Association of metabolic syndrome and hyperuricemia with mortality in patients with chronic kidney disease: a UK biobank study.

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.