Association of acidic urine pH with impaired renal function in primary gout patients: a Chinese population-based cross-sectional study.
Association of acidic urine pH with impaired renal function in primary gout patients: a Chinese population-based cross-sectional study.
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原发性痛风患者酸性尿 pH 值与肾功能受损的关联：一项基于中国人群的横断面研究。
DOI：
10.1186/s13075-022-02725-w
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发表时间：
2022-01-25
影响因子：
4.9
通讯作者：
Li C
中科院分区：
文献类型：
--
作者：
He Y;Xue X;Terkeltaub R;Dalbeth N;Merriman TR;Mount DB;Feng Z;Li X;Cui L;Liu Z;Xu Y;Chen Y;Li H;Ji A;Ji X;Wang X;Lu J;Li C
痛风患者经常有低尿pH值，这与肾结石有关。然而，尿pH值的具体分布和酸性尿pH值的潜在关系，以更广泛的肾脏疾病的痛风表现仍然知之甚少。本研究在青岛大学附属医院痛风专科门诊3565例痛风患者中开展了一项2016-2020年基于人群的横断面研究，旨在探讨低尿pH与肾脏疾病的相关性。我们研究了我们定义为“原发性痛风”的患者，基于没有> 2期CKD。所有受试者接受14天的药物洗脱和3天的标准化代谢饮食。我们在访视当天获得了一般医疗信息、血液和尿液生化以及肾脏超声检查。主要读数为尿液pH值、eGFR、肾结石、肾囊肿、微量血尿和蛋白尿。将患者分为5个亚组（尿pH ≤5.0，5.0 <pH≤ 5.5，5.5 <pH< 6.2，6.2 ≤pH≤ 6.9，和pH >6.9），与尿pH的临床意义一致。总体而言，所有患者的中位尿pH和eGFR为5.63 IQR为5.37~6.09，IQR为86.03~110.6，为98.32，46.5%的患者伴有酸性尿。肾结石、微量血尿和蛋白尿的患病率分别为16.9%、49.5%和6.9%。通过单因素分析，eGFR与年龄、性别、痛风持续时间、痛风石、体重指数、收缩压、舒张压、空腹血糖、总胆固醇、血清尿酸、高血压、糖尿病和尿液pH显著相关。尤其是尿pH < 5.0与肾病的患病率显著相关，包括> 1期CKD、肾结石、肾囊肿和微量血尿。6.2 ≤尿液pH ≤ 6.9和SU ≤ 480 μmol/L的患者eGFR最高，肾结石、微量血尿和蛋白尿的患病率最低。大约一半的痛风患者有酸性尿pH。尿pH < 5.0与肾结石、肾囊肿、微量血尿和蛋白尿显著增加相关。结果支持在选定的酸性尿pH痛风患者中进行尿碱化的前瞻性临床研究。在线版本包含补充材料，可在10.1186/s13075-022-02725-w获得。
Patients with gout frequently have low urinary pH, which is associated with the nephrolithiasis. However, the specific distribution of urinary pH and potential relationship of acidic urine pH to broader manifestations of kidney disease in gout are still poorly understood. A 2016–2020 population-based cross-sectional study was conducted among 3565 gout patients in the dedicated gout clinic of the Affiliated Hospital of Qingdao University to investigate the association between low urinary pH and kidney disease. We studied patients that we defined to have “primary gout”, based on the absence of > stage 2 CKD. All subjects underwent 14 days of medication washout and 3-day standardized metabolic diet. We obtained general medical information, blood and urine biochemistries, and renal ultrasound examination on the day of the visit. The primary readouts were urine pH, eGFR, nephrolithiasis, renal cysts, microhematuria, and proteinuria. Patients were assigned into 5 subgroups (urine pH ≤5.0, 5.0 <pH≤ 5.5, 5.5 <pH< 6.2, 6.2 ≤pH≤ 6.9, and pH >6.9), aligning with the clinical significance of urine pH. Overall, the median urine pH and eGFR of all patients was 5.63 (IQR 5.37~6.09), and 98.32 (IQR 86.03~110.6), with acidic urine in 46.5% of patients. The prevalence of nephrolithiasis, microhematuria, and proteinuria were 16.9%, 49.5%, and 6.9%, respectively. By univariate analysis, eGFR was significantly associated with age, sex, duration of gout, tophus, body mass index, systolic blood pressure, diastolic blood pressure, fasting blood glucose, total cholesterol, serum utare, hypertension, diabetes, and urine pH. On multivariable analysis, eGFR was associated with age, sex, diastolic blood pressure, serum uric acid, hypertension, diabetes, and urine pH. Acidic urine pH, especially urine pH < 5.0, was significantly associated with the prevalence of kidney disease, including > stage 1 CKD, nephrolithiasis, kidney cyst, and microhematuria. Patients with 6.2 ≤ urine pH ≤ 6.9 and SU ≤ 480 μmol/L had the highest eGFR with the lowest prevalence of nephrolithiasis, microhematuria, and proteinuria. Approximately half of gout subjects had acidic urine pH. Urine pH < 5.0 was associated with significantly increased nephrolithiasis, renal cyst, microhematuria, and proteinuria. The results support prospective clinical investigation of urinary alkalinization in selected gout patients with acidic urine pH. The online version contains supplementary material available at 10.1186/s13075-022-02725-w.