Uric Acid and Acute Kidney Injury in the Critically Ill
Rationale & Objective: Uric acid is excreted by the kidney and accumulates in acute kidney injury (AKI). Whether higher plasma uric acid level predisposes to AKI or its complications is not known. Study Design: Prospective observational cohort study. Setting & Participants: 2 independent coh...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2019-01-01
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| Series: | Kidney Medicine |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S259005951930010X |
| _version_ | 1818132974346960896 |
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| author | Anand Srivastava Ragnar Palsson David E. Leaf Angelica Higuera Margaret E. Chen Polly Palacios Rebecca M. Baron Venkata Sabbisetti Andrew N. Hoofnagle Sucheta M. Vaingankar Paul M. Palevsky Sushrut S. Waikar |
| author_facet | Anand Srivastava Ragnar Palsson David E. Leaf Angelica Higuera Margaret E. Chen Polly Palacios Rebecca M. Baron Venkata Sabbisetti Andrew N. Hoofnagle Sucheta M. Vaingankar Paul M. Palevsky Sushrut S. Waikar |
| author_sort | Anand Srivastava |
| collection | DOAJ |
| description | Rationale & Objective: Uric acid is excreted by the kidney and accumulates in acute kidney injury (AKI). Whether higher plasma uric acid level predisposes to AKI or its complications is not known. Study Design: Prospective observational cohort study. Setting & Participants: 2 independent cohorts of critically ill patients: (1) 208 patients without AKI admitted to the intensive care unit (ICU) at Brigham & Women’s Hospital between October 2008 and December 2016; and (2) 250 participants with AKI requiring renal replacement therapy (RRT) who had not yet initiated RRT enrolled in the Acute Renal Failure Trial Network (ATN) Study. Exposure: Plasma uric acid level upon ICU admission and before RRT initiation in the ICU and ATN Study cohorts, respectively. Outcomes: Incident AKI and 60-day mortality in the ICU and ATN Study cohorts, respectively. Analytical Approach: Logistic regression models were used to test the association of plasma uric acid level with incident AKI and 60-day mortality. Results: In the ICU cohort, median plasma uric acid level was 4.7 (interquartile range [IQR], 3.6-6.4) mg/dL, and 40 patients (19.2%) developed AKI. Higher plasma uric acid levels associated with incident AKI, but this association was confounded by serum creatinine level and was not significant after multivariable adjustment (adjusted OR per doubling of uric acid, 1.50; 95% CI, 0.80-2.81). In the ATN Study cohort, median plasma uric acid level was 11.1 (IQR, 8.6–14.2) mg/dL, and 125 participants (50.0%) died within 60 days. There was no statistically significant association between plasma uric acid levels and 60-day mortality in either unadjusted models or after multivariable adjustment for demographic, severity-of-illness, and kidney-specific covariates (adjusted OR per doubling of uric acid, 1.15; 95% CI, 0.71-1.86). Limitations: Heterogeneity of ICU patients. Conclusions: Plasma uric acid levels upon ICU admission or before RRT initiation are not independently associated with adverse clinical outcomes in critically ill patients. Index Words: AKI, ICU, uric acid, RRT, dialysis |
| first_indexed | 2024-12-11T08:45:21Z |
| format | Article |
| id | doaj.art-8c6ac62c596d4f51b6505888f5293ae1 |
| institution | Directory Open Access Journal |
| issn | 2590-0595 |
| language | English |
| last_indexed | 2024-12-11T08:45:21Z |
| publishDate | 2019-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Kidney Medicine |
| spelling | doaj.art-8c6ac62c596d4f51b6505888f5293ae12022-12-22T01:14:09ZengElsevierKidney Medicine2590-05952019-01-01112130Uric Acid and Acute Kidney Injury in the Critically IllAnand Srivastava0Ragnar Palsson1David E. Leaf2Angelica Higuera3Margaret E. Chen4Polly Palacios5Rebecca M. Baron6Venkata Sabbisetti7Andrew N. Hoofnagle8Sucheta M. Vaingankar9Paul M. Palevsky10Sushrut S. Waikar11Division of Nephrology and Hypertension, Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Renal Medicine, Brigham and Women’s Hospital, Boston, MA; Address for Correspondence: Anand Srivastava, MD, MPH, Center for Translational Metabolism and Health, Institute for Public Health and Medicin, Division of Nephrology and Hypertension, Northwestern University Feinberg School of Medicine, 633 N St. Clair St, Ste 18-083, Chicago, IL 60611.Division of Renal Medicine, Brigham and Women’s Hospital, Boston, MADivision of Renal Medicine, Brigham and Women’s Hospital, Boston, MADivision of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, MADivision of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, MADivision of Renal Medicine, Brigham and Women’s Hospital, Boston, MADivision of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, MADivision of Renal Medicine, Brigham and Women’s Hospital, Boston, MADepartment of Laboratory Medicine, University of Washington, Seattle, WADepartment of Medicine, University of California at San Diego, La Jolla, CARenal Section, Veterans Affairs Pittsburgh Healthcare System and Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PADivision of Renal Medicine, Brigham and Women’s Hospital, Boston, MARationale & Objective: Uric acid is excreted by the kidney and accumulates in acute kidney injury (AKI). Whether higher plasma uric acid level predisposes to AKI or its complications is not known. Study Design: Prospective observational cohort study. Setting & Participants: 2 independent cohorts of critically ill patients: (1) 208 patients without AKI admitted to the intensive care unit (ICU) at Brigham & Women’s Hospital between October 2008 and December 2016; and (2) 250 participants with AKI requiring renal replacement therapy (RRT) who had not yet initiated RRT enrolled in the Acute Renal Failure Trial Network (ATN) Study. Exposure: Plasma uric acid level upon ICU admission and before RRT initiation in the ICU and ATN Study cohorts, respectively. Outcomes: Incident AKI and 60-day mortality in the ICU and ATN Study cohorts, respectively. Analytical Approach: Logistic regression models were used to test the association of plasma uric acid level with incident AKI and 60-day mortality. Results: In the ICU cohort, median plasma uric acid level was 4.7 (interquartile range [IQR], 3.6-6.4) mg/dL, and 40 patients (19.2%) developed AKI. Higher plasma uric acid levels associated with incident AKI, but this association was confounded by serum creatinine level and was not significant after multivariable adjustment (adjusted OR per doubling of uric acid, 1.50; 95% CI, 0.80-2.81). In the ATN Study cohort, median plasma uric acid level was 11.1 (IQR, 8.6–14.2) mg/dL, and 125 participants (50.0%) died within 60 days. There was no statistically significant association between plasma uric acid levels and 60-day mortality in either unadjusted models or after multivariable adjustment for demographic, severity-of-illness, and kidney-specific covariates (adjusted OR per doubling of uric acid, 1.15; 95% CI, 0.71-1.86). Limitations: Heterogeneity of ICU patients. Conclusions: Plasma uric acid levels upon ICU admission or before RRT initiation are not independently associated with adverse clinical outcomes in critically ill patients. Index Words: AKI, ICU, uric acid, RRT, dialysishttp://www.sciencedirect.com/science/article/pii/S259005951930010X |
| spellingShingle | Anand Srivastava Ragnar Palsson David E. Leaf Angelica Higuera Margaret E. Chen Polly Palacios Rebecca M. Baron Venkata Sabbisetti Andrew N. Hoofnagle Sucheta M. Vaingankar Paul M. Palevsky Sushrut S. Waikar Uric Acid and Acute Kidney Injury in the Critically Ill Kidney Medicine |
| title | Uric Acid and Acute Kidney Injury in the Critically Ill |
| title_full | Uric Acid and Acute Kidney Injury in the Critically Ill |
| title_fullStr | Uric Acid and Acute Kidney Injury in the Critically Ill |
| title_full_unstemmed | Uric Acid and Acute Kidney Injury in the Critically Ill |
| title_short | Uric Acid and Acute Kidney Injury in the Critically Ill |
| title_sort | uric acid and acute kidney injury in the critically ill |
| url | http://www.sciencedirect.com/science/article/pii/S259005951930010X |
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