Uric Acid in the Follow-Up Determines 30% Decline in Estimated GFR Over 2 Years: a Propensity Score Analysis
Background/Aims: Higher level of serum uric acid (SUA) predicts early entry to dialysis in chronic kidney disease (CKD) patients. However, a short-term effect of SUA remains to be elucidated using a novel surrogate endpoint. Methods: Japanese CKD stage 3 to 4 patients were retrospectively examined (...
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| Veröffentlicht in: | Kidney & blood pressure research 2017-01, Vol.42 (6), p.1053-1067 |
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| creator | Chang, Wen Xiu Xu, Ning Kumagai, Takanori Iijima, Ryutaro Waki, Kaito Yamanaka, Masaki Nagura, Michito Arai, Shigeyuki Tamura, Yoshifuru Shibata, Shigeru Fujigaki, Yoshihide Uchida, Shunya |
| description | Background/Aims: Higher level of serum uric acid (SUA) predicts early entry to dialysis in chronic kidney disease (CKD) patients. However, a short-term effect of SUA remains to be elucidated using a novel surrogate endpoint. Methods: Japanese CKD stage 3 to 4 patients were retrospectively examined (n= 701). The follow-up level of SUA was estimated as time-averaged uric acid (TA-UA). A propensity score for 6.0, 6.5 or 7.0 mg/dL of TA-UA was respectively calculated using baseline 23 covariates. The time-to-event analysis was performed for 30% decline in estimated GFR over 2 years. Results: Incidence rates over 2 years were 90 of 440 in men and 36 of 261 in women (p = 0.03). Despite the negative result of baseline SUA, stratified Cox regression on the quintiles of the estimated propensity score showed that higher TA-UA of the three thresholds were all significant (crude HR 2.10 to 2.44) even after adjusting for the confounders. Kaplan-Meier analysis after propensity score matching likewise showed worse survival in the patients with the higher TA-UA (HR 3.11 to 4.26). Conclusion: Higher SUA increases likelihood of reaching a surrogate endpoint over 2 years. Early intervention for SUA less than 6.0 mg/dL is recommended for slowing CKD progression. |
| doi_str_mv | 10.1159/000485593 |
| format | Article |
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However, a short-term effect of SUA remains to be elucidated using a novel surrogate endpoint. Methods: Japanese CKD stage 3 to 4 patients were retrospectively examined (n= 701). The follow-up level of SUA was estimated as time-averaged uric acid (TA-UA). A propensity score for 6.0, 6.5 or 7.0 mg/dL of TA-UA was respectively calculated using baseline 23 covariates. The time-to-event analysis was performed for 30% decline in estimated GFR over 2 years. Results: Incidence rates over 2 years were 90 of 440 in men and 36 of 261 in women (p = 0.03). Despite the negative result of baseline SUA, stratified Cox regression on the quintiles of the estimated propensity score showed that higher TA-UA of the three thresholds were all significant (crude HR 2.10 to 2.44) even after adjusting for the confounders. Kaplan-Meier analysis after propensity score matching likewise showed worse survival in the patients with the higher TA-UA (HR 3.11 to 4.26). Conclusion: Higher SUA increases likelihood of reaching a surrogate endpoint over 2 years. Early intervention for SUA less than 6.0 mg/dL is recommended for slowing CKD progression.</description><identifier>ISSN: 1420-4096</identifier><identifier>EISSN: 1423-0143</identifier><identifier>DOI: 10.1159/000485593</identifier><identifier>PMID: 29346798</identifier><language>eng</language><publisher>Basel, Switzerland: S. Karger AG</publisher><subject>Adult ; Aged ; Chronic kidney failure ; Development and progression ; Diagnosis ; Disease Progression ; Female ; Follow-Up Studies ; Glomerular Filtration Rate ; Health aspects ; Humans ; Male ; Measurement ; Middle Aged ; Original Paper ; Propensity Score ; Renal Insufficiency, Chronic - diagnosis ; Renal Insufficiency, Chronic - mortality ; Retrospective Studies ; Uric acid ; Uric Acid - blood</subject><ispartof>Kidney & blood pressure research, 2017-01, Vol.42 (6), p.1053-1067</ispartof><rights>2017 The Author(s). Published by S. Karger AG, Basel</rights><rights>2017 The Author(s). Published by S. Karger AG, Basel.</rights><rights>COPYRIGHT 2018 S. Karger AG</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c474t-7b1cbd27ef7cf01b8cc4120d6741fa39cc449ca2fa51961a6868b0522028ff5d3</citedby><cites>FETCH-LOGICAL-c474t-7b1cbd27ef7cf01b8cc4120d6741fa39cc449ca2fa51961a6868b0522028ff5d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,864,27635,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29346798$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Chang, Wen Xiu</creatorcontrib><creatorcontrib>Xu, Ning</creatorcontrib><creatorcontrib>Kumagai, Takanori</creatorcontrib><creatorcontrib>Iijima, Ryutaro</creatorcontrib><creatorcontrib>Waki, Kaito</creatorcontrib><creatorcontrib>Yamanaka, Masaki</creatorcontrib><creatorcontrib>Nagura, Michito</creatorcontrib><creatorcontrib>Arai, Shigeyuki</creatorcontrib><creatorcontrib>Tamura, Yoshifuru</creatorcontrib><creatorcontrib>Shibata, Shigeru</creatorcontrib><creatorcontrib>Fujigaki, Yoshihide </creatorcontrib><creatorcontrib>Uchida, Shunya</creatorcontrib><title>Uric Acid in the Follow-Up Determines 30% Decline in Estimated GFR Over 2 Years: a Propensity Score Analysis</title><title>Kidney & blood pressure research</title><addtitle>Kidney Blood Press Res</addtitle><description>Background/Aims: Higher level of serum uric acid (SUA) predicts early entry to dialysis in chronic kidney disease (CKD) patients. However, a short-term effect of SUA remains to be elucidated using a novel surrogate endpoint. Methods: Japanese CKD stage 3 to 4 patients were retrospectively examined (n= 701). The follow-up level of SUA was estimated as time-averaged uric acid (TA-UA). A propensity score for 6.0, 6.5 or 7.0 mg/dL of TA-UA was respectively calculated using baseline 23 covariates. The time-to-event analysis was performed for 30% decline in estimated GFR over 2 years. Results: Incidence rates over 2 years were 90 of 440 in men and 36 of 261 in women (p = 0.03). Despite the negative result of baseline SUA, stratified Cox regression on the quintiles of the estimated propensity score showed that higher TA-UA of the three thresholds were all significant (crude HR 2.10 to 2.44) even after adjusting for the confounders. Kaplan-Meier analysis after propensity score matching likewise showed worse survival in the patients with the higher TA-UA (HR 3.11 to 4.26). Conclusion: Higher SUA increases likelihood of reaching a surrogate endpoint over 2 years. Early intervention for SUA less than 6.0 mg/dL is recommended for slowing CKD progression.</description><subject>Adult</subject><subject>Aged</subject><subject>Chronic kidney failure</subject><subject>Development and progression</subject><subject>Diagnosis</subject><subject>Disease Progression</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Glomerular Filtration Rate</subject><subject>Health aspects</subject><subject>Humans</subject><subject>Male</subject><subject>Measurement</subject><subject>Middle Aged</subject><subject>Original Paper</subject><subject>Propensity Score</subject><subject>Renal Insufficiency, Chronic - diagnosis</subject><subject>Renal Insufficiency, Chronic - mortality</subject><subject>Retrospective Studies</subject><subject>Uric acid</subject><subject>Uric Acid - blood</subject><issn>1420-4096</issn><issn>1423-0143</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>M--</sourceid><sourceid>EIF</sourceid><recordid>eNo9kc1PGzEQxa0KVCjl0DuqfEFqD0vHXu-He4uAAFKkICCHnlZe7xhcvOvU3oDy32OaEPlgP-v3RqP3CPnG4IyxQv4CAFEXhcw_kUMmeJ4BE_ne_zdkAmR5QL7E-DdhBQD_TA64zEVZyfqQuEWwmk607agd6PiEdOqd86_ZYkkvcMTQ2wEjzeE0Se2SeOcu42h7NWJHr6Z3dP6CgXL6B1WIv6mit8EvcYh2XNN77QPSyaDcOtr4lewb5SIeb-8jsphePpxfZ7P51c35ZJZpUYkxq1qm245XaCptgLW11oJx6MpKMKNymaSQWnGjCiZLpsq6rFsoOAdeG1N0-RH5sZm7DP7fCuPY9DZqdE4N6FexYbKWJVQpmYSebdBH5bCxg_FjUDqdDnur_YDGpv9JmVdcFAwgGX5uDDr4GAOaZhlSFmHdMGje22h2bST2-3aPVdtjtyM_4k_AyQZ4VuERww7Y-t8A9GiKyQ</recordid><startdate>20170101</startdate><enddate>20170101</enddate><creator>Chang, Wen Xiu</creator><creator>Xu, Ning</creator><creator>Kumagai, Takanori</creator><creator>Iijima, Ryutaro</creator><creator>Waki, Kaito</creator><creator>Yamanaka, Masaki</creator><creator>Nagura, Michito</creator><creator>Arai, Shigeyuki</creator><creator>Tamura, Yoshifuru</creator><creator>Shibata, Shigeru</creator><creator>Fujigaki, Yoshihide </creator><creator>Uchida, Shunya</creator><general>S. Karger AG</general><scope>M--</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IAO</scope><scope>7X8</scope></search><sort><creationdate>20170101</creationdate><title>Uric Acid in the Follow-Up Determines 30% Decline in Estimated GFR Over 2 Years: a Propensity Score Analysis</title><author>Chang, Wen Xiu ; Xu, Ning ; Kumagai, Takanori ; Iijima, Ryutaro ; Waki, Kaito ; Yamanaka, Masaki ; Nagura, Michito ; Arai, Shigeyuki ; Tamura, Yoshifuru ; Shibata, Shigeru ; Fujigaki, Yoshihide ; Uchida, Shunya</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c474t-7b1cbd27ef7cf01b8cc4120d6741fa39cc449ca2fa51961a6868b0522028ff5d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Chronic kidney failure</topic><topic>Development and progression</topic><topic>Diagnosis</topic><topic>Disease Progression</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Glomerular Filtration Rate</topic><topic>Health aspects</topic><topic>Humans</topic><topic>Male</topic><topic>Measurement</topic><topic>Middle Aged</topic><topic>Original Paper</topic><topic>Propensity Score</topic><topic>Renal Insufficiency, Chronic - diagnosis</topic><topic>Renal Insufficiency, Chronic - mortality</topic><topic>Retrospective Studies</topic><topic>Uric acid</topic><topic>Uric Acid - blood</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Chang, Wen Xiu</creatorcontrib><creatorcontrib>Xu, Ning</creatorcontrib><creatorcontrib>Kumagai, Takanori</creatorcontrib><creatorcontrib>Iijima, Ryutaro</creatorcontrib><creatorcontrib>Waki, Kaito</creatorcontrib><creatorcontrib>Yamanaka, Masaki</creatorcontrib><creatorcontrib>Nagura, Michito</creatorcontrib><creatorcontrib>Arai, Shigeyuki</creatorcontrib><creatorcontrib>Tamura, Yoshifuru</creatorcontrib><creatorcontrib>Shibata, Shigeru</creatorcontrib><creatorcontrib>Fujigaki, Yoshihide </creatorcontrib><creatorcontrib>Uchida, Shunya</creatorcontrib><collection>Karger Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Gale Academic OneFile</collection><collection>MEDLINE - Academic</collection><jtitle>Kidney & blood pressure research</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Chang, Wen Xiu</au><au>Xu, Ning</au><au>Kumagai, Takanori</au><au>Iijima, Ryutaro</au><au>Waki, Kaito</au><au>Yamanaka, Masaki</au><au>Nagura, Michito</au><au>Arai, Shigeyuki</au><au>Tamura, Yoshifuru</au><au>Shibata, Shigeru</au><au>Fujigaki, Yoshihide </au><au>Uchida, Shunya</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Uric Acid in the Follow-Up Determines 30% Decline in Estimated GFR Over 2 Years: a Propensity Score Analysis</atitle><jtitle>Kidney & blood pressure research</jtitle><addtitle>Kidney Blood Press Res</addtitle><date>2017-01-01</date><risdate>2017</risdate><volume>42</volume><issue>6</issue><spage>1053</spage><epage>1067</epage><pages>1053-1067</pages><issn>1420-4096</issn><eissn>1423-0143</eissn><abstract>Background/Aims: Higher level of serum uric acid (SUA) predicts early entry to dialysis in chronic kidney disease (CKD) patients. However, a short-term effect of SUA remains to be elucidated using a novel surrogate endpoint. Methods: Japanese CKD stage 3 to 4 patients were retrospectively examined (n= 701). The follow-up level of SUA was estimated as time-averaged uric acid (TA-UA). A propensity score for 6.0, 6.5 or 7.0 mg/dL of TA-UA was respectively calculated using baseline 23 covariates. The time-to-event analysis was performed for 30% decline in estimated GFR over 2 years. Results: Incidence rates over 2 years were 90 of 440 in men and 36 of 261 in women (p = 0.03). Despite the negative result of baseline SUA, stratified Cox regression on the quintiles of the estimated propensity score showed that higher TA-UA of the three thresholds were all significant (crude HR 2.10 to 2.44) even after adjusting for the confounders. Kaplan-Meier analysis after propensity score matching likewise showed worse survival in the patients with the higher TA-UA (HR 3.11 to 4.26). Conclusion: Higher SUA increases likelihood of reaching a surrogate endpoint over 2 years. Early intervention for SUA less than 6.0 mg/dL is recommended for slowing CKD progression.</abstract><cop>Basel, Switzerland</cop><pub>S. Karger AG</pub><pmid>29346798</pmid><doi>10.1159/000485593</doi><tpages>15</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Kidney & blood pressure research, 2017-01, Vol.42 (6), p.1053-1067 |
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| source | MEDLINE; DOAJ Directory of Open Access Journals; Karger Open Access; EZB-FREE-00999 freely available EZB journals |
| subjects | Adult Aged Chronic kidney failure Development and progression Diagnosis Disease Progression Female Follow-Up Studies Glomerular Filtration Rate Health aspects Humans Male Measurement Middle Aged Original Paper Propensity Score Renal Insufficiency, Chronic - diagnosis Renal Insufficiency, Chronic - mortality Retrospective Studies Uric acid Uric Acid - blood |
| title | Uric Acid in the Follow-Up Determines 30% Decline in Estimated GFR Over 2 Years: a Propensity Score Analysis |
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