Elevated uric acid level as a significant predictor of chronic kidney disease: a cohort study with repeated measurements

Background Cohort studies evaluating increased serum uric acid (SUA) level as a chronic kidney disease (CKD) risk factor have yielded variable results. We aimed to assess the association between the pattern of longitudinal changes in SUA and incident CKD [estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m(2)]. Methods A population-based cohort study was conducted on 3,605 participants who were followed prospectively for a mean of 5.18 years. The longitudinal changes in SUA were categorized into three subgroups: persistently low, fluctuated (reduced or elevated), and persistently high. The primary outcome of interest was the development of CKD at a follow-up examination. Cox proportional hazards analysis was used to test the hypothesis. Results After adjustment for potential confounders, participants with fluctuated SUA with progressively elevated level and persistently high SUA level had significantly higher risk of developing CKD compared to subjects with persistently low SUA level: adjusted hazard ratio (95 % confidence interval) was 2.05 (1.24-3.38) vs. 1.90 (1.34-2.71). This longitudinal relationship was independent of sex, age, body mass index, and hypertension status. Conclusions Longitudinally elevated SUA independently predicts the risk of new-onset CKD.