The impact of combined trajectories of serum uric acid, renal function, and blood pressure on long-term survival in patients with chronic kidney disease.

BACKGROUND AND AIM: The long-term impact of combined trajectories of blood pressure (BP), serum uric acid (UA), and renal function on mortality is unclear.

METHODS AND

RESULTS

We analyzed 1084 Taiwanese adults from the MJ Health Database with ≥8 health checkups over eight years. Group-based trajectory modeling identified four distinct patterns of systolic/diastolic BP, UA, and eGFR. Associations with all-cause, cardiovascular (CV), and cancer mortality were assessed using Cox models. Trajectory analysis revealed that Groups 1 and 2 maintained SBP within target levels, whereas Groups 3 and 4 consistently exhibited uncontrolled SBP. DBP remained within target across all groups with less pronounced differences. Serum UA levels were lowest in Group 1, intermediate in Group 3, and persistently elevated in Groups 2 and 4. Regarding renal function, Group 1 had the most preserved eGFR, Groups 2 and 3 remained stable, while Group 4 experienced a marked progressive decline. Trajectory Group 4 had the highest risk of all-cause mortality (adjusted HR 1.835, 95 % CI 1.208-2.800), compared to Group 1. Cancer-related mortality was not significantly associated with trajectory group after adjustment. Age was an independent predictor of all mortality outcomes; male gender was protective for all-cause and cancer-related mortality. Group 2, characterized by high UA but well-controlled SBP and eGFR, was not associated with worse mortality outcomes.

CONCLUSIONS

Based on our analysis of long-term trajectories for the four parameters, poor long-term control of SBP and eGFR contributed most significantly to all-cause and CV mortality. Hyperuricemia alone was not associated with worse mortality outcomes.