Prevalence of and temporal trends in hyperuricaemia among adult patients with chronic kidney disease in Ireland
Arunkumar A. Udayakumar1, 2, Fahd Adeeb2, 3, David Ryan2, Xia Li2, Alexander D. Fraser2, 3, Austin G. Stack1, 2
1. Department of Nephrology, University Hospital Limerick, Limerick, Ireland 2. Graduate Entry Medical School, University of Limerick, Limerick, Ireland 3. Department of Rheumatology, University Hospital Limerick, Limerick, Ireland
An increasing body of evidence links hyperuricaemia with the development of several metabolic disorders and major cardiovascular outcomes. A better understanding of the burden and variation of hyperuricemia within the health system is important in order to identify high-risk groups and facilitate early intervention with effective management strategies.
The aim of this study was to describe the prevalence of hyperuricaemia, and period trends within the Irish Health System among patients with chronic kidney disease (CKD).
136,325 adult CKD patients aged 18 and above with valid measurements of serum uric acid and creatinine levels were identified between 2006 and 2014 from the laboratory systems within the Irish health system. Hyperuricaemia was defined as serum uric acid ≥420μmol/L in men and ≥360μmol/L in women. Estimated glomerular filtration rates were determined using the Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI) equation and patients were classified by CKD stage according to the Kidney Disease Improving Global Outcomes (KDIGO) staging system. Age- and sex-specific prevalence of hyperuricemia estimates with 95% confidence intervals were determined for each group and across calendar years. Comparisons among groups and across years were conducted using chi-square and multivariate logistic regression was used to explore associations using adjusted odds ratios (AOR) and 95% Confidence Intervals (CI).
Patients with hyperuricaemia were noted to be older [58.2 (18.5) vs. 51.2 (17.4) years]. The prevalence of hyperuricaemia increased progressively between 2006 and 2014 from 20.3% (19.5, 21.0) to 26.5% (25.8, 27.2%) in men and from 17.9% (17.2, 18.6) to 20.4% (19.8, 21.0) in women, p<0.001. Age-specific prevalence increased significantly over time for all age groups (18–39, 40–59, 60–79, and ≥80 years) for men and women, p<0.001. Prevalence was significantly higher with more advanced CKD stage: 15.1% (14.5, 15.6) in Stage 1 CKD compared to 43.0% (34.8, 51.1) in Stage 5 CKD, p<0.001. However, rates fell significantly for those Stage 4 and 5 CKD respectively. In multi-variable models, the adjusted likelihood of hyperuricaemia increased with each successive year.
Burden of hyperuricaemia is substantial in the Irish health system and has increased in frequency over the past decade. Burden was highest in young and middle-aged men and older age women.Although the burden was highest among patients with advanced CKD, an encouraging decline was evident in recent years, which may reflect increasing utilization of urate lowering therapies.