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논문분류	춘계학술대회 초록집
제목	The impact of hyperuricemia on kidney failure and mortality in a multi-center CKD cohort; an instrumental variable analysis.
저자	Yong Chul Kim1, Sohee Oh3, Jung Nam An2, Dong Ki Kim1, Yoon Kyu Oh2, Chun Soo Lim2, Yon Su Kim1, Jung Pyo Lee2
출판정보	2018; 2018(1):
키워드	hyperuricemia \| end stage renal disease \| mortality \| instrumental variable analysis
초록	Objectives: Hyperuricemia is an independent risk factor for mortality, cardiovascular disease, and renal disease in general population. However, the relationship between hyperuricemia with kidney failure and death in chronic kidney disease (CKD) remains controversial. Methods: The study investigated the association between uric acid with all-cause mortality, end stage renal disease (ESRD) in 42,253 CKD patients in a multi-center cohort from 2001 to 2016. We used the regional prevalence of hyperuricemia (uric acid ≥ 6.8 mg/dL) as an instrument to test our hypothesis that hyperuricemia is associated with ESRD and mortality. Results: In all subjects, the mean uric acid level was 5.4 ± 1.8 mg/dL. During a median year follow-up, there were 3,556 (8.42%) of renal failure and 5,094 (12.06%) of death in this cohort. Using an instrumental variable analysis after adjusting confounders such as age, diabetes, hypertension and estimated GFR, we found evidence suggesting a causal relationship between hyperuricemia and increased risk of all-cause mortality (HR 3.131, 95% CI 2.043-4.797, P < 0.001). This tendency was consistent regardless of gender (male: HR 2.270, 95% CI 1.338-3.851, P = 0.002, female: HR 2.656, 95% CI 1.459-4.834, P = 0.001). On the contrary, higher uric acid concentrations were independently associated with reduced risk for kidney failure in the entire participants (HR 0.539, 95% CI 0.318-0.915, P = 0.022) and also in females (HR 0.429, 95% CI 0.217-0.848, P = 0.015). The reduction in ESRD risk was of marginal significance in males (HR 0.512, 95% 0.245-1.073, P = 0.076). Conclusions: Instrumental variable analysis supports that uric acid concentration is an independent risk factor for all-cause mortality, while hyperuricemia might have protective effect for ESRD in females.
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