scholarly journals Gouty arthritis and kidney function outcomes and serum uric acid level variations in obese patients following bariatric surgery

2022 ◽  
Vol 34 (1) ◽  
Author(s):  
Mona G. Balata ◽  
Ahmed H. Helal ◽  
Ashraf H. Mohamed ◽  
Alaa-Uddin Habib ◽  
Mahmoud Awad ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Uric Acid ◽  
Risk Factor ◽  
Serum Uric Acid ◽  
Kidney Function ◽  
Gouty Arthritis ◽  
Obese Patients ◽  
Predictive Variables ◽  
Radiological Studies

Abstract Background Obesity is an independent risk factor for chronic kidney disease (CKD) and is the strongest known modifiable risk factor for hyperuricemia and gout. We aimed to discover the outcome of serum uric acid (SUA), gouty arthritis, and kidney function in obese patients after bariatric surgery and possible links with BMI variations. Methods Retrospective study has been performed in National Hospital in Riyadh, KSA, between Jan. 2018 to Jan. 2020. We studied only 98 patients who met our inclusion criteria. Patients followed-up at 1 month (for gouty attack only) postoperative, 3 months postoperative, and 6 months postoperative for body mass index (BMI), serum creatinine, dipstick urinalysis, SUA, and estimated glomerular filtration rate (eGFR). Radiological studies, medical history, follow up radiological studies, and clinical follow up were obtained from the hospital data system. Results A total of 98 patients with mean eGFR were 90.65 ± 29.34 ml/min/1.73 m2, mean SUA 5.56 ± 1.84 mg/dl, and mean BMI was 45.28 ± 7.25 kg/m2, at surgery. Mean BMI had decreased significantly to 38.52 ± 6.05 kg/m2 at 3 months and to 34.61 ± 5.35 kg/m2 at 6 months (P < 0.001). The mean GFR had improved significantly (99.14 ± 23.32 ml/min/1.73 m2) at 6 months (P < 0.001). Interestingly, proteinuria had resolved in 17 patients out of 23 patients at 6 months. Number of gouty attacks was decreased during the first month post-surgery (P < 0.001). SUA level was significantly decreased (4.32 ± 1.27 mg/dl) (P < 0.001). SUA showed significant negative correlations with eGFR at 3 months and positively significant correlations with BMI at 3 and 6 months. By multinomial logistic regression, BMI and initial eGFR were the independent predictive variables for the outcome of eGFR at 6 months, while male gender and initial SUA were the independent predictive variables on the outcome of SUA at 6 months. Postoperatively in gouty arthritis patients, the number of joints affected, patient global VAS assessment, and number of gouty attacks were significantly reduced (P < 0.001). Conclusion Bariatric surgery has been associated with reduction of BMI and subsequently reduction of SUA levels, gouty attacks, and improvement of eGFR.

Sex-specific Relationship of Serum Uric Acid with All-cause Mortality in Adults with Normal Kidney Function: An Observational Study

2017 ◽  
Vol 44 (3) ◽  
pp. 380-387 ◽  
Author(s):  
Eunjeong Kang ◽  
Seung-sik Hwang ◽  
Dong Ki Kim ◽  
Kook-Hwan Oh ◽  
Kwon Wook Joo ◽  
...  
Keyword(s):  
Uric Acid ◽  
Risk Factor ◽  
Mortality Rate ◽  
Serum Uric Acid ◽  
Kidney Function ◽  
Reference Group ◽  
Normal Kidney ◽  
Normal Kidney Function ◽  
All Cause Mortality ◽  
Relationship Of

Objective.To explain the clinical effect of serum uric acid (SUA) levels as a risk factor for mortality, considering exclusion of kidney function.Methods.Participants aged over 40 years who underwent health checkups were recruited. Individuals with estimated glomerular filtrations rates < 60 ml/min/1.73 m2 and who received laboratory study and colonoscopy on the same day were excluded.Results.SUA levels were higher in men than in women (5.7 ± 1.2 mg/dl for men and 4.2 ± 0.9 mg/dl for women, p < 0.001). During 12.3 ± 3.6 years of followup, 1402 deaths occurred among 27,490 participants. About 6.9% of men and 3.1% of women died. The overall mortality rate had a U-shaped association with SUA levels, a U-shaped association in men, and no association in women. There was a significant interaction of sex for the SUA-mortality association (p for interaction = 0.049); therefore, survival analysis was conducted by sex. In men, the lower SUA group had a higher mortality rate after adjustment (SUA ≤ 4.0 mg/dl, adjusted HR 1.413, 95% CI 1.158–1.724, p = 0.001) compared with the reference group (SUA 4.1–6.0 mg/dl). A higher SUA contributed to an insignificant increased mortality in men (> 8.0 mg/dl, adjusted HR 1.140, 95% CI 0.794–1.636, p = 0.479). Women failed to show any significant association between SUA and mortality.Conclusion.This study provided novel evidence that SUA-mortality association differed by sex. We demonstrated that a lower SUA was an independent risk factor for all-cause mortality in men with normal kidney function.

scholarly journals P0361THE PREDICTIVE VALUE OF SERUM URIC ACID IN PRIMARY GLOMERULONEPHRITIS PATIENTS: A 5-YEARS RENAL PROGNOSIS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Mykola Kolesnyk ◽  
Natalia Stepanova ◽  
Lyudmyla Snisar ◽  
Larysa Lebid
Keyword(s):  
Uric Acid ◽  
Risk Factor ◽  
Serum Uric Acid ◽  
Independent Risk Factor ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Ckd Progression ◽  
Primary Glomerulonephritis ◽  
Renal Prognosis

Abstract Background and Aims Primary glomerulonephritis (PGN) is one of the leading causes of end-stage renal disease worldwide. Preservation of renal function is a crucial global goal in the management of patients with chronic kidney disease (CKD) in general and PGN in particular. In addition to classical risk factors, hyperuricemia is regarded to be an independent risk factor for CKD development and progression. However, only a few studies have investigated the impact of hyperuricemia on PGN progression. Therefore, this study aimed to analyze the association between serum uric acid (SUA) concentration and renal prognosis in PGN patients during a 5-year follow-up. Method A total of 344 patients with CKD 1-3 stages were included in this retrospective observational single-center study. Among them, there were 194 (56.4 %) patients with biopsy-proven PGN and 150 (43.6 %) patients with a clinical diagnosis of PGN. All patients were treated according to the KDIGO Practice Clinical Guidelines for Glomerulonephritis. eGFR (milliliters per minute per 1.73 m2) was calculated using the CKD-EPI formula and its baseline value was based on the first available eGFR in PGN diagnosed patients. The patients with eGFR&lt; 30 mL//min/1.73 m2 were excluded from the study at the time of PGN diagnosis. None of the patients was on urate- or lipid-lowering therapy at the time of baseline data. Hyperuricemia was defined as SUA concentration ≥420 μmol/L (7 mg/dL) for males and ≥360 μmol/L (6 mg/dL) for females. The rate of eGFR fall per year was used to assess CKD progression. It was calculated as the difference between eGFR (mL/min/1.73m2) at baseline and the last values: (Last eGFR – Baseline eGFR) / Follow-up period per year). For the analysis, the patients were gender-stratified into 3 SUA quartiles according to average SUA levels at baseline: Q1- &lt; 265 μmol/L for men and &lt;220 μmol/L for women, Q2- 265-446 μmol/L for men and 220-369 μmol/L for women, Q3- ≥ 447 μmol/L for men and ≥ 370 for women. The analysis and all graphs were performed using MedCalc (Belgium). Results Hyperuricemia was found in 72/206 (35 %) men and 38/138 (27.5 %) women (p = 0.0003). During the average 5-years follow-up period (5.3 [3.8-6.2]), there were 114 (33.1%) patients who eventually progressed to eGFR&lt;15 mL/min/1.73 m2 or started RRT. Among them there were: Q1- 10 (12%) patients, Q2 - 52 (31.5%) patients, Q3 - 52 (54.7%) patients (p&lt; 0.0001). The highest renal progression level was observed in Q3 patients: -5.5 [-15.4; -1.8] mL/min/1.73 m2 versus -3.5 [-6.4; -1.7] and -4.6 [-10.6; -2.7] mL/min/1.73 m2 in Q2 and Q1 patients, respectively. In multivariate logistic regression analysis, SUA level in men (≥ 447 μmol/L) and women (≥ 370) was determined as an independent risk factor for rapid CKD progression (OR: 2.5, 95% CI: 1.47-4.23, P = 0.0007). Conclusion. Our study showed that a higher SUA level was associated with a significant rapid eGFR decline during a 5-year follow-up. The study findings suggest that hyperuricemia is a potentially modifiable factor for CKD progression.

scholarly journals Distinct Prognostic Role of Serum Uric Acid Levels for Predicting All-Cause Mortality Among Chinese Adults Aged 45~75 Years With and Without Diabetes

2021 ◽  
Vol 12 ◽  
Author(s):  
Bowen Zhu ◽  
Jian Zhang ◽  
Nana Song ◽  
Yiqin Shi ◽  
Yi Fang ◽  
...  
Keyword(s):  
Uric Acid ◽  
Risk Factor ◽  
Serum Uric Acid ◽  
Independent Risk Factor ◽  
Prognostic Role ◽  
Chinese Adults ◽  
Baseline Serum ◽  
All Cause Mortality

IntroductionThe current study sought to explore the effect of baseline serum uric acid (SUA) on the risk of all-cause mortality among Chinese adults aged 45~75 years and to determine its interaction relationship with diabetes.MethodsThe study was designed as a community-based cohort of 4467 adults aged between 45~75 years included in a 6-years follow-up period from 2009 to 2015 years by the China Health and Nutrition Survey (CHNS). Baseline SUA levels were grouped into quartiles and its association on all-cause mortality was explored using multivariate Cox proportional hazards models. Stratified analyses were performed to explore the associations of SUA quartiles with all-cause mortality among diabetic and non-diabetic individuals.ResultsA total of 141 deaths (5.3 per 1000 person-years) were recorded During a follow-up of 26431 person-years. Out of the 141 deaths, 28 deaths (10.1 per 1000 person-years) were reported in the diabetic groups and 113 deaths (4.8 per 1000 person-years) were recorded in the non-diabetic group. An increased risk of all-cause mortality was observed for participants in the first and fourth quartiles compared with the second SUA quartile, (Q1 SUA: aHR=2.1, 95% CI 1.1~4.1; Q4 SUA: aHR=2.1, 95% CI 1.1~4.0). Stratification of participants by diabetes status showed a U-shaped association for non-diabetic individuals. Whereas, declined eGFR, rather than SUA, was an independent risk factor for all-cause mortality in diabetic individuals (aHR=0.7, 95% CI 0.6~1.0).ConclusionOur study proved that the prognostic role of SUA for predicting all-cause death might be regulated by diabetes. Both low and high SUA levels were associated with increased mortality, supporting a U-shaped association only in non-diabetic individuals. Whereas, renal dysfunction rather than SUA was an independent risk factor for all-cause mortality. Further studies should be conducted to determine the SUA levels at which intervention should be conducted and explore target follow-up strategies to prevent progression leading to poor prognosis.

scholarly journals The effect of baseline serum uric acid on chronic kidney disease in normotensive, normoglycemic, and non-obese individuals: A health checkup cohort study

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0244106
Author(s):  
Young-Bin Son ◽  
Ji Hyun Yang ◽  
Myung-Gyu Kim ◽  
Sang Kyung Jo ◽  
Won Yong Cho ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Uric Acid ◽  
Risk Factor ◽  
Kidney Disease ◽  
Serum Uric Acid ◽  
Independent Risk Factor ◽  
Baseline Serum ◽  
Increased Risk ◽  
Egfr Decline

Introduction The independent role of serum uric acid (SUA) on kidney disease is controversial due to its association with metabolic syndrome. The objective of this study was to investigate the association of baseline SUA with development of chronic kidney disease and eGFR decline in normotensive, normoglycemic and non-obese individuals during follow up period. Materials and methods We included non-hypertensitive, non-diabetic, and non-obese 13,133 adults with estimated glomerular filtration rate (eGFR) ≥ 60ml/min/1.73m2 who had a voluntary health check-up during 2004–2017. Results SUA was positively related to adjusted means of systolic blood pressure (SBP), triglyceride, body mass index, and body fat percent. SUA was inversely associated with high density lipoprotein HDL (P for trend ≤0.001). SUA was an independent risk factor for the development of diabetes, hypertension, and obesity. During 45.0 [24.0–76.0] months of median follow up, the highest quartiles of SUA showed significant risks of 30% eGFR decline compared than the lowest quartile (RR:3.701; 95% CI: 1.504–9.108). The highest quartile had a 2.2 fold (95% CI: 1.182–4.177) increase in risk for incident chronic kidney disease (CKD). Conclusions SUA is an independent risk factor for the development of diabetes, hypertension, and obesity in the healthy population. High SUA is associated with increased risk of CKD development and eGFR decline in participants with intact renal function.

scholarly journals Elevated Serum Uric Acid is Associated with Rapid Decline in Kidney Function: A 10-Year Follow-Up Study

2020 ◽  
Vol Volume 13 ◽  
pp. 945-953
Author(s):  
Kittrawee Kritmetapak ◽  
Suranut Charoensri ◽  
Rattrai Thaopanya ◽  
Chatlert Pongchaiyakul
Keyword(s):  
Uric Acid ◽  
Serum Uric Acid ◽  
Kidney Function ◽  
Elevated Serum ◽  
Rapid Decline ◽  
Follow Up Study

scholarly journals Two-Year Changes in Hyperuricemia and Risk of Diabetes: A Five-Year Prospective Cohort Study

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Jia Liu ◽  
Lixin Tao ◽  
Zhan Zhao ◽  
Yongmin Mu ◽  
Dechun Zou ◽  
...  
Keyword(s):  
Uric Acid ◽  
Risk Factor ◽  
Cohort Study ◽  
Serum Uric Acid ◽  
Poisson Regression ◽  
Prospective Cohort ◽  
Regression Models ◽  
Health Management ◽  
Single Measurement

Background. Hyperuricemia is known to be a risk factor for diabetes. However, information is limited regarding the association between changes in hyperuricemia and the risk of diabetes. Methods. A total of 15,403 participants who were free of diabetes at the time of 2009 and 2011 surveys in the Beijing Health Management Cohort (BHMC) study were recruited and followed up until 2016. Participants were classified into four groups according to 2-year changes in hyperuricemia: no hyperuricemia, remittent hyperuricemia, incident hyperuricemia, and persistent hyperuricemia. Modified Poisson regression models were used to evaluate the effect of 2-year changes in hyperuricemia on the risk of diabetes. Results. During the 5-year follow-up, we identified 841 new cases of diabetes (216 women). Remittent hyperuricemia and incident hyperuricemia had a 35% and 48% higher risk for developing diabetes compared with no hyperuricemia. Especially, persistent hyperuricemia was associated with a 75% higher risk of diabetes (RR = 1.75, 95% CI = 1.47-2.08). Compared with minor serum uric acid (SUA) change, over 10% decline and over 30% increase in SUA levels were subsequently associated with lower (RR = 0.84, 95% CI = 0.72-0.99) and higher (RR = 1.71, 95% CI = 1.27-2.30) diabetes risk, respectively. Conclusions. Changes in hyperuricemia, especially persistent hyperuricemia, are more appropriate to reflect the risk of diabetes than a single measurement of hyperuricemia at baseline. Strategies aiming at preventing hyperuricemia are urgently needed to reduce the increasing burden of diabetes.

scholarly journals Serum Uric Acid and Kidney Disease Measures Independently Predict Cardiovascular and Total Mortality: The Uric Acid Right for Heart Health (URRAH) Project

2021 ◽  
Vol 8 ◽  
Author(s):  
Elisa Russo ◽  
Francesca Viazzi ◽  
Roberto Pontremoli ◽  
Carlo M. Barbagallo ◽  
Michele Bombelli ◽  
...  
Keyword(s):  
Uric Acid ◽  
Risk Factor ◽  
Kidney Disease ◽  
Serum Uric Acid ◽  
Total Mortality ◽  
Roc Curves ◽  
All Cause Mortality ◽  
Progression Of Kidney Disease ◽  
Definition Of

Background: Serum uric acid predicts the onset and progression of kidney disease, and the occurrence of cardiovascular and all-cause mortality. Nevertheless, it is unclear which is the appropriate definition of hyperuricemia in presence of chronic kidney disease (CKD). Our goal was to study the independent impact of uric acid and CKD on mortality.Methods: We retrospectively investigated 21,963 patients from the URRAH study database. Hyperuricemia was defined on the basis of outcome specific cut-offs separately identified by ROC curves according to eGFR strata. The primary endpoints were cardiovascular and all-cause mortality.Results: After a mean follow-up of 9.8 year, there were 1,582 (7.20%) cardiovascular events and 3,130 (14.25%) deaths for all causes. The incidence of cardiovascular and all-cause mortality increased in parallel with reduction of eGFR strata and with progressively higher uric acid quartiles. During 215,618 person-years of follow-up, the incidence rate for cardiovascular mortality, stratified based on eGFR (&gt;90, between 60 and 90 and &lt;60 ml/min) was significantly higher in patients with hyperuricemia and albuminuria (3.8, 22.1 and 19.1, respectively) as compared to those with only one risk factor or none (0.4, 2.8 and 3.1, respectively). Serum uric acid and eGFR significantly interact in determining cardiovascular and all-cause mortality. For each SUA increase of 1 mg/dl the risk for mortality increased by 10% even after adjustment for potential confounding factors included eGFR and the presence of albuminuria.Conclusions: hyperuricemia is a risk factor for cardiovascular and all-cause mortality additively to eGFR strata and albuminuria, in patients at cardiovascular risk.

Improvement in Obstructive Sleep Apnea (OSA) in Super Morbidly Obese Patients After Bariatric Surgery

2020 ◽  
Vol 103 (8) ◽  
pp. 725-728
Keyword(s):  
Bariatric Surgery ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Lifestyle Modification ◽  
Apnea Hypopnea Index ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Obstructive Sleep ◽  
Objective Evidence

Background: Lifestyle modification is the mainstay therapy for obese patients with obstructive sleep apnea (OSA). However, most of these patients are unable to lose the necessary weight, and bariatric surgery (BS) has been proven to be an effective modality in selected cases. Objective: To provide objective evidence that BS can improve OSA severity. Materials and Methods: A prospective study was conducted in super morbidly obese patients (body mass index [BMI] greater than 40 kg/m² or BMI greater than 35 kg/m² with uncontrolled comorbidities) scheduled for BS. Polysomnography (PSG) was performed for preoperative assessment and OSA was treated accordingly. After successful surgery, patients were invited to perform follow-up PSG at 3, 6, and 12 months. Results: Twenty-four patients with a mean age of 35.0±14.0 years were enrolled. After a mean follow-up period of 7.8±3.4 months, the mean BMI, Epworth sleepiness scale (ESS), and apnea-hypopnea index (AHI) significantly decreased from 51.6±8.7 to 38.2±6.8 kg/m² (p<0.001), from 8.7±5.9 to 4.7±3.5 (p=0.003), and from 87.6±38.9 to 28.5±21.5 events/hour (p<0.001), respectively. Conclusion: BS was shown to dramatically improve clinical and sleep parameters in super morbidly obese patients. Keywords: Morbid obesity, Bariatric surgery, Obstructive sleep apnea (OSA)

Management of Gouty Arthritis with special reference to Vatarakta - A Case Report

2017 ◽  
Vol 2 (4) ◽  
Author(s):  
V. Balendu Krishnan ◽  
Prashanth A. S.
Keyword(s):  
Uric Acid ◽  
Case Report ◽  
Serum Uric Acid ◽  
Serum Uric Acid Level ◽  
Gouty Arthritis ◽  
Treatment Protocol ◽  
Joint Inflammation ◽  
High Serum ◽  
Common Disease ◽  
Disease Condition

Gouty Arthritis has now become a common disease condition which we deal in Ayurveda, but a proper treatment protocol is not followed in many cases. The case reported here was as a result of improper diet and lack of exercise which resulted in an increase serum uric acid level and joint inflammation. The treatment was given at IPD level diagnosing it as Gambhira Vatarakta with valid Chikitsa Siddhanta. This case report provides us a guidelines that even a chronic gouty arthritis with a very high serum uric acid can be treated as per Vataraktha Chikitsa Siddhanta in Ayurveda.

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