Frontiers in Cardiovascular Medicine (Sep 2021)
Serum Uric Acid and Kidney Disease Measures Independently Predict Cardiovascular and Total Mortality: The Uric Acid Right for Heart Health (URRAH) Project
- Elisa Russo,
- Francesca Viazzi,
- Roberto Pontremoli,
- Carlo M. Barbagallo,
- Michele Bombelli,
- Edoardo Casiglia,
- Arrigo F. G. Cicero,
- Massimo Cirillo,
- Pietro Cirillo,
- Giovambattista Desideri,
- Lanfranco D'Elia,
- Raffaella Dell'Oro,
- Claudio Ferri,
- Ferruccio Galletti,
- Loreto Gesualdo,
- Cristina Giannattasio,
- Guido Iaccarino,
- Giovanna Leoncini,
- Francesca Mallamaci,
- Alessandro Maloberti,
- Stefano Masi,
- Alessandro Mengozzi,
- Alberto Mazza,
- Maria L. Muiesan,
- Pietro Nazzaro,
- Paolo Palatini,
- Gianfranco Parati,
- Gianfranco Parati,
- Marcello Rattazzi,
- Giulia Rivasi,
- Massimo Salvetti,
- Valérie Tikhonoff,
- Giuliano Tocci,
- Fosca A. L. Quarti Trevano,
- Andrea Ungar,
- Paolo Verdecchia,
- Agostino Virdis,
- Massimo Volpe,
- Guido Grassi,
- Claudio Borghi
Affiliations
- Elisa Russo
- Department of Internal Medicine, University of Genoa and IRCCS Ospdedale Policlinico San Martino, Genova, Italy
- Francesca Viazzi
- Department of Internal Medicine, University of Genoa and IRCCS Ospdedale Policlinico San Martino, Genova, Italy
- Roberto Pontremoli
- Department of Internal Medicine, University of Genoa and IRCCS Ospdedale Policlinico San Martino, Genova, Italy
- Carlo M. Barbagallo
- Biomedical Department of Internal Medicine and Specialistics, University of Palermo, Palermo, Italy
- Michele Bombelli
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Edoardo Casiglia
- Studium Patavinum, Department of Medicine, University of Padua, Padua, Italy
- Arrigo F. G. Cicero
- Department of Medical and Surgical Science, Alma Mater Studiorum University of Bologna, Bologna, Italy
- Massimo Cirillo
- Department of Public Health, Federico II University of Naples Medical School, Naples, Italy
- Pietro Cirillo
- Department of Emergency and Organ Transplantation-Nephrology, Dialysis and Transplantation Unit, Aldo Moro University of Bari, Bari, Italy
- Giovambattista Desideri
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
- Lanfranco D'Elia
- Department of Clinical Medicine and Surgery, Federico II University of Naples Medical School, Naples, Italy
- Raffaella Dell'Oro
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Claudio Ferri
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
- Ferruccio Galletti
- Department of Clinical Medicine and Surgery, Federico II University of Naples Medical School, Naples, Italy
- Loreto Gesualdo
- Department of Emergency and Organ Transplantation-Nephrology, Dialysis and Transplantation Unit, Aldo Moro University of Bari, Bari, Italy
- Cristina Giannattasio
- 0Cardiology IV, A. De Gasperis Department, School of Medicine and Sugery, Niguarda Ca' Granda Hospital, Milano-Bicocca University, Milan, Italy
- Guido Iaccarino
- 1Department of Advanced Biomedical Sciences, Federico II University of Naples Medical School, Naples, Italy
- Giovanna Leoncini
- Department of Internal Medicine, University of Genoa and IRCCS Ospdedale Policlinico San Martino, Genova, Italy
- Francesca Mallamaci
- 2CNR-IFC, Clinical Epidemiology of Renal Diseases and Hypertension, Reggio Cal Unit, Reggio Calabria, Italy
- Alessandro Maloberti
- 0Cardiology IV, A. De Gasperis Department, School of Medicine and Sugery, Niguarda Ca' Granda Hospital, Milano-Bicocca University, Milan, Italy
- Stefano Masi
- 3Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Alessandro Mengozzi
- 3Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Alberto Mazza
- 4Department of Internal Medicine, Hypertension Unit, General Hospital, Rovigo, Italy
- Maria L. Muiesan
- 5Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Pietro Nazzaro
- 6Department of Medical Basic Sciences, Neurosciences and Sense Organs, University of Bari Medical School, Bari, Italy
- Paolo Palatini
- Studium Patavinum, Department of Medicine, University of Padua, Padua, Italy
- Gianfranco Parati
- 7Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Gianfranco Parati
- 8Department of Cardiology, San Luca Hospital, Istituto Auxologico Italiano, IRCCS, Milan, Italy
- Marcello Rattazzi
- 9Department of Medicine, Ca' Foncello University Hospital, University of Padova, Treviso, Italy
- Giulia Rivasi
- 0Department of Geriatric and Intensive Care Medicine, Careggi Hospital, University of Florence, Florence, Italy
- Massimo Salvetti
- 5Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Valérie Tikhonoff
- 1Department of Medicine, University of Padua, Padua, Italy
- Giuliano Tocci
- 2Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant'Andrea Hospital, University of Rome Sapienza, Rome, Italy
- Fosca A. L. Quarti Trevano
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Andrea Ungar
- 0Department of Geriatric and Intensive Care Medicine, Careggi Hospital, University of Florence, Florence, Italy
- Paolo Verdecchia
- 3Hospital S. Maria della Misericordia, Perugia, Italy
- Agostino Virdis
- 3Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Massimo Volpe
- 2Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant'Andrea Hospital, University of Rome Sapienza, Rome, Italy
- Guido Grassi
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Claudio Borghi
- Department of Medical and Surgical Science, Alma Mater Studiorum University of Bologna, Bologna, Italy
- DOI
- https://doi.org/10.3389/fcvm.2021.713652
- Journal volume & issue
-
Vol. 8
Abstract
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 (>90, between 60 and 90 and <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.
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