정상 범위의 혈중 요산과 만성신질환
Normal Serum Uric Acid Levels and Chronic Kidney Disease
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초록
연구배경: 고요산혈증은 신질환과 관련이 있다. 또한, 정상 범위의 요산치에서도 관련성이 있을 수 있다. 이에 본 연구는 정상범위의 혈중 요산과 만성신질환과의 관련성을 살펴보고자 한다. 방법: 본 연구는 2006년 7월부터 2008년 6월까지 서울의 일개 대학병원 건강증진센터에서 검진을 받은 50세 이상의 성인 3,011명을 대상으로 하였다. 혈중 요산 7 mg/dL 미만인 정상 범위의 혈중 요산 내에서 4등분하여 요산치 증가와 만성신질환의 관계를 조사하였다. 결과: 정상 혈중 요산치 내에서 나이, 성별, 교육수준, 월평균 수입, 흡연상태, 위험음주, 정기적 운동, 비만, 고혈압, 당뇨, 대사증후군 등을 보정한 후 가장 낮은 요산 범위(≤4.20 mg/dL)를 나타내는 군에 대해 요산이 증가하는 군으로 갈수록 만성신질환의 교차비가 1.53 (95% 신뢰수준, 1.00- 2.34), 1.97 (95% 신뢰수준, 1.27-3.08), 3.92 (95% 신뢰수준, 2.46-6.25)로 증가하는 경향을 보였다(P for trend<0.001). 결론: 정상 범위의 혈중 요산치 내에서 요산의 증가는 만성신질환의 위험과 관련이 있다. 정상 범위의 혈중 요산치 내에서 요산의 증가가 신질환 발생에 대한 초기의 위험인자인지와 정상 범위 내에서도 요산을 감소시키면 만성신질환의 발생을 예방할 수 있는지에 대한 추가 연구가 필요하다.
Abstract
Background: Hyperuricemia is related to renal disease. However, normal uric acid levels have been seen with renal disease. The aim of this study was to investigate the association between normal uric acid levels and chronic kidney disease. Methods: Our subjects included 3,011 patients, 50 years and older, who underwent health examinations at the health promotion center at a university hospital in Seoul from July 2006 to June 2008. We categorized normal serum uric acid levels below 7 mg/dL into four quartiles and assessed the association between chronic kidney disease and increasing uric acid levels. Results : After adjusting for age, gender, education level, income, smoking status, at-risk drinking, regular exercise, obesity, hypertension, diabetes mellitus, and metabolic syndrome, odds ratios of chronic kidney disease for the quartiles of normal serum uric acid levels were 1.53 (95% CI, 1.00-2.34), 1.97 (95% CI, 1.27-3.08), 3.92 (95% CI, 2.46-6.25), compared with the bottom quartile (less than 4.20 mg/dL); and this showed a positive trend (P<0.001). Conclusions : We observed that even within the normal serum uric acid range, increasing levels of uric acid was associated with the risk of chronic kidney disease. Follow-up studies are needed to confirm whether rising, though normal, levels of uric acid, per se, is an early risk for chronic kidney disease and to determine whether its reduction would prevent the development of the disease.
참고문헌 (26)
- 신영태, "혈중 요산 수치의 임상적 의의", 가정의학회지, 30(09), pp.670~680 (2009), 대한가정의학회
- Feig DI, "Uric acid: a novel mediator and marker of risk in chronic kidney disease?", Curr Opin Nephrol Hypertens, 18(6), pp.526~530 (2009)
- Mellen PB, "Serum uric acid predicts incident hypertension in a biethnic cohort: the atherosclerosis risk in communities study", Hypertension, 48(6), pp.1037~1042 (2006)
- Forman JP, "Plasma uric acid level and risk for incident hypertension among men", J Am Soc Nephrol, 18(1), pp.287~292 (2007)
- Dehghan A, "High serum uric acid as a novel risk factor for type 2 diabetes", Diabetes Care, 31(2), pp.361~362 (2008)
- Masuo K, "Serum uric acid and plasma norepinephrine concentrations predict subsequent weight gain and blood pressure elevation", Hypertension, 42(4), pp.474~480 (2003)
- See LC, "Serum uric acid is independently associated with metabolic syndrome in subjects with and without a low estimated glomerular filtration rate", J Rheumatol, 36(8), pp.1691~1698 (2009)
- Johnson RJ, "Is there a pathogenetic role for uric acid in hypertension and cardiovascular and renal disease?", Hypertension, 41(6), pp.1183~1190 (2003)
- Perez-Ruiz F, "Renal underexcretion of uric acid is present in patients with apparent high urinary uric acid output", Arthritis Rheum, 47(6), pp.610~613 (2002)
- Iseki K, "Significance of hyperuricemia on the early detection of renal failure in a cohort of screened subjects", Hypertens Res, 24(6), pp.691~697 (2001)
- Obermayr RP, "Knechtelsdorfer M, Oberbauer R, Klauser-Braun R. Elevated uric acid increas es the risk for kidney disease", J Am Soc Nephrol, 19(12), pp.2407~2413 (2008)
- Rosolowsky ET, "High-normal serum uric acid is associated with impaired glomerular filtration rate in nonproteinuric patients with type 1 diabetes", Clin J Am Soc Nephrol, 3(3), pp.706~713 (2008)
- Hsu CY, "Risk factors for end-stage renal disease: 25-year follow-up", Arch Intern Med, 169(4), pp.342~350 (2009)
- World Health Organization Western Pacific Region, "International Association for the Study of Obesity, and International Obesity Task Force. The Asian-Pacific perspective: redefining obesity and its treatment", pp.15~21 (2000), Health Communications Australia
- Park JT, "Uric acid is associated with the rate of residual renal function decline in peritoneal dialysis patients", Nephrol Dial Transplant, 24(11), pp.3520~3525 (2009)
- Stevens LA, "Measurement of kidney function", Med Clin North Am, 89(3), pp.457~473 (2005)
- Levey AS, "National Kidney Foundation. National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification", Ann Intern Med, 139(2), pp.137~147 (2003)
- Grundy SM, "American Heart Association; National Heart,Lung, and Blood Institute. Diagnosis and management of themetabolic syndrome: an American Heart Association", National Heart, Lung, and Blood Institute Scientific Statement, 2005, pp.112, 2735~2752
- Lee SY, "Cut-off points of waist circumference for defining abdominal obesity in the Korean population", Korean J Obes, 15(1), pp.1~9 (2006)
- Matthews DR, "Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man", Diabetologia, 28(7), pp.412~419 (1985)
- Kang DH, "A role for uric acid in the progression of renal disease", J Am Soc Nephrol, 13(12), pp.2888~2897 (2002)
- Mazzali M, "Elevated uric acid increases blood pressure in the rat by a novel crystal-independent mechanism", Hypertension, 38(5), pp.1101~1106 (2001)
- Lee JE, "Serum uric acid is associated with microalbuminuria in prehypertension", Hypertension, 47(5), pp.962~967 (2006)
- Siu YP, "Use of allopurinol in slowing the progression of renal disease through its ability to lower serum uric acid level", Am J Kidney Dis, 47(1), pp.51~59 (2006)
- Kanbay M, "Effect of treatment of hyperuricemia with allopurinol on blood pressure, creatinine clearence, and proteinuria in patients with normal renal functions", Int Urol Nephrol, 39(4), pp.1227~1233 (2007)
- Talaat KM, "The effect of mild hyperuricemia on urinary transforming growth factor beta and the progression of chronic kidney disease", Am J Nephrol, 27(5), pp.435~440 (2007)