Longitudinal uric acid has nonlinear association with kidney failure and mortality in chronic kidney disease

We investigated the shape of the relationship between longitudinal uric acid (UA) and the hazard of kidney failure and death in chronic kidney disease (CKD) patients, and attempted to identify thresholds associated with increased hazards. We included CKD stage 3–5 patients from the CKD-REIN cohort w...

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Veröffentlicht in:Scientific reports Jg. 13; H. 1; S. 3952 - 11
Hauptverfasser: Prezelin-Reydit, Mathilde, Combe, Christian, Fouque, Denis, Frimat, Luc, Jacquelinet, Christian, Laville, Maurice, Massy, Ziad A., Lange, Céline, Ayav, Carole, Pecoits-Filho, Roberto, Liabeuf, Sophie, Stengel, Bénédicte, Harambat, Jérôme, Leffondré, Karen
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Sprache:Englisch
Veröffentlicht: London Nature Publishing Group UK 09.03.2023
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ISSN:2045-2322, 2045-2322
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Abstract We investigated the shape of the relationship between longitudinal uric acid (UA) and the hazard of kidney failure and death in chronic kidney disease (CKD) patients, and attempted to identify thresholds associated with increased hazards. We included CKD stage 3–5 patients from the CKD-REIN cohort with one serum UA measurement at cohort entry. We used cause-specific multivariate Cox models including a spline function of current values of UA (cUA), estimated from a separate linear mixed model. We followed 2781 patients (66% men, median age, 69 years) for a median of 3.2 years with a median of five longitudinal UA measures per patient. The hazard of kidney failure increased with increasing cUA, with a plateau between 6 and 10 mg/dl and a sharp increase above 11 mg/dl. The hazard of death had a U-shape relationship with cUA, with a hazard twice higher for 3 or 11 mg/dl, compared to 5 mg/dl. In CKD patients, our results indicate that UA above 10 mg/dl is a strong risk marker for kidney failure and death and that low UA levels below 5 mg/dl are associated with death before kidney failure.
AbstractList We investigated the shape of the relationship between longitudinal uric acid (UA) and the hazard of kidney failure and death in chronic kidney disease (CKD) patients, and attempted to identify thresholds associated with increased hazards. We included CKD stage 3–5 patients from the CKD-REIN cohort with one serum UA measurement at cohort entry. We used cause-specific multivariate Cox models including a spline function of current values of UA (cUA), estimated from a separate linear mixed model. We followed 2781 patients (66% men, median age, 69 years) for a median of 3.2 years with a median of five longitudinal UA measures per patient. The hazard of kidney failure increased with increasing cUA, with a plateau between 6 and 10 mg/dl and a sharp increase above 11 mg/dl. The hazard of death had a U-shape relationship with cUA, with a hazard twice higher for 3 or 11 mg/dl, compared to 5 mg/dl. In CKD patients, our results indicate that UA above 10 mg/dl is a strong risk marker for kidney failure and death and that low UA levels below 5 mg/dl are associated with death before kidney failure.
Abstract We investigated the shape of the relationship between longitudinal uric acid (UA) and the hazard of kidney failure and death in chronic kidney disease (CKD) patients, and attempted to identify thresholds associated with increased hazards. We included CKD stage 3–5 patients from the CKD-REIN cohort with one serum UA measurement at cohort entry. We used cause-specific multivariate Cox models including a spline function of current values of UA (cUA), estimated from a separate linear mixed model. We followed 2781 patients (66% men, median age, 69 years) for a median of 3.2 years with a median of five longitudinal UA measures per patient. The hazard of kidney failure increased with increasing cUA, with a plateau between 6 and 10 mg/dl and a sharp increase above 11 mg/dl. The hazard of death had a U-shape relationship with cUA, with a hazard twice higher for 3 or 11 mg/dl, compared to 5 mg/dl. In CKD patients, our results indicate that UA above 10 mg/dl is a strong risk marker for kidney failure and death and that low UA levels below 5 mg/dl are associated with death before kidney failure.
We investigated the shape of the relationship between longitudinal uric acid (UA) and the hazard of kidney failure and death in chronic kidney disease (CKD) patients, and attempted to identify thresholds associated with increased hazards. We included CKD stage 3-5 patients from the CKD-REIN cohort with one serum UA measurement at cohort entry. We used cause-specific multivariate Cox models including a spline function of current values of UA (cUA), estimated from a separate linear mixed model. We followed 2781 patients (66% men, median age, 69 years) for a median of 3.2 years with a median of five longitudinal UA measures per patient. The hazard of kidney failure increased with increasing cUA, with a plateau between 6 and 10 mg/dl and a sharp increase above 11 mg/dl. The hazard of death had a U-shape relationship with cUA, with a hazard twice higher for 3 or 11 mg/dl, compared to 5 mg/dl. In CKD patients, our results indicate that UA above 10 mg/dl is a strong risk marker for kidney failure and death and that low UA levels below 5 mg/dl are associated with death before kidney failure.We investigated the shape of the relationship between longitudinal uric acid (UA) and the hazard of kidney failure and death in chronic kidney disease (CKD) patients, and attempted to identify thresholds associated with increased hazards. We included CKD stage 3-5 patients from the CKD-REIN cohort with one serum UA measurement at cohort entry. We used cause-specific multivariate Cox models including a spline function of current values of UA (cUA), estimated from a separate linear mixed model. We followed 2781 patients (66% men, median age, 69 years) for a median of 3.2 years with a median of five longitudinal UA measures per patient. The hazard of kidney failure increased with increasing cUA, with a plateau between 6 and 10 mg/dl and a sharp increase above 11 mg/dl. The hazard of death had a U-shape relationship with cUA, with a hazard twice higher for 3 or 11 mg/dl, compared to 5 mg/dl. In CKD patients, our results indicate that UA above 10 mg/dl is a strong risk marker for kidney failure and death and that low UA levels below 5 mg/dl are associated with death before kidney failure.
We investigated the shape of the relationship between longitudinal uric acid (UA) and the hazard of kidney failure and death in chronic kidney disease (CKD) patients, and attempted to identify thresholds associated with increased hazards. We included CKD stage 3–5 patients from the CKD-REIN cohort with one serum UA measurement at cohort entry. We used cause-specific multivariate Cox models including a spline function of current values of UA (cUA), estimated from a separate linear mixed model. We followed 2781 patients (66% men, median age, 69 years) for a median of 3.2 years with a median of five longitudinal UA measures per patient. The hazard of kidney failure increased with increasing cUA, with a plateau between 6 and 10 mg/dl and a sharp increase above 11 mg/dl. The hazard of death had a U-shape relationship with cUA, with a hazard twice higher for 3 or 11 mg/dl, compared to 5 mg/dl. In CKD patients, our results indicate that UA above 10 mg/dl is a strong risk marker for kidney failure and death and that low UA levels below 5 mg/dl are associated with death before kidney failure.
ArticleNumber 3952
Author Liabeuf, Sophie
Massy, Ziad A.
Jacquelinet, Christian
Laville, Maurice
Fouque, Denis
Stengel, Bénédicte
Pecoits-Filho, Roberto
Harambat, Jérôme
Lange, Céline
Combe, Christian
Frimat, Luc
Leffondré, Karen
Ayav, Carole
Prezelin-Reydit, Mathilde
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  surname: Leffondré
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  organization: INSERM, Bordeaux Population Health Research Center, UMR1219, Univ Bordeaux, INSERM, CIC1401-EC, Univ Bordeaux
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PublicationTitleAlternate Sci Rep
PublicationYear 2023
Publisher Nature Publishing Group UK
Nature Publishing Group
Nature Portfolio
Publisher_xml – name: Nature Publishing Group UK
– name: Nature Publishing Group
– name: Nature Portfolio
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R Core Team (2019). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. Available from: https://www.R-project.org
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StengelBCombeCJacquelinetCBrianconSFouqueDLavilleMThe French chronic kidney disease-renal epidemiology and information network (CKD-REIN) cohort studyNephrol Dial Transpl.20142981500150710.1093/ndt/gft388
ZawadaAMCarreroJJWolfMFeuersengerAStuardSGaulyASerum uric acid and mortality risk among hemodialysis patientsKidney Int. Rep.2020581196120632775819740356010.1016/j.ekir.2020.05.021
ChewLDGriffinJMPartinMRNoorbaloochiSGrillJPSnyderAValidation of screening questions for limited health literacy in a large VA outpatient populationJ. Gen. Intern. Med.200823556156618335281232416010.1007/s11606-008-0520-5
LeeCLTsaiSFAssociation between mortality and serum uric acid levels in non-diabetes-related chronic kidney disease: An analysis of the National Health and Nutrition Examination Survey, USA, 1999–2010Sci. Rep.2020101175852020NatSR..1017585L1:CAS:528:DC%2BB3cXitFCkt7nN33067501756853410.1038/s41598-020-74747-w
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DoriaAGaleckiATSpinoCPop-BusuiRCherneyDZLingvayISerum urate lowering with allopurinol and kidney function in type 1 diabetesN. Engl. J. Med.202038226249325031:CAS:528:DC%2BB3cXht12rtLrJ32579810737570810.1056/NEJMoa1916624
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BjornstadPMaahsDMRoncalCASnell-BergeonJKShahVNMilagresTRole of bicarbonate supplementation on urine uric acid crystals and diabetic tubulopathy in adults with type 1 diabetesDiabetes Obes. Metab.2018207177617801:CAS:528:DC%2BC1cXhtFKhtLjJ29498467634434910.1111/dom.13274
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MazzaliMHughesJKimYGJeffersonAKangDHGordonKLElevated uric acid increases blood pressure in the rat by a novel crystal-independent mechanismHypertension2001385110111061:CAS:528:DC%2BD3MXovVOrsbg%3D1171150510.1161/hy1101.092839
BjornstadPRoncalCMilagresTPyleLLanaspaMABishopFKHyperfiltration and uricosuria in adolescents with type 1 diabetesPediatr. Nephrol. Berl. Ger.201631578779310.1007/s00467-015-3299-8
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SrivastavaAKazeADMcMullanCJIsakovaTWaikarSSUric acid and the risks of kidney failure and death in individuals with CKDAm. J. Kidney Dis.20187133623701:CAS:528:DC%2BC2sXhsl2qt7%2FM2913294510.1053/j.ajkd.2017.08.017
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TsaiCWChiuHTHuangHCTingIWYehHCKuoCCUric acid predicts adverse outcomes in chronic kidney disease: a novel insight from trajectory analysesNephrol. Dial Transpl.20183322312411:CAS:528:DC%2BC1MXps1OhsLc%3D10.1093/ndt/gfx297
BoninoBLeonciniGRussoEPontremoliRViazziFUric acid in CKD: Has the jury come to the verdict?J. Nephrol.20203347157241:CAS:528:DC%2BB3cXnvVCmtA%3D%3D3193316110.1007/s40620-020-00702-7
EilersPHCMarxBDFlexible smoothing with B-splines and penaltiesStat. Sci.1996118912114354850955.6256210.1214/ss/1038425655
Sánchez-LozadaLGTapiaESantamaríaJAvila-CasadoCSotoVNepomucenoTMild hyperuricemia induces vasoconstriction and maintains glomerular hypertension in normal and remnant kidney ratsKidney Int.20056712372471561024710.1111/j.1523-1755.2005.00074.x
SuttorpMMSiegerinkBJagerKJZoccaliCDekkerFWGraphical presentation of confounding in directed acyclic graphsNephrol. Dial. Transpl.20153091418142310.1093/ndt/gfu325
KDIGO. KDIGOClinical practice guideline for the evaluation and management of chronic kidney diseaseKidney Int. Suppl.2012201331150
Kalantar-ZadehKFouqueDNutritional management of chronic kidney diseaseN. Engl. J. Med.201737718176517761:CAS:528:DC%2BC2sXhvFChtbfN2909156110.1056/NEJMra1700312
RizopoulosDJoint Models for Longitudinal and Time-to-Event Data: With Applications in R20121New-YorkCRC Press1284.6203210.1201/b12208
NacakHvan DiepenMQureshiARCarreroJJStijnenTDekkerFWUric acid is not associated with decline in renal function or time to renal replacement therapy initiation in a referred cohort of patients with Stage III, IV and V chronic kidney diseaseNephrol. Dial. Transpl.201530122039204510.1093/ndt/gfv225
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MazzaliMKanellisJHanLFengLXiaYYChenQHyperuricemia induces a primary renal arteriolopathy in rats by a blood pressure-indepen
KDIGO. KDIGO (30902_CR16) 2012; 2013
Y Cang (30902_CR45) 2021; 8
A Doria (30902_CR53) 2020; 382
CW Tsai (30902_CR41) 2017; 12
B Stengel (30902_CR15) 2014; 29
TA Ikizler (30902_CR17) 2020; 76
LG Sánchez-Lozada (30902_CR37) 2005; 67
M Li (30902_CR47) 2020; 42
MM Suttorp (30902_CR24) 2015; 30
PHC Eilers (30902_CR30) 1996; 11
AM Zawada (30902_CR42) 2020; 5
M Madero (30902_CR3) 2009; 53
30902_CR2
30902_CR1
Q Chen (30902_CR51) 2020; 15
GJ Ko (30902_CR28) 2020; 31
RJ Johnson (30902_CR33) 1999; 33
LD Chew (30902_CR19) 2008; 23
A Srivastava (30902_CR10) 2018; 71
CL Lee (30902_CR44) 2020; 10
H Nacak (30902_CR5) 2015; 30
LG Sánchez-Lozada (30902_CR34) 2012; 121
U Dafni (30902_CR20) 1998; 54
K Kalantar-Zadeh (30902_CR27) 2017; 377
Y Shi (30902_CR11) 2012; 35
WC Tseng (30902_CR49) 2018; 7
K Iseki (30902_CR40) 2004; 44
MA Hediger (30902_CR26) 2005; 20
C Zoccali (30902_CR12) 2018; 33
H Nacak (30902_CR9) 2014; 15
MJ Sweeting (30902_CR21) 2011; 53
LG Sanchez-Lozada (30902_CR25) 2020; 33
N Altemtam (30902_CR8) 2012; 27
SV Badve (30902_CR52) 2020; 382
S Uchida (30902_CR7) 2015; 10
CW Tsai (30902_CR14) 2018; 33
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MV Perez-Gomez (30902_CR54) 2019; 132
K Leffondre (30902_CR31) 2014; 29
M Mazzali (30902_CR35) 2001; 38
SK Cho (30902_CR43) 2018; 70
Q Li (30902_CR46) 2021; 53
WC Liu (30902_CR4) 2012; 7
P Bjornstad (30902_CR38) 2018; 20
R Paul (30902_CR29) 2008; 27
D Rizopoulos (30902_CR50) 2012
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FE Harrell (30902_CR23) 2015
M Mazzali (30902_CR36) 2002; 282
X Girerd (30902_CR18) 2001; 94
30902_CR32
B Bonino (30902_CR13) 2020; 33
WX Chang (30902_CR6) 2015; 10
W Ye (30902_CR22) 2008; 64
References_xml – reference: HedigerMAJohnsonRJMiyazakiHEndouHMolecular physiology of urate transportPhysiology20052021251331:CAS:528:DC%2BD2MXjs1Ontrk%3D1577230110.1152/physiol.00039.2004
– reference: BjornstadPRoncalCMilagresTPyleLLanaspaMABishopFKHyperfiltration and uricosuria in adolescents with type 1 diabetesPediatr. Nephrol. Berl. Ger.201631578779310.1007/s00467-015-3299-8
– reference: SrivastavaAKazeADMcMullanCJIsakovaTWaikarSSUric acid and the risks of kidney failure and death in individuals with CKDAm. J. Kidney Dis.20187133623701:CAS:528:DC%2BC2sXhsl2qt7%2FM2913294510.1053/j.ajkd.2017.08.017
– reference: GirerdXEvaluation de l’observance par l’interrogatoire au cours du suivi des hypertendus dans des consultations spécialiséesArch. Mal. Coeur. Vaiss.20019488398421:STN:280:DC%2BD3MrivFaitg%3D%3D11575214
– reference: TsaiCWLinSYKuoCCHuangCCSerum uric acid and progression of kidney disease: A longitudinal analysis and mini-reviewPLoS ONE2017121e017039328107415524924510.1371/journal.pone.0170393
– reference: ZoccaliCMallamaciFUric acid in chronic kidney disease: The quest for causality continuesNephrol Dial Transpl.20183321931951:CAS:528:DC%2BC1MXps1Oht7w%3D10.1093/ndt/gfx341
– reference: NacakHvan DiepenMQureshiARCarreroJJStijnenTDekkerFWUric acid is not associated with decline in renal function or time to renal replacement therapy initiation in a referred cohort of patients with Stage III, IV and V chronic kidney diseaseNephrol. Dial. Transpl.201530122039204510.1093/ndt/gfv225
– reference: BoninoBLeonciniGRussoEPontremoliRViazziFUric acid in CKD: Has the jury come to the verdict?J. Nephrol.20203347157241:CAS:528:DC%2BB3cXnvVCmtA%3D%3D3193316110.1007/s40620-020-00702-7
– reference: BjornstadPMaahsDMRoncalCASnell-BergeonJKShahVNMilagresTRole of bicarbonate supplementation on urine uric acid crystals and diabetic tubulopathy in adults with type 1 diabetesDiabetes Obes. Metab.2018207177617801:CAS:528:DC%2BC1cXhtFKhtLjJ29498467634434910.1111/dom.13274
– reference: SuttorpMMSiegerinkBJagerKJZoccaliCDekkerFWGraphical presentation of confounding in directed acyclic graphsNephrol. Dial. Transpl.20153091418142310.1093/ndt/gfu325
– reference: MazzaliMHughesJKimYGJeffersonAKangDHGordonKLElevated uric acid increases blood pressure in the rat by a novel crystal-independent mechanismHypertension2001385110111061:CAS:528:DC%2BD3MXovVOrsbg%3D1171150510.1161/hy1101.092839
– reference: LiMYeZCLiCMZhaoWBTangHLiuXLow serum uric acid levels increase the risk of all-cause death and cardiovascular death in hemodialysis patientsRen. Fail.20204213153221:CAS:528:DC%2BB3cXlvVygsrc%3D32223483717027710.1080/0886022X.2020.1745234
– reference: LeffondreKJagerKJBoucquemontJStelVSHeinzeGRepresentation of exposures in regression analysis and interpretation of regression coefficients: Basic concepts and pitfallsNephrol. Dial. Transpl.201429101806181410.1093/ndt/gft500
– reference: ZawadaAMCarreroJJWolfMFeuersengerAStuardSGaulyASerum uric acid and mortality risk among hemodialysis patientsKidney Int. Rep.2020581196120632775819740356010.1016/j.ekir.2020.05.021
– reference: AltemtamNRussellJEl NahasMA study of the natural history of diabetic kidney disease (DKD)Nephrol Dial Transpl.2012275184718541:CAS:528:DC%2BC38XmvVejuro%3D10.1093/ndt/gfr561
– reference: KDIGO. KDIGOClinical practice guideline for the evaluation and management of chronic kidney diseaseKidney Int. Suppl.2012201331150
– reference: ChenQWangZZhouJChenZLiYLiSEffect of urate-lowering therapy on cardiovascular and kidney outcomes: A systematic review and meta-analysisClin. J. Am. Soc. Nephrol.202015111576158633055192764624410.2215/CJN.05190420
– reference: Perez-GomezMVBartschLACastillo-RodriguezEFernandez-PradoRKanbayMOrtizAPotential dangers of serum urate-lowering therapyAm. J. Med.201913244574671:CAS:528:DC%2BC1MXisFWgu7o%3D3061183310.1016/j.amjmed.2018.12.010
– reference: YeWLinXTaylorJMGSemiparametric modeling of longitudinal measurements and time-to-event data—a two-stage regression calibration approachBiometrics2008644123812462522273182611601151.6209310.1111/j.1541-0420.2007.00983.x
– reference: IkizlerTABurrowesJDByham-GrayLDCampbellKLCarreroJJChanWKDOQI clinical practice guideline for nutrition in CKD: 2020 updateAm. J. Kidney Dis.2020763S1S1071:CAS:528:DC%2BB3cXhs1Gqs7bN3282975110.1053/j.ajkd.2020.05.006
– reference: ShiYChenWJalalDLiZChenWMaoHClinical outcome of hyperuricemia in IgA nephropathy: A Retrospective Cohort Study and Randomized Controlled TrialKidney Blood Press Res.20123531531601:CAS:528:DC%2BC38XmtlOrtbg%3D2211619610.1159/000331453
– reference: EilersPHCMarxBDFlexible smoothing with B-splines and penaltiesStat. Sci.1996118912114354850955.6256210.1214/ss/1038425655
– reference: Sturm G, Kollerits B, Neyer U, Ritz E, Kronenberg F, MMKD Study Group. Uric acid as a risk factor for progression of non-diabetic chronic kidney disease? The mild to Moderate Kidney Disease (MMKD) Study. Exp. Gerontol.43(4), 347–352 (2008).
– reference: HarrellFEHarrellJFrankEGeneral aspects of fitting regression modelsRegression Modeling Strategies: With Applications to Linear Models, Logistic and Ordinal Regression, and Survival Analysis2015New YorkSpringer13441330.6200110.1007/978-3-319-19425-7_2
– reference: MaderoMSarnakMJWangXGreeneTBeckGJKusekJWUric acid and long-term outcomes in CKDAm. J. Kidney Dis.20095357968031:CAS:528:DC%2BD1MXlvFOjsrs%3D19303683269155310.1053/j.ajkd.2008.12.021
– reference: DoriaAGaleckiATSpinoCPop-BusuiRCherneyDZLingvayISerum urate lowering with allopurinol and kidney function in type 1 diabetesN. Engl. J. Med.202038226249325031:CAS:528:DC%2BB3cXht12rtLrJ32579810737570810.1056/NEJMoa1916624
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– reference: R Core Team (2019). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. Available from: https://www.R-project.org/
– reference: Modification of Diet in Renal Disease Study Group, Hunsicker LG, Adler S, Caggiula A, England BK, Greene T, et al. Predictors of the progression of renal disease in the Modification of Diet in Renal Disease Study. Kidney Int.51(6), 1908–1919 (1997).
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– reference: Sanchez-LozadaLGRodriguez-IturbeBKelleyEENakagawaTMaderoMFeigDIUric acid and hypertension: An update with recommendationsAm. J. Hypertens.20203375835941:CAS:528:DC%2BB3cXisF2ntL7K32179896736816710.1093/ajh/hpaa044
– reference: ChewLDGriffinJMPartinMRNoorbaloochiSGrillJPSnyderAValidation of screening questions for limited health literacy in a large VA outpatient populationJ. Gen. Intern. Med.200823556156618335281232416010.1007/s11606-008-0520-5
– reference: Kalantar-ZadehKFouqueDNutritional management of chronic kidney diseaseN. Engl. J. Med.201737718176517761:CAS:528:DC%2BC2sXhvFChtbfN2909156110.1056/NEJMra1700312
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– reference: TsaiCWChiuHTHuangHCTingIWYehHCKuoCCUric acid predicts adverse outcomes in chronic kidney disease: a novel insight from trajectory analysesNephrol. Dial Transpl.20183322312411:CAS:528:DC%2BC1MXps1OhsLc%3D10.1093/ndt/gfx297
– reference: RizopoulosDJoint Models for Longitudinal and Time-to-Event Data: With Applications in R20121New-YorkCRC Press1284.6203210.1201/b12208
– reference: Sánchez-LozadaLGTapiaESantamaríaJAvila-CasadoCSotoVNepomucenoTMild hyperuricemia induces vasoconstriction and maintains glomerular hypertension in normal and remnant kidney ratsKidney Int.20056712372471561024710.1111/j.1523-1755.2005.00074.x
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Snippet We investigated the shape of the relationship between longitudinal uric acid (UA) and the hazard of kidney failure and death in chronic kidney disease (CKD)...
Abstract We investigated the shape of the relationship between longitudinal uric acid (UA) and the hazard of kidney failure and death in chronic kidney disease...
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SubjectTerms 692/4022
692/499
692/53
Aged
Death
Female
Health hazards
Human health and pathology
Humanities and Social Sciences
Humans
Kidney diseases
Kidney Failure, Chronic
Kidneys
Life Sciences
Male
Mortality
multidisciplinary
Proportional Hazards Models
Renal failure
Renal Insufficiency, Chronic - complications
Risk Factors
Science
Science (multidisciplinary)
Uric Acid
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Title Longitudinal uric acid has nonlinear association with kidney failure and mortality in chronic kidney disease
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