Uric Acid in the Follow-Up Determines 30% Decline in Estimated GFR Over 2 Years: a Propensity Score Analysis

作者：Chang, Wen Xiu; Xu, Ning; Kumagai, Takanori; Iijima, Ryutaro; Waki, Kaito; Yamanaka, Masaki; Nagura, Michito; Arai, Shigeyuki; Tamura, Yoshifuru; Shibata, Shigeru; Fujigaki, Yoshihide; Uchida, Shunya^*

来源：Kidney & Blood Pressure Research, 2017, 42(6): 1053-1067.

DOI：10.1159/000485593

• Uric acid
• Time-averaged uric acid
• 30% decline in eGFR
• Propensity score analysis
• Stratified Cox proportional hazards model
• Propensity score matching

Background/Aims: Higher level of serum uric acid (SUA) predicts early entry to dialysis in chronic kidney disease (CKD) patients. However, a short-term effect of SUA remains to be elucidated using a novel surrogate endpoint. Methods: Japanese CKD stage 3 to 4 patients were retrospectively examined (n=701). The follow-up level of SUA was estimated as time-averaged uric acid (TA-UA). A propensity score for 6.0, 6.5 or 7.0 mg/dL of TA-UA was respectively calculated using baseline 23 covariates. The time-to-event analysis was performed for 30% decline in estimated GFR over 2 years. Results: Incidence rates over 2 years were 90 of 440 in men and 36 of 261 in women (p = 0.03). Despite the negative result of baseline SUA, stratified Cox regression on the quintiles of the estimated propensity score showed that higher TA-UA of the three thresholds were all significant (crude HR 2.10 to 2.44) even after adjusting for the confounders. Kaplan-Meier analysis after propensity score matching likewise showed worse survival in the patients with the higher TA-UA (HR 3.11 to 4.26). Conclusion: Higher SUA increases likelihood of reaching a surrogate endpoint over 2 years. Early intervention for SUA less than 6.0 mg/dL is recommended for slowing CKD progression.

• 出版日期2017
• 单位天津市第一中心医院