research article

Hyperuricemia is the Independent Risk Factor of All-Cause Mortality in Aged Patients with Chronic Kidney Disease

Yun-qiang Zhang1, Min-jia Li1, Hong-yong Liu1, Shu-xia Fu1, Rong Li1 and Xun-Liu2*

1Department of nephrology, The Third Affiliated Hospital, Sun Yat-Sen University, Yuedong Hospital, Meizhou city, Guangdong province, China

2Department of Nephrology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China

*Corresponding author: Xun Liu, Department of Nephrology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China

Received Date: 01 September, 2020; Accepted Date: 21 September, 2020; Published Date: 25 September, 2020

Citation: Zhang Y, Li M, Liu H, Fu S, Li R (2020) Hyperuricemia is the Independent Risk Factor of All-Cause Mortality in Aged Patients with Chronic Kidney Disease. J Urol Ren Dis 05: 1198. DOI: 10.29011/2575-7903.001198

Abstract

Objectives: To investigate the relationship between hyperuricemia and all-cause mortality in aged chronic kidney disease (CKD) patients.

Methods: A retrospective case-controlled study was carried out on 536 Chinese patients (age; 64-74 years) with CKD. The link between hyperuricemia and all-cause mortality in these patients was analyzed using Cox proportional hazards model. In this study, baseline data included: demographic data (age and gender), eGFR (CKD-Epi equation), urate-lowering drug application, nutritional index (BMI, albumin, total cholesterol, triglyceride, fasting blood glucose, low density lipoprotein, high density lipoprotein, pre-albumin), kidney function indices (potassium, carbon dioxide combining power, calcium, phosphorus, urea nitrogen) and proteinuria.

Results: Out of the 536 patients (age range; 64–74 years; median age; 69 years), 274 (51.1%) had hyperuricemia and 82 deaths (15.3%) were recorded. After the data was corrected for confounding factors, the results showed hyperuricemia (HUA ≥360 μmol/L in females and ≥420μmol/L in males) as the independent risk factor of all-cause mortality in aged patients with CKD (β=1.81, P=.0032).This was corroborated by a positive correlation between the levels of uric acid in the serum and all-cause mortality (β=1.002, P=.0036), whereby, the lowest group (serum uric acid:90.8-310.14μmol/L) was protected from all-cause mortality (β=0.445, P=0.004) unlike the next highest group (serum uric acid:310.15-401.54μmol/L).

Conclusion: Herein, we found that hyperuricemia could be a distinctive risk factor of all-cause mortality in aged CKD patients. Also, uric acid levels in the serum were positively related to all-cause mortality. The 4th serum uric acid quartile was protective for all-cause mortality, compared with the 2nd serum uric acid quartile.

Keywords

Aged; All-cause mortality; Chronic kidney disease; Hyperuricemia

List of Abbreviations

ANOVA: Analysis Of Variance; BMI: Body Mass Index; CKD: Chronic Kidney Disease; eGFR: Estimated Glomerular Filtration Rate; ESRD: End-Stage Renal Disease; GFR: Glomerular Filtration Rate; HUA: Hyperuricemia; WHO: World Health Organization

Introduction

The current global prevalence of Chronic Kidney Disease (CKD) is 13.4% [1]. However, the awareness rate is 9.5% and its mortality is 1.5% [2]. The condition is one of the top 20 causes of death globally. Deaths due to CKD increased by 34% worldwide between 1990 and 2013 [3], making CKD a “silent killer” [4]. Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation using creatinine measurement is used globally to estimate glomerular filtration rate (eGFR) [5]. An aging population is a global issue [6] with the number of individuals older than 60 years increasing at an annual rate of 2.6% [7]. Although there is no exact definition of “elderly” most developed countries define it as an age ≥ 65years [8] , while the standard is ≥ 60 years in most developing countries [9]. The structure and functionality of kidneys gradually decline at a rate of 6.3mL/min per 1.73m2 every 10 years, with increase in age [10]. Renal efficiency has been shown to diminish with age [11] with an incidence rate of between 23.4% and 58.5% in the elderly [12-15]. As people age, renal uric acid excretion is reduced, hence becoming more susceptible to Hyperuricemia (HUA) [16]. The prevalence of HUA in American adults was 21.4% [17]. CKD has a higher prevalence in those suffering from hyperuricemia relative to the rest of the population [18]. Evidence indicates that the possibility of kidney function deterioration increases by 14% for each 1 mg/dl rise in uric acid level in the serum [19]. One study showed that for every 60umol/L rice in the levels of uric acid in the serum, there is a 17% increase in all-cause mortality [20] but other studies have concluded otherwise [21]. So far, only a few papers have examined the link between uric acid levels in the serum and death in aged CKD patients. Considering that CKD occurs more frequently, understanding the potential connection between these two will improve the clinical management of CKD patients. Herein, we enrolled aged CKD patients to delineate the impact of uric acid levels in the serum on mortality rates.

Materials and Methods

Patient recruitment and methods

From January 1, 2009 to July 31, 2016 536 inpatients were enrolled from the Third Affiliated Hospital of Sun Yat-sen University and were followed up until December 31, 2016. The inclusion criteria included: age ≥18 years, CKD and complete (99m) Tc-DTPA renal dynamic imaging. Patients with incomplete clinical data and initiation of renal replacement therapy were excluded from the study.

Baseline data collection and Biochemical Evaluation

Baseline data included demographic characteristics (age and gender) and measurement index (BMI and eGFR). The data also included blood Analysis Of Albumin (ALB), Fasting Blood Glucose (FBS), Total Cholesterol (CHOL), triglyceride, High Density Lipoprotein (HDL), Low Density Lipoprotein (LDL), Hemoglobin (HGB), pre-albumin, Potassium (K), carbon dioxide combining power (CO2CP), Calcium (Ca), Phosphorus (P) and Blood Urea Nitrogen (BUN). We applied the CKD-EPI equation to compute the urine routine including, medication status of uratelowering drug use and eGFR [22].

CKD-EPI equation for eGFR

GFR=141×min (Scr/0.9,1)-0.4111×max (Scr/0.9,1)-1.209×0.993Age×1.159 (if black), if male

GFR=141×1.018×min (Scr/0.7,1)-0.329×max (Scr/0.7,1)-1.209×0.993Age×1.159 (if black), if female

Definition

Hyperuricemia referred to serum UA ≥360 μmol/L in females and ≥420μmol/L in males [23].

Statistical analyses

Data analysis was completed with SPSS statistical software version 22.0. Normality of the data was determined with Kolmogorov-Smirnov test (P>0.05) Table 1). Continuous variables that met the normal distribution parameters were reported as the mean ± SD. Other variables were presented as median (interquartile range). Chi-square and Wilcoxon rank sum tests were employed to analyze continuous variables and compare the categorical variables, respectively. Analysis of Variance (ANOVA) was used to compare different treatments. Cox proportional hazards model was utilized for multivariate analysis. Confounding factors were adjusted by 7 models as described below. Variables with P<0.1 in univariate evaluations were subjected to multivariate assessments.

Model I: non-adjusted.

Model II: adjusted demographic data (gender & age).

Model III: adjusted demographic data (gender & age), eGFR and urate-lowering drug application.

Model IV: adjusted model 3 plus nutritional index (BMI, albumin, fasting blood glucose, triglyceride, CHOL, HDL, LDL, prealbumin, HGB).

Model V: adjusted model 3 plus kidney function indices (potassium, carbon dioxide combining power, calcium, phosphorus, urea nitrogen).

Model VI: adjusted model 3 plus proteinuria.

Model VII: adjusted all factors.

Results

Baseline characteristics of all the patients

Baseline features were presented based on quartiles of uric acid levels in the serum with the participants being classified into 4 groups according to SUA quartiles. The 1st, 2nd, 3rd and 4th quartiles were: 808-504.15μmol/L, 401.55-504.14μmol/L, 310.15-401.54μmol/L and 90.8-310.14μmol/L, respectively. The patient’s age was between 64-74 years, with the median age being 69 years. Out of the 536 patients, 285 (53.2%) were males and 251 (46.8%) females. The estimated GFR (CKD-Epi equation) was24.093 (22.195.26.573)/ min/1.73m2. Deaths recorded were 82(15.3%) and 274 patients (51.1%) had hyperuricemia (Table 2).

Hyperuricemia versus all-cause mortality

In model I, hyperuricemia was positively correlated with all-cause mortality (β=2.319, P<0.001). After correcting for confounding factors as per model II (β=2.37, P<.001), model IV (β=1.793, P=.0027) and model VII (β=1.81, P=.0032), (the same correlation as in model I was observed. However, in model III (β=1.531, P=0.085), model V (β=1.59, P=.0069) and model VI (β=1.547, P=0.078) there was no correlation with regards to hyperuricemia versus all-cause mortality (Table 3A).

Serum uric acid levels versus all-cause mortality

The levels of uric acid in the serum was positively linked to all-cause mortality in; model I (β=1.003, P<0.001), model II (β=1.003, P<0.001), model V (β=1.002, P=.0047), model VI (β=1.002, P=0.022) and model 7 (β=1.002, P=.0036). No correlation was observed with regards to serum uric acid levels versus all-cause mortality in; model 3(β=1.002, P=0.053) and model 4(β=1.002, P=0.061) (Table 3B).

Serum uric acid quartiles versus all-cause mortality

Serum uric acid quartiles were grouped into 4. Uric acid levels in the serum from the highest to the lowest group were;808- 504.15μmol/L,401.55-504.14μmol/L,310.15-401.54μmol/L and 90.8-310.14μmol/L respectively. The third group was considered as the reference group. The lowest serum uric acid was protective for all-cause mortality in model 1 (β=0.398, P=0.009). In addition, the same correlation was observed in; the third serum uric acid quartile in model II (β=0.502, 0.423,P=0.047, 0.017) and the lowest serum uric acid group in model IV (β=0.478, 0.45, P=0.041, 0.039) and model VII (β=0.445, P=0.004). No correlation was observed with regards to serum uric acid quartiles versus all-cause mortality in models III, V and VII (Table 3C).

Discussion

After correcting for confounding factors, cox proportional hazards analysis revealed that hyperuricemia is the distinct risk factors of all-cause mortality in aged CKD patients, with 81% increment risk. The uric acid levels in the serum were positively correlated with all-cause mortality, with lower levels exhibiting significant protective effect for all-cause mortality. The results presented herein are similar to findings from other studies [24-27]. Nevertheless, hyperuricemia was also a protective factor of all-cause death but such results were only observed in hemodialysis patients [28,29]. Hyperuricemia may thus considered a marker in hemodialysis patients. Some studies have shown a J-shaped link in serum uric acid levels versus mortality [30,31]. Moreover,a clinical and cohort studies showed that hyperuricaemia was an independent risk factor for CKD progression in children and adolescents [32]. These studies however, did not target the aged population whereas this study majorly focused on an aged CKD population, a large sample size, complete followup and exclusion of confounding factors. Since the number of people suffering from hyperuricemia or CKD is constantly increasing with the aging of the population, aged CKD patients were the preferred study population. Furthermore, there was exclusion of most factors such as; demographic data, eGFR, urate-lowering drug application, nutritional index, kidney function indices and proteinuria.The results showed that hyperuricemia had a detrimental effect onall-cause mortality. Excellent medical care should therefore be accorded t to hyperuricemia in aged non-dialysis CKD patients, as it may offer a survival benefit when the serum uric acid is maintained at a low level. If not well- treated, hyperuricemia can negatively influence multiple mechanisms in the body such as; platelet function and subsequently the blood rheology [33], proliferation of vascular smooth muscle cells , reduce nitric oxide production , vascular endothelial cell dysfunction , activating the renin angiotensin system and many others [34-37].

Limitations of The Study

This research had a few limitations of limited sample size, being retrospective. Additionally, the serum uric acid was only assessed at baseline, without follow-up data.

Conclusion

This study showed that hyperuricemia is the independent risk factor of all-cause mortality in aged CKD patients with 81% increment risk. Nevertheless, a low level of uric acid in the serum has a significant protective effect for all-cause mortality. This insight will help improve diagnostic and treatment measures for hyperuricemia in aged patients with CKD, remarkably reducing the all- cause mortality in aged populations.


Variables

Normal Parametersa,b

Most Extreme Differences

Test Statistic

Asymp. Sig.        (2-tailed)

Mean

Std. Deviation

Absolute

Positive

Negative

Age

69.752

6.625

0.083

0.083

-0.071

0.083

.000c

BMI

24.444

3.497

0.047

0.047

-0.025

0.047

.007c

ALB

38.189

4.632

0.056

0.032

-0.056

0.056

.000c

K

4.111

0.521

0.066

0.066

-0.042

0.066

.000c

CO2CP

22.741

3.331

0.036

0.018

-0.036

0.036

.086c

CA

2.273

0.162

0.043

0.043

-0.043

0.043

.018c

P

1.190

0.263

0.095

0.095

-0.068

0.095

.000c

FBS

7.273

3.796

0.176

0.176

-0.152

0.176

.000c

BUN

9.766

6.786

0.189

0.189

-0.148

0.189

.000c

UA

410.498

142.881

0.047

0.047

-0.023

0.047

.007c

CHOL

4.724

1.293

0.055

0.055

-0.034

0.055

.001c

TRI

1.955

1.634

0.182

0.182

-0.181

0.182

.000c

HDL-C

1.203

0.675

0.228

0.228

-0.168

0.228

.000c

LDL-C

2.780

1.091

0.043

0.043

-0.033

0.043

.018c

HGB

115.935

22.216

0.079

0.041

-0.079

0.079

.000c

Prealbumin

228.441

69.432

0.036

0.036

-0.034

0.036

.095c

e-GFR

54.805

30.668

0.089

0.069

-0.089

0.089

.000c

a. Test distribution is Normal.
b. Calculated from data.
c. Lilliefors Significance Correction.


Table 1: One-Sample Kolmogorov-Smirnov Test.

Item

All participants

Q1808-504.15μmol/L

Q2401.55-504.14μmol/L

Q3310.15-401.54μmol/L

Q490.8-310.14μmol/L

P

n=536

n=134

n=134

n=134

n=134

 

Age(Years

69(64,74)

70(64,75.25)

68(64,74)

70(65,75)

68(63,73)

0.159

Gender, (% male)

285(53.2)

88(16.4)

84(15.7)

66(12.3)

47(8.8)

0.000

BMI(kg/m2)

24.093(22.195,26.573)

24.529(22.642,26.819)

24.719(22.86,26.977)

23.788(22.006,25.904)

23.379(20.944,25.921)

0.000

ALB(g/L)

38.6(35.4,41.2)

38.6(35.2,41.)

38.55(34.975,41.15)

38.05(35.175,40.825)

39.3(36.075,41.125)

0.578

K(mmol/L)

4.07(3.77,4.37)

4.24(3.938,4.593)

4.04(3.76,4.333)

4.075(3.808,4.36)

3.925(3.63,4.283)

0.000

CO2CPmmol/l

22.741±3.331

21.855±3.747

22.634±2.949

22.643±3.206

23.831±3.101

0.022

CA(mmol/L)

2.28(2.18,2.37)

2.295(2.180,2.393)

2.305(2.19,2.39)

2.28(2.18,2.383)

2.25(2.16,2.33)

0.149

P(mmol/L)

1.16(1.04,1.308)

1.24(1.1,1.383)

1.18(1.06,1.34)

1.13(1.03,1.25)

1.12(0.99,1.243)

0.000

FBS(mmol/L)

6.02(4.83,8.11)

5.515(4.708,7.053)

5.64(4.78,7.07)

6.485(5.11,8.77)

6.805(4.948,10.843)

0.000

BUN(mmol/L)

7.39(5.583,11.248)

10.55(7.818,19.08)

7.93(5.94,12.055)

6.775(5.16,9.485)

5.725(4.525,7.443)

0.000

UA(μmol/L)

401.55(310.15,504.15)

587.25(540.725,656.5)

448.75(423.775,474.95)

347.5(330.925,374.775)

242.5(206.375,279.025)

0.000

Diabetes[n, (%)]

389(72.6)

87(16.2)

95(17.7)

102(19)

105(19.6)

0.065

Proteinuria[n, (%)]

 

 

 

 

 

0.004

(-)

323(60.3)

70(13.1)

71(13.2)

85(15.9)

97(18.1)

 

(±)~(+)

97(18.1)

25(4.7)

26(4.9)

27(5)

19(3.5)

 

(++) or more

116(21.6)

39(7.3)

37(6.9)

22(4.1)

18(3.4)

 

CHOL (mmol/L)

4.605(3.805,5.54)

4.41(3.748,5.54)

4.615(3.798,5.4)

4.68(3.8,5.648)

4.675(3.878,5.345)

0.738

TRI(mmol/L)

1.555(1.07,2.276)

1.75(1.208,2.7)

1.5(1.008,2.29)

1.575(1.163,2.213)

1.4(0.94,1.925)

0.002

HDLC(mmol/L)

1.035(0.853,1.26)

0.95(0.78,1.18)

0.98(0.85,1.235)

1.07(0.88,1.303)

1.135(0.975,1.435)

0.000

LDLC(mmol/L)

2.695(1.93,3.48)

2.63(1.905,3.618)

2.695(1.905,3.338)

2.66(1.985,3.583)

2.79(1.955,3.483)

0.908

HGB(g/L)

120(102,132)

11(92,128)

120.5(103,135.25)

121(107,133)

124(103.75,132.25)

0.002

Prealbumin(mg/L)

228.44±69.432

252.16±71.335

238.48±66.910

220.81±62.805

202.32±66.837

0.023

eGFR (CKD-EPI equation) (min/1.73m2)

53.997(27.551,83.957)

31.663(15.107,51.758)

48.746(23.987,71.49)

60.289(36.645,87.11)

85.739(58.829,94.751)

0.000

CKD stage 1:(eGFR ≥ 90 mL/min/1.73m2)[n,(%)]

92(17.2)

2(0.4)

11(2.1)

27(5)

52(9.7)

0.000

Hyperuricemia(%)

274(51.1)

134(25)

118(22)

22(4.1)

0(0)

0.000

Urate-lowering drug application
[n, (%)]

28(5.2)

28(5.2)

8(1.5)

8(1.5)

5(0.9)

0.000

Death [n, (%)]

82 (15.3)

33(6.2)

24(4.5)

13(2.4)

12(2.2)

0.001


Table 2: Characteristics of the study participants.

 

B

SE

Wald

df

Sig.

Exp(B)

95.0% CI for Exp(B)

Lower

Upper

model 1

 

 

 

 

 

 

 

 

hyperuricemia

0.841

0.236

12.75

1

0

2.319

1.462

3.68

model 2

 

 

 

 

 

 

 

 

hyperuricemia

0.797

0.236

11.396

1

0.001

2.22

1.397

3.527

Age

0.063

0.016

15.254

1

0

1.065

1.032

1.099

Gender

0.433

0.23

3.55

1

0.06

1.542

0.983

2.421

model 3

 

 

 

 

 

 

 

 

hyperuricemia

0.426

0.247

2.967

1

0.085

1.531

0.943

2.487

Age

0.058

0.016

12.59

1

0

1.06

1.026

1.094

Gender

0.365

0.23

2.516

1

0.113

1.44

0.918

2.26

eGFR (CKD-EPI)

-0.019

0.004

18.445

1

0

0.981

0.972

0.99

Urate-lowering drug application

-0.017

0.361

0.002

1

0.961

0.983

0.485

1.993

model 4

 

 

 

 

 

 

 

 

hyperuricemia

0.584

0.264

4.874

1

0.027

1.793

1.068

3.01

Age

0.056

0.017

11.376

1

0.001

1.058

1.024

1.093

Gender

0.84

0.267

9.886

1

0.002

2.315

1.372

3.908

eGFR (CKDEPI)

-0.011

0.006

3.401

1

0.065

0.989

0.977

1.001

Urate-lowering drug application

0.348

0.375

0.858

1

0.354

1.416

0.679

2.953

BMI

-0.01

0.034

0.084

1

0.772

0.99

0.927

1.058

ALB

0.007

0.029

0.053

1

0.818

1.007

0.951

1.066

FBS

0.027

0.036

0.568

1

0.451

1.028

0.957

1.104

CHOL

-0.016

0.201

0.006

1

0.936

0.984

0.664

1.459

TRI

0.192

0.09

4.537

1

0.033

1.212

1.015

1.446

HDLC

0.202

0.186

1.177

1

0.278

1.224

0.85

1.762

LDLC

0.225

0.18

1.558

1

0.212

1.252

0.88

1.781

HGB

-0.024

0.007

12.703

1

0

0.977

0.964

0.989

Prealbumin

-0.006

0.002

8.339

1

0.004

0.994

0.99

0.998

model 5

 

 

 

 

 

 

 

 

hyperuricemia

0.464

0.255

3.312

1

0.069

1.59

0.965

2.62

Age

0.059

0.017

12.232

1

0

1.06

1.026

1.096

Gender

0.333

0.232

2.053

1

0.152

1.395

0.885

2.2

eGFR (CKDEPI)

-0.016

0.006

6.754

1

0.009

0.984

0.973

0.996

Urate-lowering drug application

0.038

0.366

0.011

1

0.917

1.039

0.507

2.131

K

0.012

0.219

0.003

1

0.957

1.012

0.659

1.554

CO2CP

0.014

0.036

0.149

1

0.7

1.014

0.945

1.088

CA

-0.917

0.722

1.614

1

0.204

0.4

0.097

1.645

P

-0.001

0.478

0

1

0.999

0.999

0.392

2.55

BUN

0.01

0.022

0.197

1

0.658

1.01

0.967

1.055

model 6

 

 

 

 

 

 

 

 

hyperuricemia

0.436

0.247

3.112

1

0.078

1.547

0.953

2.511

Age

0.069

0.017

15.929

1

0

1.071

1.036

1.108

Gender

0.346

0.23

2.254

1

0.133

1.413

0.9

2.219

eGFR (CKDEPI)

-0.013

0.005

6.557

1

0.01

0.987

0.978

0.997

Urate-lowering drug application

-0.073

0.362

0.04

1

0.841

0.93

0.457

1.891

proteinuria

0.399

0.146

7.427

1

0.006

1.491

1.119

1.986

model 7

 

 

 

 

 

 

 

 

hyperuricemia

0.594

0.277

4.599

1

0.032

1.81

1.052

3.114

Age

0.063

0.017

13.144

1

0

1.065

1.03

1.103

Gender

0.802

0.275

8.479

1

0.004

2.231

1.3

3.827

eGFR (CKDEPI)

-0.007

0.007

1.078

1

0.299

0.993

0.979

1.007

Urate-lowering drug application

0.318

0.383

0.686

1

0.407

1.374

0.648

2.912

BMI

-0.019

0.035

0.298

1

0.585

0.981

0.916

1.051

ALB

0.014

0.033

0.181

1

0.671

1.014

0.951

1.081

FBS

0.031

0.037

0.684

1

0.408

1.031

0.959

1.109

CHOL

-0.022

0.201

0.012

1

0.913

0.978

0.66

1.451

TRI

0.183

0.094

3.802

1

0.051

1.201

0.999

1.443

HDLC

0.129

0.19

0.464

1

0.496

1.138

0.784

1.651

LDLC

0.196

0.181

1.169

1

0.28

1.217

0.853

1.736

HGB

-0.023

0.007

10.115

1

0.001

0.978

0.964

0.991

Prealbumin

-0.007

0.002

9.489

1

0.002

0.993

0.989

0.998

K

-0.023

0.219

0.011

1

0.916

0.977

0.636

1.501

CO2CP

0.007

0.037

0.038

1

0.846

1.007

0.937

1.082

CA

0.594

0.819

0.525

1

0.469

1.811

0.363

9.024

P

-0.077

0.494

0.025

1

0.876

0.926

0.351

2.438

BUN

0.009

0.023

0.148

1

0.7

1.009

0.964

1.056

proteinuria

0.299

0.16

3.494

1

0.062

1.349

0.986

1.846

Model 1: non-adjusted.
Model 2: adjusted demographic data (age and gender).
Model 3: adjusted demographic data (age and gender),eGFR and urate-lowering drug application.
Model 4: adjusted model 3 plus nutritional index(BMI,ALB, FBS
CHOL, TRI, HDLC, LDLC,HGB, prealbumin).
Model 5: adjusted model 3 plus kidney function indices (eGFR,K, CO2CP, calcium, phosphorus, urea nitrogen).
Model 6: adjusted model 3 plus proteinuria.
Model 7: adjusted all factors.


Table 3A: Cox proportional hazard regression analysis for association between hyperuricemia and all-cause mortality.

 

B

SE

Wald

df

Sig.

Exp(B)

95.0% CI for Exp(B)

Lower

Upper

model 1

 

 

 

 

 

 

 

 

UA

0.003

0.001

19.13

1

0

1.003

1.002

1.005

model 2

 

 

 

 

 

 

 

 

UA

0.003

0.001

15.425

1

0

1.003

1.001

1.004

Age

0.061

0.016

14.544

1

0

1.063

1.03

1.097

Gender

0.333

0.232

2.053

1

0.152

1.395

0.885

2.199

model 3

 

 

 

 

 

 

 

 

UA

0.002

0.001

3.74

1

0.053

1.002

1

1.003

Age

0.057

0.016

12.196

1

0

1.059

1.025

1.093

Gender

0.313

0.231

1.839

1

0.175

1.368

0.87

2.151

eGFR (CKD-EPI)

-0.019

0.005

17.155

1

0

0.981

0.973

0.99

Urate-lowering drug application

-0.073

0.362

0.041

1

0.839

0.929

0.457

1.889

model 4

 

 

 

 

 

 

 

 

UA

0.002

0.001

3.505

1

0.061

1.002

1

1.003

Age

0.057

0.017

11.37

1

0.001

1.058

1.024

1.094

Gender

0.769

0.272

7.973

1

0.005

2.157

1.265

3.678

eGFR (CKDEPI)

-0.011

0.006

3.318