Uric Acid Levels, Kidney Function, and Cardiovascular Mortality in US Adults: NHANES 1988-1994 and 1999-2002 Public Deposited

http://ir.library.oregonstate.edu/concern/articles/tq57ns896

This is an author's peer-reviewed final manuscript, as accepted by the publisher. The published article is copyrighted by the National Kidney Foundation and published by Elsevier. It can be found at:  http://www.journals.elsevier.com/american-journal-of-kidney-diseases/

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  • BACKGROUND: Chronic kidney disease (CKD) and hyperuricemia often coexist and both conditions are increasing in prevalence in the U.S., although their shared role on cardiovascular risk remains highly debated. STUDY DESIGN: Cross-sectional and longitudinal SETTING AND PARTICIPANTS: Participants in the National Health and Nutrition Examination Survey (NHANES) from 1988 to 2002 (n = 10,956); data were linked to mortality data from the National Death Index through December 31st, 2006. PREDICTORS: Serum uric acid concentration, categorized as the sex-specific lowest 25th percentile, 25th-75th, and 75th percentile and higher; and kidney function measured by estimated glomerular filtration rate (eGFR) based on the combined creatinine and cystatin C estimating equation developed by the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), and urinary albumin to creatinine ratio (ACR) OUTCOMES: Cardiovascular death and all-cause mortality RESULTS: Uric acid levels were correlated with eGFR[Cr-Cys (r = -0.29, p<0.001), and were only slightly correlated with ACR (r = 0.04, p<0.001). There were 2,203 deaths up until December 31st, 2006, of which 981 were due to cardiovascular causes. Overall, there was a U-shaped association between uric acid levels and cardiovascular mortality in both women and men, although the lowest risk of cardiovascular mortality occurred at a lower level of uric acid for women compared with men. There was an association between the highest quartile of uric acid and cardiovascular mortality even after adjustment for potential confounders (1.48, 95% CI: 1.13, 1.96), although this association was attenuated after adjustment for ACR and eGFRCr-Cys (HR = 1.25, 95% CI: 0.89, 1.75). The pattern of association between uric acid levels and all-cause mortality was similar. LIMITATIONS: GFR not measured; mediating events were not observed. CONCLUSIONS: High uric acid is associated with cardiovascular and all-cause mortality, although this relationship was no longer statistically significant after accounting for kidney function.
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  • Odden, M. C., Amadu, A. R., Smit, E., Lo, L., & Peralta, C. A. (2014). Uric Acid Levels, Kidney Function, and Cardiovascular Mortality in US Adults: National Health and Nutrition Examination Survey (NHANES) 1988-1994 and 1999-2002. American Journal of Kidney Diseases, 64(4), 550-557. doi:10.1053/j.ajkd.2014.04.024
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