A nonlinear correlation between the serum uric acid to creatinine ratio and the prevalence of hypertension: a large cross-sectional population-based study

Abstract

Objective

To explore the relationship between the serum uric acid to creatinine (UA/Cr) ratio and the prevalence of hypertension.

Methods

In this cross-sectional study, we included 8571 individuals from the China Health and Nutrition Survey. Logistic regression analysis and restricted cubic spline (RCS) were used to analyze the relationship between the UA/Cr ratio and hypertension.

Results

Compared with individuals without hypertension, individuals with hypertension had higher UA/Cr ratios. Multivariate logistic regression analysis showed that a higher UA/Cr ratio was closely related to a higher risk of hypertension (as a continuous variable, OR: 1.054, 95% CI: 1.014-1.095, p = 0.007; as a categorical variable, Q3 vs. Q1, OR: 1.183, 95% CI: 1.011-1.384, p = 0.035; Q4 vs. Q1, OR: 1.347, 95% CI: 1.146-1.582, p < 0.001). Subgroup analysis revealed that the correlation between the UA/Cr ratio and hypertension risk was stable in all subgroups except for the subgroup with diabetes and the subgroup with a BMI ≥ 28 kg/m² (p < 0.05). Sensitivity analysis confirmed the robustness of the relationship between a higher UA/Cr ratio and a higher risk of hypertension (p < 0.05). The RCS showed that the UA/Cr ratio was nonlinearly related to hypertension risk. Further threshold effect showed that only a UA/Cr ratio less than 5.0 was related to hypertension risk (OR: 1.178, 95% CI: 1.086-1.278, p < 0.001), and the 2-piecewise linear regression model was superior to the 1-line linear regression model (p < 0.05).

Conclusion

The UA/Cr ratio was associated with the prevalence of hypertension.

Keywords:

• Serum uric acid to creatinine ratio
• serum uric acid
• creatinine
• hypertension
• nonlinearity

Acknowledgments

This research uses data from China Health and Nutrition Survey (CHNS). We are grateful to research grant funding from the National Institute for Health (NIH), the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) for R01 HD30880, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) for R01DK104371 and R01HL108427, the NIH Fogarty grant D43 TW009077 for financial support for the CHNS data collection and analysis files since 1989, and the China-Japan Friendship Hospital, Ministry of Health for support for CHNS 2009, Chinese National Human Genome Center at Shanghai since 2009, and Beijing Municipal Center for Disease Prevention and Control since 2011. We thank the National Institute for Nutrition and Health, China Center for Disease Control and Prevention, Beijing Municipal Center for Disease Control and Prevention, and the Chinese National Human Genome Center at Shanghai.

Author contributions

Ru Wang conceived and designed the study. Shuxing Wu, Jing Wang, Wenting Li and Jian Cui contributed to initial data analysis and interpretation. Ru Wang drafted the initial manuscript. Shuxing Wu, Jing Wang, Wenting Li, Jian Cui and Zhuhua Yao revised the manuscript. Zhuhua Yao was the guarantor of this work and had full access to all the data in the study and take responsibility for its integrity and the accuracy of the data analysis. All authors read and approved the final manuscript.

Ethics approval and consent to participate

The CHNS was approved by the institutional review committees at the University of North Carolina at Chapel Hill and the National Institute of Nutrition and Food Safety, Chinese Center for Disease Control and Prevention. All participants signed written informed consent form, and the study protocol was carried out in accordance with the Declaration of Helsinki.

Disclosure statement

The authors report no conflicts of interest.

Data availability statement

All raw data and materials included in this study are publicly available on the CHNS website.

Additional information

Funding

National Institute for Health (NIH); Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD); National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK);NIH Fogarty; CHNS; China-Japan Friendship Hospital, Ministry of Health; Chinese National Human Genome Center at Shanghai; Beijing Municipal Center for Disease Prevention and Control.