BMC nephrology · 2025
Association of metabolic syndrome and hyperuricemia with mortality in patients with chronic kidney disease: a UK biobank study.
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Wu Chengkai, Pan Chuqing, Liu Li, Li Wenyuan
Аннотация
BACKGROUND: Chronic kidney disease (CKD) has detrimental effects on health through multiple pathophysiological mechanisms, significantly reducing life expectancy and contributing to a substantial disease burden. Therefore, this study aims to explore the association of metabolic syndrome (MetS) and hyperuricemia (HUA) with all-cause and cardiovascular mortality in patients with chronic kidney disease (CKD).
METHODS: Overall, 28,278 patients with CKD, defined by estimated glomerular filtration rate < 60 mL/min/1.73 m2 or urine albumin creatinine ratio > 3 mg/mmol, MetS (≥ 3 of 5 criteria), and HUA (> 7.0 mg/dL in males, > 6.0 mg/dL in females) were assessed. The outcomes included all-cause and cardiovascular mortality. Associations were assessed using multivariate-adjusted Cox proportional hazards models and Kaplan-Meier survival analysis, supplemented by subgroup analyses and sensitivity tests.
RESULTS: During a median follow-up of 13.21 years, 3564 all-cause deaths (17.28%) were recorded, including 1025 (4.97%) attributable to cardiovascular causes. After multiple adjustments, both HUA and MetS were strongly associated with all-cause and cardiovascular mortality. Patients with CKD and coexisting HUA or MetS exhibited a significantly higher risk of all-cause mortality (adjusted hazard ratio [aHR] = 1.45, 95% confidence interval [CI]: 1.30-1.62) and cardiovascular mortality (aHR = 2.09, 95% CI: 1.70-2.58) than those without HUA or MetS. Kaplan-Meier curves demonstrated that elevated uric acid levels and a high number of MetS components significantly reduced survival probability (P < 0.001), with an increasing trend as the uric acid levels and the number of MetS components increased. Subgroup and sensitivity analyses confirmed the robustness and consistency of our findings.
CONCLUSION: MetS and HUA significantly increased all-cause and cardiovascular mortality in patients with CKD, particularly in those with high uric acid levels and a high number of MetS components.
CLINICAL TRIAL NUMBER: Not applicable.
METHODS: Overall, 28,278 patients with CKD, defined by estimated glomerular filtration rate < 60 mL/min/1.73 m2 or urine albumin creatinine ratio > 3 mg/mmol, MetS (≥ 3 of 5 criteria), and HUA (> 7.0 mg/dL in males, > 6.0 mg/dL in females) were assessed. The outcomes included all-cause and cardiovascular mortality. Associations were assessed using multivariate-adjusted Cox proportional hazards models and Kaplan-Meier survival analysis, supplemented by subgroup analyses and sensitivity tests.
RESULTS: During a median follow-up of 13.21 years, 3564 all-cause deaths (17.28%) were recorded, including 1025 (4.97%) attributable to cardiovascular causes. After multiple adjustments, both HUA and MetS were strongly associated with all-cause and cardiovascular mortality. Patients with CKD and coexisting HUA or MetS exhibited a significantly higher risk of all-cause mortality (adjusted hazard ratio [aHR] = 1.45, 95% confidence interval [CI]: 1.30-1.62) and cardiovascular mortality (aHR = 2.09, 95% CI: 1.70-2.58) than those without HUA or MetS. Kaplan-Meier curves demonstrated that elevated uric acid levels and a high number of MetS components significantly reduced survival probability (P < 0.001), with an increasing trend as the uric acid levels and the number of MetS components increased. Subgroup and sensitivity analyses confirmed the robustness and consistency of our findings.
CONCLUSION: MetS and HUA significantly increased all-cause and cardiovascular mortality in patients with CKD, particularly in those with high uric acid levels and a high number of MetS components.
CLINICAL TRIAL NUMBER: Not applicable.