts and slopes. SUA was modeled with restricted cubic splines and multivariable adjustment. Prespecified subgroup analyses were performed by age, sex, BMI, blood pressure, diabetes, and baseline eGFR.

Results

Mean age was 61.7±13.6 years, 64% were women, mean SUA was 5.1±1.4 mg/dL, mean baseline eGFR was 78.0±12.2 mL/min/1.73 m², and 371 participants (4.5%) had proteinuria. Mean follow-up was 7.1±2.6 years. In participants without proteinuria, eGFR slope was nearly unchanged across SUA levels (-1.11 [95% CI -1.18, -1.05] mL/min/1.73 m²/year; P=0.220). In those with proteinuria, eGFR slope showed a non-linear association with SUA, with the slowest decline at 5.0 mg/dL (-1.27 [95% CI -1.42, -1.11]) and steeper decline thereafter, reaching -2.04 [95% CI -2.24, -1.82] mL/min/1.73 m²/year at 7.8 mg/dL (P<0.001). Interaction was significant (P<0.001). In subgroup analyses, only baseline eGFR significantly modified this association after Bonferroni correction. Among participants with baseline eGFR <60 mL/min/1.73 m², eGFR decline was consistently steeper in those with proteinuria across SUA levels. Sensitivity analysis using proteinuria ≥1+ showed a similar pattern.

Conclusion

Higher SUA was associated with faster subsequent eGFR decline in those with baseline proteinuria, but not in those without.

Funding

• Government Support – Non-U.S.