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Hyperuricemia in Kidney Disease: A Major Risk Factor for Cardiovascular Events, Vascular Calcification, and Renal Damage

  • 주제(키워드) Hyperuricemia , acute kidney injury , chronic kidney disease , allopurinol , cardiovascular mortality
  • 주제(기타) Urology & Nephrology
  • 설명문(일반) [Ejaz, A. Ahsan] Univ Florida, Div Nephrol Hypertens & Renal Transplantat, Gainesville, FL USA; [Nakagawa, Takahiko] Rakuwakai Otowa Hosp, Dept Nephrol, Kyoto, Japan; [Kanbay, Mehmet] Koc Univ, Dept Med, Div Nephrol, Sch Med, Istanbul, Turkey; [Kuwabara, Masanari] Toranomon Gen Hosp, Dept Cardiol, Intens Care Unit, Tokyo, Japan; [Kumar, Ada] Horizon Therapeut, Renal Sect, Lake Forest, IL USA; [Garcia Arroyo, Fernando E.; Sanchez-Lozada, Laura G.] Inst Nacl Cardiol Ignacio Chavez, Dept Cardiorenal Physiopathol, Mexico City, DF, Mexico; [Roncal-Jimenez, Carlos; Sasai, Fumihiko; Hernando, Ana Andres; Garcia, Gabriela; Lanaspa, Miguel A.; Johnson, Richard J.] Univ Colorado, Div Renal Dis & Hypertens, Anschutz Med Campus,12700 East 19th Ave, Aurora, CO 80045 USA; [Kang, Duk-Hee] Ewha Womans Univ, Div Renal Dis, Seoul, South Korea; [Jensen, Thomas] Univ Colorado, Div Endocrinol, Anschutz Med Campus, Aurora, CO USA; [Rodriguez-Iturbe, Bernardo] Inst Nacl Ciencias Med & Nutr Salvador Zubiran, Mexico City, DF, Mexico; [Tolan, Dean R.] Boston Univ, Dept Biol, 5 Cummington St, Boston, MA 02215 USA
  • 등재 SCIE, SCOPUS
  • 발행기관 W B SAUNDERS CO-ELSEVIER INC
  • 발행년도 2020
  • 총서유형 Journal
  • URI http://www.dcollection.net/handler/ewha/000000181505
  • 본문언어 영어
  • Published As http://dx.doi.org/10.1016/j.semnephrol.2020.12.004

초록/요약

Kidney disease, especially when it is associated with a reduction in estimated glomerular filtration rate, can be associated with an increase in serum urate (uric acid), suggesting that hyperuricemia in subjects with kidney disease may be a strictly secondary phenomenon. Mendelian randomization studies that evaluate genetic scores regulating serum urate also generally have not found evidence that serum urate is a causal risk factor in chronic kidney disease. Nevertheless, this is countered by a large number of epidemiologic, experimental, and clinical studies that have suggested a potentially important role for uric acid in kidney disease and cardiovascular disease. Here, we review the topic in detail. Overall, the studies strongly suggest that hyperuricemia does have an important pathogenic role that likely is driven by intracellular urate levels. An exception may be the role of extracellular uric acid in atherosclerosis and vascular calcification. One of the more striking findings on reviewing the literature is that the primary benefit of lowering serum urate in subjects with CKD is not by slowing the progression of renal disease, but rather by reducing the incidence of cardiovascular events and mortality. We recommend large-scale clinical trials to determine if there is a benefit in lowering serum urate in hyperuricemic subjects in acute and chronic kidney disease and in the reduction of cardiovascular morbidity and mortality in subjects with end-stage chronic kidney disease. (C) 2020 Elsevier Inc. All reserved.

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