P50
HYPERURICAEMIA IS ASSOCIATED WITH CARDIOVASCULAR MORTALITY IN
CHRONIC KIDNEY DISEASE
Chiu, D, Ritchie, J, Green, D, Sinha, S, Kalra, PA
Salford Vascular Research Group, University of Manchester, MAHSC, Manchester, United
Kingdom.
INTRODUCTION: Hyperuricaemia is a common finding in patients with Chronic Kidney Disease
(CKD). There are few long-term outcomes studies examining the association of hyperuricaemia
with cardiovascular deaths in CKD.
METHODS: Baseline bloods were analysed from the Chronic Renal Insufficiency Standards
Implementation Study (CRISIS), a prospective observational study of outcome in patients with allcause CKD stages 3-5, managed in secondary care. Hyperuricaemia was defined as serum uric acid
>0.43mmol/l. Predictors of cardiovascular deaths, data from Office for National Statistics, were
selected using forward stepwise cox regression (included variables with p<0.05 on univariate
analysis). As Allopurinol affects uric acid levels, only patients not on this medication were included
in this particular analysis.
RESULTS: From 883 patients, with available baseline uric acid results and not taking allopurinol,
mean eGFR was 35±16.2 ml/min/1.73m2, 542 (61.4%) were males, 293 (33.2%) were diabetics,
171 (19.4%) had history of ischaemic heart disease (IHD) and 596 (67.5%) were current/exsmokers. Median follow-up was 41 months (interquartile range 25-57months), and there were 225
(25.5%) deaths with 60 (6.8%) cardiovascular deaths. In the final cox regression model
hyperuricaemia was an independent predictor of cardiovascular death (Table 1).
Table 1
Cox regression model
Variable
Hazard Ratio
95% CI
P
Hyperuricaemia
2.22
1.10-4.47
0.03
Age
1.05
1.02-1.08
<0.01
Diabetes Mellitus
2.40
1.37-4.19
<0.01
History of IHD
2.76
1.59-4.79
<0.01
Albumin
0.90
0.84-0.97
<0.01
eGFR
0.96
0.93-0.98
<0.01
Predictors included: Age, gender, smoker, diabetes mellitus, history of ischaemic heart
disease, diuretic use, ACE inhibitor use, albumin, haemoglobin, C-reactive protein, eGFR.
There was no association between hyperuricaemia with all-cause mortality in a cox regression
model with the same predictors (p=0.325).
CONCLUSION: Hyperuricaemia is an independent predictor of cardiovascular deaths in this nondialysis CKD cohort. Further studies are required to explore causality in this relationship.