Longitudinal trends in the prevalence of hyperuricaemia and chronic kidney disease in hypertensive and normotensive adults

Figures & data

Table 1. Demographic and clinical characteristics by gender, Czech post-MONICA studies 2006–2009 and 2015–2018.

	Men			Women
	Survey 2006–2009 n = 1707	Survey 2015–2018 n = 1096	p Value	Survey 2006–2009 n = 1797	Survey 2015–2018 n = 1213	p Value
Age, years	47.8 ± 11.5	48.3 ± 10.9	ns	46.6 ± 11.2	47.8 ± 10.9	0.006
Education
Basic, n (%)	68 (4.0)	18 (1.7)	< 0.001	174 (9.7)	55 (4.6)	< 0.001
Secondary without school leaving examination, n (%)	804 (47.1)	383 (35.3)		545 (30.4)	286 (23.7)
Secondary with school leaving examination, n (%)	579 (33.9)	421 (38.8)		819 (45.6)	588 (48.8)
University, n (%)	256 (15.0)	262 (24.3)		257 (14.3)	277 (23.0)
Current smoker, n (%)	605 (35.5)	290 (26.6)	< 0.001	491 (27.3)	281 (23.2)	0.012
Alcohol intake, g/week^a	102 [34−187]	100 [40−200]	0.861	17 [0−43]	17 [0−57]	0.004
Waist circumference, cm	98.7 ± 12.3	100.3 ± 12.4	0.001	86.8 ± 14.5	88.6 ± 14.8	0.001
Waist-to-height ratio, cm/cm	0.56 ± 0.07	0.57 ± 0.07	< 0.001	0.53 ± 0.09	0.54 ± 0.09	< 0.001
Waist-to-height ratio > 0.5	1328 (77.9)	913 (83.4)	< 0.001	989 (55.2)	740 (61.1)	0.002
Systolic BP, mmHg	130.3 ± 16.4	130.0 ± 15.1	ns	124.2 ± 18.2	123.5 ± 17.0	ns
Diastolic BP, mmHg	83.7 ± 9.8	84.3 ± 9.1	ns	79.5 ± 9.4	79.5 ± 9.3	ns
Hypertension, n (%)	780 (45.8)	528 (48.2)	ns	612 (34.1)	385 (31.7)	ns
Triglycerides, mmol/l	1.5 [1.0−2.2]	1.3 [0.9−1.9]	< 0.001	1.1 [0.8−1.6]	0.95 [0.7−1.3]	< 0.001
Fasting plasma glucose, mmol/l	5.4 [5.0−5.9]	5.4 [5.1−5.9]	ns	5.1 [4.7−5.5]	5.2 [4.9−5.6]	< 0.001
Diabetes mellitus, n (%)	155 (9.1)	87 (7.9)	ns	88 (4.9)	64 (5.3)	ns
Use of xanthine-oxidase inhibitors, n (%)	84 (4.9)	64 (5.8)	ns	21 (1.2)	26 (2.1)	0.037
Use of antihypertensive medication, n (%)	489 (28.7)	327 (29.8)	ns	419 (23.3)	250 (20.6)	ns
Use of RAS inhibitors, n (%)	342 (20.0)	268 (24.5)	0.006	233 (13.0)	197 (16.2)	0.013
Use of CCB, n (%)	163 (9.6)	155 (14.1)	< 0.001	118 (6.6)	69 (6.7)	ns
Use of beta blockers, n (%)	225 (13.2)	112 (10.2)	0.020	205 (11.4)	103 (8.5)	0.010
Use of diuretics, n (%)	168 (9.8)	105 (9.6)	ns	174 (9.7)	84 (6.9)	0.010
Use of losartan, n (%)	64 (3.8)	18 (1.6)	0.001	59 (3.3)	19 (1.6)	0.005
Use of antidiabetic medication, n (%)	85 (5.1)	63 (5.7)	ns	52 (2.9)	49 (4.0)	ns
Use of fenofibrate, n (%)	47 (2.8)	31 (2.8)	ns	24 (1.3)	15 (1.2)	ns

BP: blood pressure; CCB: calcium channel blockers; ns: not significant; RAS: renin–angiotensin–aldosterone system.

Mean ± standard deviation are presented for the continuous variables with normal distribution.

Median and interquartile range are presented for the continuous variables with skewed distribution.

Bold value indicates a significant difference as a two-sided p value < 0.05.

^aMedian and 10^th–90 ^th percentile is presented for alcohol intake.

Table 2. Ten-year trends in crude prevalence estimates of hyperuricaemia and CKD by gender.

	Men			Women
	Survey 2006–2009 n = 1707	Survey 2015–2018 n = 1096	p Value	Survey 2006–2009 n = 1797	Survey 2015–2018 n = 1213	p Value
Hyperuricaemia, % (95% CI)	16.4 (14.6−18.2)	25.2 (22.6−27.8)	< 0.001	7.6 (6.4−8.8)	10.9 (9.2−12.7)	0.002
SUA, µmol/l; mean ± SD	344.7 ± 81.0	374.6 ± 73.2	< 0.001	250.2 ± 73.8	279.0 ± 66.3	< 0.001
Total CKD, % (95% CI)	6.8 (5.6−8.0)	3.6 (2.5−4.7)	< 0.001	7.6 (6.4−8.8)	4.8 (3.6−6)	0.002
CKD stages
G1 A2−3, % (95% CI)	1.9 (1.30−2.7)	1.6 (0.9−2.5)	< 0.001	1.8 (1.2−2.5)	1.7 (1.1−2.6)	< 0.001
G2 A2−3, % (95% CI)	2.8 (2.1−3.8)	0.8 (0.4−1.6)		3.1 (2.4−4.0)	0.8 (0.4−1.5)
G3, % (95% CI)	1.8 (1.2−2.5)	1.0 (0.5−1.8)		2.6 (1.9−3.4)	1.8 (1.1−2.6)
G4, % (95% CI)	0.2 (0−0.5)	0.2 (0−0.7)		0.1 (0−0.4)	0.3 (0−0.6))
G5, % (95% CI)	0.1 (0−0.3)	0.0 (0˗0.3)		0.0 (0˗0.2)	0.1 (0−0.5)
eGFR < 60 ml/min/1.73m^2, % (95% CI)	2.1(1.4−2.8)	1.2 (0.6−1.8)	ns	2.7 (2.0−3.5)	2.2 (1.4−3.0)	ns
eGFR, ml/min/1.73m^2; mean ± SD	91.6 ± 16.1	92.2 ± 13.9	ns	88.2 ± 16.3	91.5 ± 16.1	< 0.001
ACR category (mg/mmol)
A1 (< 3), % (95% CI)	94.4 (93.2−95.5)	97.4 (96.3−98.3)	0.001	94.5 (93.4−95.6)	97.0 (95.8−97.8)	0.004
A2 (3−30), % (95% CI)	4.8 (3.8−5.9)	2.1 (1.3−3.1)		5.1 (4.1−6.2)	2.6 (1.8−3.7)
A3 (> 30), % (95% CI)	0.8 (0.4−1.3)	0.5 (0.1−1.1)		0.4 (0.2−0.8)	0.3 (0.1−0.8)
ACR ≥ 3 mg/mmol, % (95% CI)	5.6 (4.5−6.7)	2.6 (1.7−3.5)	< 0.001	5.5 (4.5−6.6)	3.0 (2.0−4.0)	0.002

ACR: albumin/creatinine ratio; CI: confidence interval; CKD: chronic kidney disease; eGFR: estimated glomerular filtration rate; ns: not significant; SD: standard deviation; SUA: serum uric acid.

Bold value indicates a significant difference as a two-sided p value < 0.05.

Early CKD stages G1 A2–3 and G2 A2–3 were classified by the presence of ACR ≥ 3 mg/mmol (A2) and ≥ 30 mg/mmol (A3) and either eGFR ≥ 90 ml/min/1.73 m² (Stage G1 A2–3) or eGFR 60–89 ml/min/1.73 m² (Stage G2 A2–3). Stages G3–G5 were only classified according to eGFR values: 30–59 mL/min/1.73 m² (Stage G3), 15–29 ml/min/1.73 m² (Stage G4) and < 15 mL/min/1.73 m² (Stage G5).

Figure 1. Ten-year trends in the prevalence of hyperuricaemia (A) and CKD (B) by blood pressure status. CKD: chronic kidney disease; HT: hypertensives; NT: normotensives. *p < 0.05, **p < 0.005, ***p < 0.001. (A) Multivariate adjusted p values for the effect of the interaction between HT and hyperuricaemia on 10-year trends was 0.192 in men and 0.851 in women. (B) Multivariate adjusted p values for the effect of the interaction between HT and CKD on 10-year trends was = 0.001 in men and 0.011 in women. Each interaction analysis was adjusted for: age, education, current smoking, triglycerides, waist-to-height ratio > 0.5, diabetes, quartiles of alcohol intake, the use of xanthine-oxidase inhibitors, diuretics, and losartan, as well as for hyperuricaemia, CKD and HT per se.

Figure 2. Multivariate logistic regression analysis showing the odds ratio of hyperuricaemia, chronic kidney disease, abdominal obesity, hypertension, diabetes, and the use of antihypertensive medication in 2015–18 vs. in 2006–09 in men. Abd. obesity: abdominal obesity; BB: beta blockers; CCBs: calcium channel blockers; CKD: chronic kidney disease; DM: diabetes mellitus; HT: arterial hypertension; RAS: renin-angiotensin-aldosterone system. *p < 0.05, **p < 0.005, ***p < 0 .001. (A) Total study population; n = 2803. (B) Hypertensive individuals; n = 1308. (C) Normotensive individuals; n = 1495. The year of survey (2015–2018 vs. 2006–2009) was used as a dependent variable. In addition to all factors graphically displayed, each multivariate logistic regression analysis was adjusted for: age, education, current smoking, triglycerides, and the use of xanthine-oxidase inhibitors. Further adjustment for quartiles of alcohol intake did not alter the results.

Figure 3. Multivariate logistic regression analysis showing the odds ratio of hyperuricaemia, chronic kidney disease, abdominal obesity, hypertension, diabetes, and the use of antihypertensive medication in 2015–18 vs. in 2006–09 in women. Abd. obesity: abdominal obesity; BB: beta blockers; CCBs: calcium channel blockers; CKD: chronic kidney disease; DM: diabetes mellitus; HT: arterial hypertension; RAS: renin-angiotensin-aldosterone system. *p < 0.05, **p < 0.005, ***p < 0.001. (A) Total study population; n = 3010. (B) Hypertensive individuals; n = 997. (C) Normotensive individuals; n = 2013. The year of survey (2015–2018 vs. 2006–2009) was used as a dependent variable. In addition to all factors graphically displayed, each multivariate logistic regression analysis was adjusted for: age, education, current smoking, triglycerides, and the use of xanthine-oxidase inhibitors. Further adjustment for quartiles of alcohol intake did not alter the results.