Hyperuricemia Predicts an Early Decline in Renal Function among Older People: A Community-Based Cohort Study

Whether elevated serum uric acid levels (SUA) predict renal dysfunction remains controversial in the elderly. Therefore, we investigated the association between SUA and early renal function decline defined as an estimated glomerular filtration rate (eGFR) reduction >= 30% over 2 years. From 2001 to 2010, we conducted a longitudinal cohort study comprising 44,078 participants aged >= 65 years in the Taipei City Elderly Health Examination Database. Participants were classified by 1-mg/dL increment of SUA. We used multivariable logistic and Cox regression analyses to compare the risk of early renal function decline in different SUA groups. Compared to the reference SUA group of 5.0-5.9 mg/dL, hyperuricemic participants had increased risks of eGFR decline, starting at SUA >= 6.0 mg/dL (adjusted odds ratio [aOR] = 1.21, 95% confidence interval [CI] = 1.00-1.45). The risk progressively elevated as SUA increased, with the highest in the SUA >= 10.0 mg/dL group (aOR = 3.20, CI = 2.39-4.28). Multivariable Cox regression further confirmed that hyperuricemia was 1.12-fold (CI = 1.03-1.22, SUA >= 6.0 mg/dL) to 1.6-fold (CI = 1.37-1.86, SUA >= 10.0 mg/dL) more likely to develop early eGFR decline. Hyperuricemia-associated increased risks for early eGFR decline were consistent across subgroup and sensitivity analyses. Collectively, SUA >= 6.0 mg/dL independently predicted early renal dysfunction with eGFR decline >= 30% over 2 years in older people.