Hyperuricemia and progression of CKD in children and adolescents: The Chronic Kidney Disease in Children (CKiD) cohort study

Kyle E. Rodenbach, Michael F. Schneider, Susan L. Furth, Marva M. Moxey-Mims, Mark M. Mitsnefes, Donald J. Weaver, Bradley A. Warady, George J. Schwartz

Research output: Contribution to journalArticlepeer-review

Abstract

Background Hyperuricemia is associated with essential hypertension in children. No previous studies have evaluated the effect of hyperuricemia on progression of chronic kidney disease (CKD) in children. Study Design Prospective observational cohort study. Setting & Participants Children and adolescents (n = 678 cross-sectional; n = 627 longitudinal) with a median age of 12.3 (IQR, 8.6-15.6) years enrolled at 52 North American sites of the CKiD (CKD in Children) Study. Predictor Serum uric acid level (<5.5, 5.5-7.5, and >7.5 mg/dL). Outcomes Composite end point of either >30% decline in glomerular filtration rate (GFR) or initiation of renal replacement therapy. Measurements Age, sex, race, blood pressure status, GFR, CKD cause, urine protein-creatinine ratio (<0.5, 0.5-<2.0, and ≥2.0 mg/mg), age- and sex-specific body mass index > 95th percentile, use of diuretics, and serum uric acid level. Results Older age, male sex, lower GFR, and body mass index > 95th percentile were associated with higher uric acid levels. 162, 294, and 171 participants had initial uric acid levels < 5.5, 5.5 to 7.5, or >7.5 mg/dL, respectively. We observed 225 instances of the composite end point over 5 years. In a multivariable parametric time-to-event analysis, compared with participants with initial uric acid levels < 5.5 mg/dL, those with uric acid levels of 5.5 to 7.5 or >7.5 mg/dL had 17% shorter (relative time, 0.83; 95% CI, 0.62-1.11) or 38% shorter (relative time, 0.62; 95% CI, 0.45-0.85) times to event, respectively. Hypertension, lower GFR, glomerular CKD cause, and elevated urine protein-creatinine ratio were also associated with faster times to the composite end point. Limitations The study lacked sufficient data to examine how use of specific medications might influence serum uric acid levels and CKD progression. Conclusions Hyperuricemia is a previously undescribed independent risk factor for faster progression of CKD in children and adolescents. It is possible that treatment of children and adolescents with CKD with urate-lowering therapy could slow disease progression.

Original languageEnglish (US)
Pages (from-to)984-992
Number of pages9
JournalAmerican Journal of Kidney Diseases
Volume66
Issue number6
DOIs
StatePublished - Dec 2015

Keywords

  • CKD progression
  • CKiD (Chronic Kidney Disease in Children)
  • Uric acid
  • adolescents
  • children
  • chronic kidney disease (CKD)
  • disease trajectory
  • end-stage renal disease (ESRD)
  • glomerular filtration rate (GFR)
  • hyperuricemia
  • pediatric kidney disease
  • renal function decline
  • renal replacement therapy (RRT)
  • risk factor
  • urate

ASJC Scopus subject areas

  • Nephrology

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