Obermayr RP et al. (2008) Elevated uric acid increases the risk for kidney disease. J Am Soc Nephrol 19: 2407–2413

Epidemiological studies have previously linked high blood uric acid levels to kidney disease. Now, an Austrian study has found that hyperuricemia is an independent predictor of kidney disease.

The study population comprised 21,475 healthy volunteers from the Vienna Health Screening Project who were followed up for a median of 7 years. Obermayr et al. classified participants into three groups based on their blood uric acid concentration: a 'reference' group of 19,466 people with uric acid levels <416 µmol/l; a 'slightly elevated' group of 1,821 people with uric acid levels of 416–529 µmol/l; and an 'elevated' group of 188 people with uric acid levels ≥535 µmol/l. After adjustment for other risk factors, individuals in the 'slightly elevated' group and those in the 'elevated' group had odds ratios of 1.26 and 1.63, respectively, for the development of stage 3 chronic kidney disease compared with the reference group. The influence of uric acid levels on the risk of incident kidney disease was greater in women than in men, and was substantially increased by hypertension. Odds ratios for new-onset kidney disease increased rapidly with increasing uric acid levels (>357–416 µmol/l in women and >416–476 µmol/l in men).

The authors conclude that prescription of uric acid-lowering drugs may be justified in apparently healthy hyperuricemic individuals, especially those with hypertension or prehypertension.