Association between post-transplant serum uric acid levels and kidney transplantation outcomes

Deok Gie Kim, Hoon Young Choi, Ha Yan Kim, Eun Ju Lee, Kyu Ha Huh, Myoung Soo Kim, Chung Mo Nam, Beom Seok Kim, Yu Seun Kim

Research output: Contribution to journalArticle

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Abstract

Background Serum uric acid (UA) level has been reported to be associated with chronic allograft nephropathy and graft failure in patients who undergo kidney transplantation (KT). However, the role of serum UA level in renal graft survival remains controversial. Objective This study aimed to investigate the effect of mean serum UA level during two different post-KT periods on long-term renal graft outcomes in a large population cohort in which living donor KT prevails. Material and methods A retrospective cohort study was performed using KT data prospectively collected at a single institution. Patients (n = 2,993) were divided into low-, normal-, and high-UA groups according to the mean serum UA level within the first year (1-YR) and 1–5 years (5-YR) after transplantation. Results In the 1-YR Cox proportional hazards analysis, the low- and high-UA groups had a significantly decreased and increased risk, respectively, for overall graft failure (OGF), death-censored graft failure (DCGF), and composite event (return to dialysis, retransplantation, death from graft dysfunction, and 40% decline in estimated glomerular filtration rate) compared with the normal-UA group. Similarly, in the 5-YR analysis, the low-UA group had a significantly reduced risk of DCGF compared with the normal-UA group, whereas the high-UA group had a significantly increased risk of all three graft outcomes. In a marginal structural model, hyperuricemia had a significant causal effect on worsening graft outcomes, with consideration of all confounding variables (OGF: hazard ratio [HR] 2.27, 95% confidence interval [CI] 1.33–3.78; DCGF: HR 2.38, 95% CI 1.09–4.9; composite event: HR 3.05, 95% CI 1.64–5.49). Conclusions A low-to-normal serum UA level within the first year and 1–5 years after KT is an independent factor for better renal allograft outcomes in the long-term follow-up period rather than high serum UA level.

Original languageEnglish
Article numbere0209156
JournalPloS one
Volume13
Issue number12
DOIs
Publication statusPublished - 2018 Dec

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Transplantation (surgical)
kidney transplant
Transplants
uric acid
Uric Acid
Kidney Transplantation
Grafts
Serum
Hazards
death
confidence interval
allografting
kidneys
Confidence Intervals
Kidney
Allografts
hyperuricemia
hazard characterization
Hyperuricemia
Confounding Factors (Epidemiology)

All Science Journal Classification (ASJC) codes

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

Kim, Deok Gie ; Choi, Hoon Young ; Kim, Ha Yan ; Lee, Eun Ju ; Huh, Kyu Ha ; Kim, Myoung Soo ; Nam, Chung Mo ; Kim, Beom Seok ; Kim, Yu Seun. / Association between post-transplant serum uric acid levels and kidney transplantation outcomes. In: PloS one. 2018 ; Vol. 13, No. 12.
@article{13e3e3187011424685af875be3f62c3c,
title = "Association between post-transplant serum uric acid levels and kidney transplantation outcomes",
abstract = "Background Serum uric acid (UA) level has been reported to be associated with chronic allograft nephropathy and graft failure in patients who undergo kidney transplantation (KT). However, the role of serum UA level in renal graft survival remains controversial. Objective This study aimed to investigate the effect of mean serum UA level during two different post-KT periods on long-term renal graft outcomes in a large population cohort in which living donor KT prevails. Material and methods A retrospective cohort study was performed using KT data prospectively collected at a single institution. Patients (n = 2,993) were divided into low-, normal-, and high-UA groups according to the mean serum UA level within the first year (1-YR) and 1–5 years (5-YR) after transplantation. Results In the 1-YR Cox proportional hazards analysis, the low- and high-UA groups had a significantly decreased and increased risk, respectively, for overall graft failure (OGF), death-censored graft failure (DCGF), and composite event (return to dialysis, retransplantation, death from graft dysfunction, and 40{\%} decline in estimated glomerular filtration rate) compared with the normal-UA group. Similarly, in the 5-YR analysis, the low-UA group had a significantly reduced risk of DCGF compared with the normal-UA group, whereas the high-UA group had a significantly increased risk of all three graft outcomes. In a marginal structural model, hyperuricemia had a significant causal effect on worsening graft outcomes, with consideration of all confounding variables (OGF: hazard ratio [HR] 2.27, 95{\%} confidence interval [CI] 1.33–3.78; DCGF: HR 2.38, 95{\%} CI 1.09–4.9; composite event: HR 3.05, 95{\%} CI 1.64–5.49). Conclusions A low-to-normal serum UA level within the first year and 1–5 years after KT is an independent factor for better renal allograft outcomes in the long-term follow-up period rather than high serum UA level.",
author = "Kim, {Deok Gie} and Choi, {Hoon Young} and Kim, {Ha Yan} and Lee, {Eun Ju} and Huh, {Kyu Ha} and Kim, {Myoung Soo} and Nam, {Chung Mo} and Kim, {Beom Seok} and Kim, {Yu Seun}",
year = "2018",
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Kim, DG, Choi, HY, Kim, HY, Lee, EJ, Huh, KH, Kim, MS, Nam, CM, Kim, BS & Kim, YS 2018, 'Association between post-transplant serum uric acid levels and kidney transplantation outcomes', PloS one, vol. 13, no. 12, e0209156. https://doi.org/10.1371/journal.pone.0209156

Association between post-transplant serum uric acid levels and kidney transplantation outcomes. / Kim, Deok Gie; Choi, Hoon Young; Kim, Ha Yan; Lee, Eun Ju; Huh, Kyu Ha; Kim, Myoung Soo; Nam, Chung Mo; Kim, Beom Seok; Kim, Yu Seun.

In: PloS one, Vol. 13, No. 12, e0209156, 12.2018.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Association between post-transplant serum uric acid levels and kidney transplantation outcomes

AU - Kim, Deok Gie

AU - Choi, Hoon Young

AU - Kim, Ha Yan

AU - Lee, Eun Ju

AU - Huh, Kyu Ha

AU - Kim, Myoung Soo

AU - Nam, Chung Mo

AU - Kim, Beom Seok

AU - Kim, Yu Seun

PY - 2018/12

Y1 - 2018/12

N2 - Background Serum uric acid (UA) level has been reported to be associated with chronic allograft nephropathy and graft failure in patients who undergo kidney transplantation (KT). However, the role of serum UA level in renal graft survival remains controversial. Objective This study aimed to investigate the effect of mean serum UA level during two different post-KT periods on long-term renal graft outcomes in a large population cohort in which living donor KT prevails. Material and methods A retrospective cohort study was performed using KT data prospectively collected at a single institution. Patients (n = 2,993) were divided into low-, normal-, and high-UA groups according to the mean serum UA level within the first year (1-YR) and 1–5 years (5-YR) after transplantation. Results In the 1-YR Cox proportional hazards analysis, the low- and high-UA groups had a significantly decreased and increased risk, respectively, for overall graft failure (OGF), death-censored graft failure (DCGF), and composite event (return to dialysis, retransplantation, death from graft dysfunction, and 40% decline in estimated glomerular filtration rate) compared with the normal-UA group. Similarly, in the 5-YR analysis, the low-UA group had a significantly reduced risk of DCGF compared with the normal-UA group, whereas the high-UA group had a significantly increased risk of all three graft outcomes. In a marginal structural model, hyperuricemia had a significant causal effect on worsening graft outcomes, with consideration of all confounding variables (OGF: hazard ratio [HR] 2.27, 95% confidence interval [CI] 1.33–3.78; DCGF: HR 2.38, 95% CI 1.09–4.9; composite event: HR 3.05, 95% CI 1.64–5.49). Conclusions A low-to-normal serum UA level within the first year and 1–5 years after KT is an independent factor for better renal allograft outcomes in the long-term follow-up period rather than high serum UA level.

AB - Background Serum uric acid (UA) level has been reported to be associated with chronic allograft nephropathy and graft failure in patients who undergo kidney transplantation (KT). However, the role of serum UA level in renal graft survival remains controversial. Objective This study aimed to investigate the effect of mean serum UA level during two different post-KT periods on long-term renal graft outcomes in a large population cohort in which living donor KT prevails. Material and methods A retrospective cohort study was performed using KT data prospectively collected at a single institution. Patients (n = 2,993) were divided into low-, normal-, and high-UA groups according to the mean serum UA level within the first year (1-YR) and 1–5 years (5-YR) after transplantation. Results In the 1-YR Cox proportional hazards analysis, the low- and high-UA groups had a significantly decreased and increased risk, respectively, for overall graft failure (OGF), death-censored graft failure (DCGF), and composite event (return to dialysis, retransplantation, death from graft dysfunction, and 40% decline in estimated glomerular filtration rate) compared with the normal-UA group. Similarly, in the 5-YR analysis, the low-UA group had a significantly reduced risk of DCGF compared with the normal-UA group, whereas the high-UA group had a significantly increased risk of all three graft outcomes. In a marginal structural model, hyperuricemia had a significant causal effect on worsening graft outcomes, with consideration of all confounding variables (OGF: hazard ratio [HR] 2.27, 95% confidence interval [CI] 1.33–3.78; DCGF: HR 2.38, 95% CI 1.09–4.9; composite event: HR 3.05, 95% CI 1.64–5.49). Conclusions A low-to-normal serum UA level within the first year and 1–5 years after KT is an independent factor for better renal allograft outcomes in the long-term follow-up period rather than high serum UA level.

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