Disparity of serum uric acid threshold for CKD among hypertensive and non-hypertensive individuals

Abstract

Introduction

Hypertension and rising serum uric acid (sUA) played a pivotal role in the development of Chronic Kidney Disease (CKD). This study investigates the interactive effect of sUA and hypertension on CKD and identifies the optimal threshold of sUA among individuals with and without hypertension in the Chinese community population.

Materials and methods

The study included 4180 individuals aged 45–85 years, derived from the China Health and Retirement Longitudinal Study (CHARLS) between 2011 and 2015. Additionally, a hospital-based study enrolled subjects in the Department of Nephrology at Zhongshan Hospital, China from January 1, 2019, to December 31, 2021. The interaction effect analysis were used to assess the impact of sUA and hypertension on CKD. We also compared the distribution of sUA and the CKD risk in community populations, distinguishing between those with and without hypertension. For the hospital-based population, kidney injury was marked by a KIM-1 positive area.

Results

Our results indicate a higher prevalence of CKD in the community population with hypertension (10.2% vs. 3.9%, p < .001). A significant additive synergistic effects of the sUA and hypertension on the CKD risk were found. When the sUA level was < 4.55 mg/dL in the hypertensive population and < 5.58 mg/dL in the non-hypertensive population, the risk of CKD was comparable (p = .809). In the propensity score matched (PSM) population, the result remained roughly constant.

Conclusion

Therefore, even moderate levels of sUA was associated with a higher risk of CKD in middle-aged hypertensive patients, who warrant stricter sUA control.

Keywords:

• Hypertension
• serum uric acid
• chronic kidney disease
• CHARLS

Acknowledgments

We thank all study participants without whom this research would not be possible.

Authors contributions

BZ, HL and YL contributed to the conception or design of the work. FL and WZ contributed to the acquisition, analysis, or interpretation of data for the work. BZ and WZ drafted the manuscript. FL critically revised the manuscript. NS, SZ, SJ, ZS, and YL contribute to the acquisition, analysis, or interpretation of the work. All gave final approval and agreed to be accountable for all aspects of work ensuring integrity and accuracy.

Ethics statement

The CHARLS was approved by the biomedical ethics committee of Peking University.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data underlying this article are available in CHARLS Database at http://charls.pku.edu.cn/.

Additional information

Funding

This work was supported by the National Natural Science Foundation of China (82200792), National Natural Science Foundation of China (82103911), the Shanghai Municipal Key Clinical Specialty (shslczdzk02501), Shanghai Federation of Nephrology Project (SHDC2202230), Shanghai Clinical Medical Center for Kidney Disease (2017ZZ01015), Shanghai Sailing Program (20YF1406000), Youth Fund of Zhongshan Hospital (2022ZSQN10), and Shanghai three-year action plan to strengthen the public health system (GWVI-11.2-YQ10).