Hyperuricemia is associated with progression of CKD: uric acid aggravates renal function

Abstract Background: With the change of living standard and dietary structure, the incidence of hyperuricemia is on the rise. Hyperuricemia has become one of the metabolic diseases threatening human health. There is paucity of literature on the association between serum uric acid levels and the progression of CKD. This study aimed at assessing the effect of serum baseline uric acid level on the progression of CKD. Methods: This retrospective study included 800 CKD patients in our center. The information on baseline and follow-up characteristics were collected from our Renal Treatment System (RTS) database. Cox regression analysis was used to evaluate the risk factors for CKD progression. The Kaplan–Meier analysis was used to test associations between serum uric acid levels and renal survival rates. Results: A total of 800 patients were included in the study, and the mean age at entry was 36.6±14.4 years. There was no significant difference in gender distribution. The mean eGFR, Cr, serum uric acid at baseline were 99.23±31.54 ml/min/1.73㎡, 82.08±41.40 μmol/L, 371.60±103.18 μmol/L, respectively. 306 (38.3%) patients had HUA and 494 (61.7%) had non-HUA. We established different adjusted models and found that HUA was a risk factor for CKD patients to reach the composite endpoint after adjustment in six models. All models show that HUA was a risk factor for the progression of CKD. Among them, model 4 (adjusted for Cr + Alb + age + BP + gender) was the best model with the largest HR value (HR:2.010, 95%CI:1.310-3.084, P<0.05). The cumulative survival rate of non-hyperuricemia group was higher than that of hyperuricemia group (P<0.001). Conclusions: Hyperuricemia was not only widespread in patients with CKD, but also a risk factor for the progression of CKD. Anti-hyperuricemia therapy may need to be considered in CKD patients to slow the disease progression, which needs to be tested further in clinical studies. Key words: hyperuricemia, chronic kidney disease, renal function, progression

Download Full-text

Hyperuricemia and Impaired Renal Function: A Prospective Cohort Study

Kidney Diseases ◽

10.1159/000511196 ◽

2020 ◽

pp. 1-9

Author(s):

Noppawit Aiumtrakul ◽

Puvanant Wiputhanuphongs ◽

Ouppatham Supasyndh ◽

Bancha Satirapoj

Keyword(s):

Renal Function ◽

Uric Acid ◽

Regression Analysis ◽

Cohort Study ◽

Serum Uric Acid ◽

Prospective Cohort ◽

Impaired Renal Function ◽

Cox Regression ◽

Community Based ◽

Cox Regression Analysis

Background: Related studies have demonstrated a relationship of elevated serum uric levels with a decline in kidney function. However, limited evidence exists in a Southeast Asian community-based population. Objective: The study aimed to examine the relationship between serum uric acid levels and impaired renal function. Methods: A prospective cohort study was conducted in the Thai army health checkup population between July 1, 2006 and December 31, 2012. Inclusion criteria included age older than 20 years and baseline estimated glomerular filtration rate (eGFR) over 60 mL/min/1.73 m2. Cox regression analysis was used to evaluate the association between incidence of impaired renal function and baseline serum uric acid quartiles. Impaired renal function was defined as eGFR <60 mL/min/1.73 m2 over 3 months. Results: A total of 9,534 participants (7,474 men and 2,060 women) were enrolled. Cox regression analysis revealed a significant association of serum uric acid level with impaired renal function in the whole population as the unadjusted hazard ratio (HR) (95% CI) of impaired renal function in second, third, and fourth quartiles were 2.1 (1.39, 3.17), 2.39 (1.6, 3.59), and 3.94 (2.71, 5.74), respectively, when compared with serum uric acid in the first quartile, respectively. After adjusting in 2 models, the HR still significantly persisted with similar magnitudes in all quartiles. Higher incidences of impaired renal function were observed among males than among females in all quartiles. Kaplan-Meier curve showed better renal survival rate in the lower quartile groups. Linear regression analysis showed that eGFR negatively correlated with serum uric acid (r = −0.213, p < 0.001). Conclusion: Our study suggests that an independent association exists of serum uric acid levels with the incidence of impaired renal function and renal progression in the Southeast Asian community-based population.

Download Full-text

Association between uric acid lowering and renal function progression: a longitudinal study

PeerJ ◽

10.7717/peerj.11073 ◽

2021 ◽

Vol 9 ◽

pp. e11073

Author(s):

Liyi Liu ◽

Lili You ◽

Kan Sun ◽

Feng Li ◽

Yiqin Qi ◽

...

Keyword(s):

Renal Function ◽

Uric Acid ◽

Serum Uric Acid ◽

Regression Models ◽

Cox Regression ◽

Population Based ◽

Hazard Ratio ◽

Cox Regression Analysis ◽

Renal Function Decline ◽

Reduced Risk

Background This study aimed to explore the association between uric acid lowering and renal function. Materials and Methods We conducted a population-based cohort study with 1,534 subjects for 4 years from 2012 to 2016. The population was divided into four groups according to the interquartile range of changes in serum uric acid with quartile 1 representing lower quarter. Renal function decline was defined as eGFR decreased more than 10% from baseline in 2016. Renal function improvement was defined as eGFR increased more than 10% from baseline in 2016. Cox regression analysis was used to calculate the hazard ratio (HR) and 95% confidence interval (CI). Results In the adjusted Cox regression models, compared to quartile 4, quartile 1 (HR = 0.64, 95% CI [0.49–0.85]), quartile 2 (HR = 0.65, 95% CI [0.50–0.84]) and quartile 3 (HR = 0.75, 95% CI [0.58–0.96]) have reduced risk of renal function decline. An increasing hazard ratio of renal function improvement was shown in quartile 1 (HR = 2.27, 95% CI [1.45–3.57]) and quartile 2 (HR = 1.78, 95% CI [1.17–2.69]) compared with quartile 4. Conclusions Uric acid lowering is associated with changes in renal function. The management of serum uric acid should receive attention in clinical practice and is supposed to be part of the treatment of chronic kidney disease.

Download Full-text

Effects of mild and moderate renal dysfunction on pharmacokinetics, pharmacodynamics, and safety of dotinurad: a novel selective urate reabsorption inhibitor

Clinical and Experimental Nephrology ◽

10.1007/s10157-019-01825-3 ◽

2019 ◽

Vol 24 (S1) ◽

pp. 17-24 ◽

Cited By ~ 2

Author(s):

Hiroyuki Fukase ◽

Daisuke Okui ◽

Tomomitsu Sasaki ◽

Masahiko Fushimi ◽

Tetsuo Ohashi ◽

...

Keyword(s):

Renal Function ◽

Uric Acid ◽

Renal Dysfunction ◽

Serum Uric Acid ◽

Normal Renal Function ◽

Reduction Rate ◽

Significant Difference ◽

Function Group ◽

Urate Reabsorption ◽

Renal Function Group

Abstract Background Dotinurad, a novel selective urate reabsorption inhibitor, exerts a serum uric acid-lowering effect by selectively inhibiting urate transporter 1 (URAT1) in patients with hyperuricemia. It is generally known that the progression of renal dysfunction is associated with a reduction in the serum uric acid-lowering effects of uricosuric drugs. We, therefore, investigated the pharmacokinetics (PK), pharmacodynamics (PD), and safety of dotinurad in subjects with renal dysfunction. Methods This was a parallel-group, open-label, single-dose clinical pharmacology study. Dotinurad (1 mg) was administered once, orally to subjects with mild (estimated glomerular filtration rate [eGFR], ≥ 60 to < 90 mL/min/1.73 m2) or moderate (eGFR, ≥ 30 to < 60 mL/min/1.73 m2) renal dysfunction or normal (eGFR, ≥ 90 mL/min/1.73 m2) renal function. Results The time-course of mean plasma concentration of dotinurad had similar profiles across the groups. Regarding PK, there was no significant difference between the renal dysfunction groups and normal renal function group. Regarding PD, the maximum reduction rate in serum uric acid levels and the fractional uric acid excretion (FE) ratio (FE0–24/FE−24–0) were significantly lower in the moderate renal dysfunction group than in the normal renal function group. However, other PD parameters were not significantly different among the groups. No notable adverse events or adverse drug reactions were observed in this study. Conclusion These results suggested that no dose adjustment might be necessary when administering dotinurad to patients with mild-to-moderate renal dysfunction. ClinicalTrials.gov Identifier: NCT02347046.

Download Full-text

Early and Midterm Outcome of TEVAR for Thoracic Aortic Pseudoaneurysm

10.21203/rs.3.rs-659146/v1 ◽

2021 ◽

Author(s):

Hui Wang ◽

Tun Wang ◽

Hao He ◽

Xin Li ◽

Yuan Peng ◽

...

Keyword(s):

Risk Factors ◽

Clinical Outcome ◽

Cardiac Disease ◽

Cox Regression ◽

Cox Regression Analysis ◽

Aortic Pseudoaneurysm ◽

Significant Difference ◽

Independent Risk Factors ◽

The Mean

Abstract Backgrounds: The prognosis of thoracic aortic pseudoaneurysm (TAP) after thoracic endovascular aortic repair (TEVAR) remains unclear. This study investigates the early and midterm clinical outcome as well as relevant risk factors of TAP patients following TEVAR therapy.Methods: From July 2010 to July 2020, 37 eligible TAP patients who underwent TEVAR were selected into our research. We retrospectively explored their baseline, perioperative and follow-up data. Fisher exact test and Kaplan-Meier method were applied for comparing difference between groups. Risk factors of late survival were discerned using Cox regression analysis.Results: There were 29 men and 12 women, with the mean age as 59.5±13.0 years (range, 30-82). The mean follow-up time was 30.7±28.3 months (range, 1-89). For early result, early mortality (≦30days) happened in 3(8.1%) zone 3 TAP patients versus 0 in zone 4 (p= 0.028); acute arterial embolism of lower extremity and type II endoleak respectively occurred in 1(2.7%) case. For midterm result, survival at 3 months, 1 year and 5 years was 88.8±5.3%, 75.9±7.5% and 68.3±9.9%, which showed significant difference between zone 2/3 versus zone 4 group (56.3±14.8% versus 72.9±13.2%, p= 0.013) and emergent versus elective TEVAR groups (0.0±0.0% versus 80.1±8.0%, p= 0.049). On multivariate Cox regression, lesions at zone 2/3 (HR 4.605, 95%CI 1.095-19.359), concomitant cardiac disease (HR 4.932, 95%CI 1.086-22.403) and emergent TEVAR (HR 4.196, 95%CI 1.042-16.891) were significant independent risk factors for worse late clinical outcome. Conclusions: TEVAR therapy is effective and safe with satisfactory early and midterm clinical outcome for TAP patients. Lesions at zone 2/3, concomitant cardiac disease and emergent TEVAR were independent risk factors for midterm survival outcome.

Download Full-text

Association between uric acid level and incidence of macroalbuminuria in people with type 2 diabetes mellitus: A 4.5-year cohort study

10.21203/rs.2.18350/v1 ◽

2019 ◽

Author(s):

Yun-Ju Lai ◽

Yu-Yen Chen ◽

Li-Jung Chen ◽

Po-Wen Ku ◽

Kuo-Chuan Hung ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Uric Acid ◽

Serum Uric Acid ◽

Cox Regression ◽

Characteristic Curve ◽

Cox Regression Analysis ◽

Increased Risk

Abstract Background: Using animal models and molecular biology researches, hyperuricemia has been shown to instruct renal arteriolopathy, arterial hypertension, and microvascular injury involving the renin-angiotensin system and resulting in renal function impairment. Nevertheless, the association between uric acid levels and the development of macroalbuminuria has been under-investigated in people with type 2 diabetes mellitus. Methods: Patients with type 2 diabetes and regular outpatient visits were recruited from a community hospital in Taiwan since January 2014. Demographics, lifestyle features, and medical history were gathered by well-trained interviewers. All participants underwent comprehensive physical examinations, including a biochemical assay of venous blood specimens and urine samples after an 8-hour overnight fast. Participants were followed until June 2018. The primary outcome was the macroalbuminuria incidence. Univariable and multivariable Cox regression analysis were employed to explore the relation between uric acid and incident macroalbuminuria. Uric acid cutoffs for incident macroalbuminuria were determined with the receiver operator characteristic curve. Results: We included 247 qualified subjects (mean age: 64.78 years old [standard deviation=11.29 years]; 138 [55.87%] men). During a 4.5-year follow-up duration, 20 subjects with incident macroalbuminuria were recognized. Serum uric acid was significantly associated with an increased risk of incident macroalbuminuria (adjusted hazard ratio=2.39; 95% confidence interval: 1.53-3.75; p<0.001) with potential confounders adjustment. The uric acid cutoff point was 6.9 mg/dL (area under the curve 0.708, sensitivity 60.0%, specificity 84.58%) for incident macroalbuminuria. Conclusions: Serum uric acid was associated with incident macroalbuminuria among people with type 2 diabetes.

Download Full-text

Serum Uric Acid Revealed a U-Shaped Relationship With All-Cause Mortality and Cardiovascular Mortality in High Atherosclerosis Risk Patients: The ASSURE Study

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.641513 ◽

2021 ◽

Vol 8 ◽

Author(s):

Yan Cang ◽

Shaojie Xu ◽

Jingyin Zhang ◽

Jingyi Ju ◽

Zijun Chen ◽

...

Keyword(s):

Uric Acid ◽

Regression Model ◽

Serum Uric Acid ◽

Cardiovascular Mortality ◽

Cox Regression ◽

Multicenter Cohort Study ◽

Male And Female ◽

Cox Regression Analysis ◽

All Cause Mortality ◽

Cvd Mortality

Background: Previous studies have demonstrated an association between hyperuricemia and cardiovascular disease (CVD). The Framingham study confirmed that patients with high atherosclerotic risks (HARs) had worse prognoses. However, after adjusting for confounding factors, the association between serum uric acid (SUA) and all-cause mortality and cardiovascular mortality remains unclear, especially for HAR patients.Objective: The aim of this study was to reveal the relationship of SUA with all-cause and cardiovascular mortality in HAR patients.Methods: This multicenter cohort study enrolled 3,047 participants, and the follow-up was 68.85 ± 11.37 months. Factors related to cardiovascular and all-cause mortality were tested by multivariate Cox regression analysis. Restricted cubic splines (RCSs) with knots were used to explore the shape of the dose–response relationship with SUA and the hazard ratio (HR) of all-cause and CVD mortality. SUA transformed by RCS was added to the Cox regression model as an independent variable, and all-cause and CVD mortality scores were calculated. Survival receiver operating characteristic curves were produced using a regression model predicting the score.Results: SUA demonstrated a “U-shaped” relationship with all-cause and cardiovascular mortality. SUA predicted all-cause and CVD mortality, with cutoff values of values of >370.5 μmol/L for males and >327.65 μmol/L for females and <180.5 μmol/L for males and <165.7 μmol/L for females, respectively. The survival ROC curve indicated that SUA is able to predict all-cause and CVD mortality, with areas under the curve of 0.702 and 0.711, respectively. The HRs of all-cause mortality (male and female) with hyperuricemia and hypouricemia were 2.08 and 2.01 and 2.04 and 1.98, respectively, and the HRs of CVD mortality (male and female) were 2.09 and 1.79, and 2.02 and 1.89, respectively.Conclusion: Abnormal SUA levels were significant and independent risk factors for all-cause and CVD mortality. Hyperuricemia and hypouricemia increased mortality in both males and females. Routine SUA evaluation and intensive management are needed for HAR patients.Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT03616769.

Download Full-text

Correlation of serum uric acid with renal function parameters in preeclampsia.

The Professional Medical Journal ◽

10.29309/tpmj/2020.27.12.4267 ◽

2020 ◽

Vol 27 (12) ◽

pp. 2703-2707

Author(s):

Muddasir Zia ◽

Rukhshan Khurshid ◽

Uzma Jabbar ◽

Adnan Riaz ◽

Roohi Jabbar ◽

...

Keyword(s):

Renal Function ◽

Uric Acid ◽

Serum Creatinine ◽

Serum Uric Acid ◽

Cross Sectional Study ◽

Urinary Protein ◽

Estimation Of Parameters ◽

Cross Sectional ◽

Significant Difference ◽

Relationship Of

Objectives: Study was designed to find out the Correlation of serum uric acid with renal function parameters in Preeclampsia. Study Design: Cross Sectional study. Setting: Sir Ganga Ram Hospital Lahore. Period: July 2016 to July 2017. Material & Methods: Level of serum uric acid, serum creatinine and blood urea of 40 Preeclamptic women and 30 gestation-matched normotensive controls were estimated. Their Demographic and clinical characteristics were noted. The blood sample was analyzed for biochemical parameters, blood urea, serum uric acid, serum creatinine and urinary protein. Result: Mean age and gestational age of women was 25 weeks with BMI 29 Kg/m2. Level of serum uric acid and blood urea and serum creatinine were increased, but significant difference only observed with serum uric acid and blood urea with marked proteinuria. An inverse relationship of serum uric acid with urinary protein was observed. A direct relationship, of serum uric acid with serum creatinine was observed. Conclusion: it is concluded that estimation of parameters of renal function of preeclamptic women are important along with hyperuicaemia.

Download Full-text

Correlations of complete blood count, liver enzyme and serum uric Acid in Sudanese pre-eclamptic cases

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20181322 ◽

2018 ◽

Vol 7 (4) ◽

pp. 1308

Author(s):

Hind M. Beheiry ◽

Ibrahim A. Ali ◽

Mazin S. Abdalla ◽

Ahmed M. Sharif ◽

Amal M. Saeed

Keyword(s):

Uric Acid ◽

Serum Uric Acid ◽

Liver Enzymes ◽

Complete Blood Count ◽

Maternity Hospital ◽

Prognostic Indicators ◽

Cross Sectional ◽

Significant Difference ◽

The Mean ◽

Wbc Count

Background: Pre-eclampsia is a serious disorder of pregnancy with unknown ethological factors that may occur at any stage of second or third trimester of pregnancy. The objectives of the present study were to assess changes in complete blood counts including platelets, liver enzymes and serum uric acid in pre-eclamptic cases compared to second-half normal pregnant and non-pregnant Sudanese women and their correlations to other biomarkers.Methods: This was a cross-sectional, case-control study performed from December 2008 to December 2010; in Omdurman Maternity Hospital, in concomitance with other studies in pre-eclampsia. The sample size included three groups, 72 up pre-eclamptic cases in their recent pregnancies, 96 normal pregnant in their second half of pregnancy and 63 non- pregnant (control) women; a total of 231 subjects. Questionnaire Interviews and clinical examination were done for all participants. Laboratory investigations were done including complete blood picture, liver enzymes and uric acid. Results: The mean Hb concentration of the pre-eclamptic (11.3g/dl±1.7) was statistically significantly lower than that of the non-pregnant (12.1g/dl±0.2) (P=0.01) but not from that of the normal pregnant (11.4g/dl±0.1) (P=0.882) .There was no statistical significant difference in the mean WBC count between the pre-eclamptic (7.4x103/mm3±0.3) and non-pregnant (7.3x103/mm3±0.3) (P=0.797) and between the pre-eclamptic and normal pregnant (7.7x103/mm3±0.2) (P=0.270). There was a considerable statistical significant decrease in the mean platelets count of the pre-eclamptic (236.4/mm3±8.3) compared to the non-pregnant group (322.0/mm3±10.4) (P=0.0001) s well as to the normal pregnant (275.0/mm3±8.9) (P = 0.003). In the pre-eclamptic cases, serum ALT correlated significantly with TWCC (r=0.26, P=0.03) and serum AST (r=0.65, P=0.000). In the pre-eclamptic cases, serum AST correlated significantly with Hb (r=0.26, P=0.03), serum ALT and serum uric acid (r=0.36, P=0.01).Conclusions: There was a considerable statistical significant decrease in mean platelets count of the pre-eclamptic compared to the non-pregnant group and to the normal pregnant may be explained by hemodilution; whereas further decrease was due to pre-eclampsia. ALT and AST are strong prognostic indicators of pre-eclampsia.

Download Full-text

Correlation between serum uric acid levels and outcomes of pre-eclampsia in Abakaliki, South-east, Nigeria

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20213913 ◽

2021 ◽

Vol 9 (10) ◽

pp. 2914

Author(s):

Nnabugwu A. Adiele ◽

Odidika U. J. Umeora ◽

Robinson C. Onoh ◽

Ikechukwu B. O. Dimejesi ◽

Arinze C. Ikeotuonye ◽

...

Keyword(s):

Uric Acid ◽

Serum Uric Acid ◽

Operating Characteristic ◽

Characteristic Curve ◽

Threshold Value ◽

Controlled Study ◽

Perinatal Morbidity ◽

Significant Difference ◽

The Mean

Background: Pre-eclampsia is a leading cause of fetomaternal and perinatal morbidity and mortality. The role of serum uric acid (SUA) in determining the complications of preeclampsia has been controversial. This study compared mean SUA levels between severe pre-eclamptics and normotensive women at term and ascertained its correlation with outcomes of preeclampsia; as well as determined if there is a threshold value of SUA level beyond which fetomaternal complications occur.Methods: A case-controlled study where 80 severe pre-eclamptics at term and 80 normotensive women matched for gestational age were recruited. Blood samples were collected from them for assay of SUA levels and they were followed till delivery. The fetomaternal outcomes and the corresponding SUA levels at diagnosis were documented and variables statistically analyzed. A receiver operating characteristic curve was used to determine the cut-off value of SUA beyond which adverse fetomateral complications are likely to occur in pre-eclampsia.Results: The mean SUA level in severe pre-eclamptics (0.283±0.09 mmol/l) was not significantly higher than that of normotensive women (0.263±0.09 mmol/l, p=0.13). There was a weak positive correlation between the SUA levels and fetomaternal outcomes [maternal (r=0.102, p=0.236) and fetal (r=0.096, p=0.226)]. The study was unable to identify the threshold SUA level at which adverse fetomaternal outcomes occur as the values of SUA were closely related.Conclusions: SUA levels of pre-eclamptics and normotensive women did not show significant difference and correlated weakly with fetomaternal outcomes and are therefore poor predictor of fetomaternal outcomes in pre-eclampsia.

Download Full-text

Assessment of the relationship between serum uric acid levels and liver enzymes activity in Bangladeshi adults

Scientific Reports ◽

10.1038/s41598-021-99623-z ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Noyan Hossain Molla ◽

Rahanuma Raihanu Kathak ◽

Abu Hasan Sumon ◽

Zitu Barman ◽

Ananya Dutta Mou ◽

...

Keyword(s):

Uric Acid ◽

General Population ◽

Serum Uric Acid ◽

Liver Enzymes ◽

Multinomial Logistic Regression ◽

Adult Population ◽

Enzymes Activity ◽

Significant Difference ◽

The Mean ◽

The Relationship

AbstractSerum uric acid (SUA) level has been suggested to be associated with cardiovascular disease, diabetes and metabolic syndrome. However, little is known about the relationship between SUA and liver enzymes activity in the general population. The present study aimed to assess the relationship between SUA and serum liver enzymes in an adult population in Bangladesh. In this cross-sectional study, a total of 410 blood samples were collected from apparently healthy adults aged > 18 years. SUA, liver enzymes, lipid profile and other biochemical markers were measured in the collected samples by using standard methods. Multinomial logistic regression model was used to assess the relationship between SUA and elevated levels of liver enzymes among the participants. Overall, the prevalence of hyperuricemia was 30.1% with 32.2% in male and 18.6% in female participants. About 33% of the participants had at least one or more elevated levels of liver enzymes. The mean level of SUA was significantly higher in males (389.3 ± 96.9 µmol/L) than in the female (290.4 ± 89.8 µmol/L) subjects (p < 0.001). There was a significant difference in the mean levels of serum ALT and GGT between the male (34.5 ± 16.0 U/L and 26.7 ± 19.5 U/L, respectively) and female (25.0 ± 13.0 U/L and 19.5 ± 13.2 U/L, respectively) participants (p < 0.001 and p < 0.01, respectively). An increasing trend was observed in the mean levels of serum ALT and GGT across the SUA quartile groups (p < 0.001 and p < 0.01, respectively). SUA showed a positive and significant correlation with serum ALT (p < 0.001) and GGT (p < 0.01). In further statistical analysis after adjustment for potential confounders, SUA showed an independent and significant association with serum ALT and GGT in all regression models. In conclusion, SUA was strongly associated with serum levels of ALT and GGT after adjustment for potential confounders. More prospective studies are needed to clarify the complex relationship between SUA and liver enzymes in the general population.

Download Full-text