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2015 ; 10
(12
): e0145506
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Targeting Uric Acid and the Inhibition of Progression to End-Stage Renal
Disease--A Propensity Score Analysis
#MMPMID26700005
Uchida S
; Chang WX
; Ota T
; Tamura Y
; Shiraishi T
; Kumagai T
; Shibata S
; Fujigaki Y
; Hosoyamada M
; Kaneko K
; Shen ZY
; Fujimori S
PLoS One
2015[]; 10
(12
): e0145506
PMID26700005
show ga
BACKGROUND: The role of uric acid (UA) in the progression of chronic kidney
disease (CKD) remains controversial due to the unavoidable cause and result
relationship. This study was aimed to clarify the independent impact of UA on the
subsequent risk of end-stage renal disease (ESRD) by a propensity score analysis.
METHODS: A retrospective CKD cohort was used (n = 803). Baseline 23 covariates
were subjected to a multivariate binary logistic regression with the targeted
time-averaged UA of 6.0, 6.5 or 7.0 mg/dL. The participants trimmed 2.5
percentile from the extreme ends of the cohort underwent propensity score
analyses consisting of matching, stratification on quintile and covariate
adjustment. Covariate balances after 1:1 matching without replacement were tested
for by paired analysis and standardized differences. A stratified Cox regression
and a Cox regression adjusted for logit of propensity scores were examined.
RESULTS: After propensity score matching, the higher UA showed elevated hazard
ratios (HRs) by Kaplan-Meier analysis (? 6.0 mg/dL, HR 4.53, 95%CI 1.79-11.43; ?
6.5 mg/dL, HR 3.39, 95%CI 1.55-7.42; ? 7.0 mg/dL, HR 2.19, 95%CI 1.28-3.75). The
number needed to treat was 8 to 9 over 5 years. A stratified Cox regression
likewise showed significant crude HRs (? 6.0 mg/dL, HR 3.63, 95%CI 1.25-10.58; ?
6.5 mg/dL, HR 3.46, 95%CI 1.56-7.68; ? 7.0 mg/dL, HR 2.05, 95%CI 1.21-3.48).
Adjusted HR lost its significance at 6.0 mg/dL. The adjustment for the logit of
the propensity scores showed the similar results but with worse model fittings
than the stratification method. Upon further adjustment for other covariates the
significance was attained at 6.5 mg/dL. CONCLUSIONS: Three different methods of
the propensity score analysis showed consistent results that the higher UA
accelerates the progression to the subsequent ESRD. A stratified Cox regression
outperforms other methods in generalizability and adjusting for residual bias.
Serum UA should be targeted less than 6.5 mg/dL.
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