Significance of hyperuricemia as a risk factor for developing ESRD in a screened cohort
Significance of hyperuricemia as a risk factor for developing ESRD in a screened cohort
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DOI：
10.1053/j.ajkd.2004.06.006
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发表时间：
2004-10-01
影响因子：
13.2
通讯作者：
Takishita, S
中科院分区：
文献类型：
--
作者：
Iseki, K;Ikemiya, Y;Takishita, S
背景：尿酸可能是肾脏疾病和进展的真正介质。然而，流行病学证据的意义，血清尿酸水平对发展为终末期肾病（ESRD）的风险是稀缺的，在设置以社区为基础的筛查。研究方法：对1993年日本冲绳的冲绳一般健康维护协会进行的大规模筛查的参与者进行了调查：研究了48，177名年龄大于20岁的筛查者（22，949名男性，25，228名女性），他们的血清尿酸数据可用。在冲绳接受治疗的所有透析患者均在冲绳透析研究登记中心独立登记。通过使用2个计算机登记系统识别1993年筛选中后来进入透析项目的受试者。根据基线血清尿酸水平的四分位数计算每种性别的ESRD累积发生率。高尿酸血症的临床意义在校正年龄、血压、体重指数、蛋白尿、红细胞压积、以及总胆固醇、甘油三酯、空腹血糖和血清肌酐水平。结果：男性平均血清尿酸水平为6.4 +/- 1.4（SD）mg/dL（381 mumol/L），女性为4.8 +/- 1.1 mg/dL（286 mumol/L）。男性高尿酸血症患病率为31.9%，女性为13.6%。到2000年底，共有103名被筛查者（53名男子，50名妇女）参加了透析方案。每1,000名筛查者中，ESRD的发病率在无高尿酸血症的男性中为1.22，在有高尿酸血症的男性中为4.64，在无高尿酸血症的女性中为0.87，在有高尿酸血症的女性中为9.03。高尿酸血症的校正风险比男性为2.004（95%置信区间，0.904至4.444; P =无显著性），女性为5.770（95%置信区间，2.309至14.421; P = 0.0002）。结论：高尿酸血症的筛查者与ESRD的发生率较高相关。高尿酸血症（血清尿酸大于或等于6.0 mg/dL [大于或等于357 mumol/L]）是女性ESRD的独立预测因子。将血清尿酸水平控制在正常范围内的策略可能会减少ESRD的人群负担。
Background: Uric acid may be a true mediator of renal disease and progression. However, epidemiological evidence for the significance of serum uric acid levels on the risk for developing end-stage renal disease (ESRD) is scarce in a setting of community-based screening. Methods: Participants in a 1993 mass screening conducted by the Okinawa General Health Maintenance Association in Okinawa, Japan, were investigated: 48,177 screenees (22,949 men, 25,228 women) older than 20 years for whom serum uric acid data were available were studied. All dialysis patients treated in Okinawa were independently registered in the Okinawa Dialysis Study registry. Participants in the 1993 screening who later entered a dialysis program were identified by using 2 computer registries. The cumulative incidence of ESRD was calculated according to quartiles of baseline serum uric acid levels for each sex. The significance of hyperuricemia (serum uric acid level greater than or equal to7.0 mg/dL [greater than or equal to416 mumol/L] in men and greater than or equal to6.0 mg/dL [greater than or equal to357 mumol/L] in women) for the risk for developing ESRD was evaluated by means of the Cox model after adjusting for age, blood pressure, body mass index, proteinuria, hematocrit, and total cholesterol, triglyceride, fasting blood glucose, and serum creatinine levels. Results: Mean serum uric acid level was 6.4 +/- 1.4 (SD) mg/dL (381 mumol/L) in men and 4.8 +/- 1.1 mg/dL (286 mumol/L) in women. Prevalences of hyperuricemia were 31.9% in men and 13.6% in women. By the end of 2000, a total of 103 screenees (53 men, 50 women) entered dialysis programs. Calculated incidences of ESRD per 1,000 screenees were 1.22 for men without hyperuricemia and 4.64 for men with hyperuricemia and 0.87 for women without hyperuricemia and 9.03 for women with hyperuricemia. Adjusted hazard ratios for hyperuricemia were 2.004 (95% confidence interval, 0.904 to 4.444; P = not significant) in men and 5.770 (95% confidence interval, 2.309 to 14.421; P = 0.0002) in women. Conclusion: Screenees with hyperuricemia were associated with a greater incidence of ESRD. Hyperuricemia (serum uric acid greater than or equal to 6.0 mg/dL [greater than or equal to357 mumol/L]) was an independent predictor of ESRD in women. Strategies to control serum uric acid levels in the normal range may reduce the population burden of ESRD.