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韓国人集団における血清尿酸値とESRDまたは死亡との関連
Association between Serum Uric Acid Level and ESRD or Death in a Korean Population.
PMID: 32686371 DOI: 10.3346/jkms.2020.35.e254.
抄録
背景:
血清尿酸（SUA）は慢性腎臓病（CKD）と死亡の危険因子として認識されている。しかし，SUA の高値または低値が CKD の進行または死亡のリスクと関連しているかどうか，また，男性と女性で異なるかどうかについては論争がある．
BACKGROUND: Serum uric acid (SUA) is recognized as a risk factor for chronic kidney disease (CKD) and mortality. However, there is controversy as to whether a high or low level of SUA is related to the risk of CKD progression or death, and whether it differs between males and females.
方法:
韓国で1995年から2009年の間に任意の健康診断を受けた成人143,762人を対象とした。各性について、参加者をSUA値に応じて性別の五分位に分け、SUA値が低い群と高い群と中程度のSUA値の群との間で末期腎疾患（ESRD）の発生率と死亡率を比較した。ESRDと全死因死亡率については、性特異的Cox比例ハザード解析を行った。
METHODS: We included 143,762 adults who underwent voluntary health screening between 1995 and 2009 in Korea. For each sex, we divided participants into sex-specific quintiles according to SUA levels and compared end-stage renal disease (ESRD) incidence and mortality between the groups with low and high SUA levels and those with middle SUA levels. Sex-specific Cox proportional hazard analyses were performed for ESRD and all-cause mortality.
結果:
143,762人の参加者のうち、0.2％（n = 272人）がESRDを発症した。ESRDのハザード比（HR）は、男性のSUA中間値および女性のSUA最高値（調整済みHR、2.31；95％信頼区間[CI]、1.10-4.84）よりも、SUA最高値（調整済みHR、2.13；95％信頼区間[CI]、1.18-3.84）およびSUA最低値（調整済みHR、1.90；95％CI、1.02-3.51）の方が高かった。参加者の 4 分位 3％（n = 6,215）が平均追跡期間 157 ヵ月間に死亡した。全死因死亡のハザード比（HR）は、男性（調整HR、1.15；95％CI、1.03～1.28）および女性（調整HR、1.17；95％CI、1.01～1.35）では、SUA分位の最も高い方がSUA分位の中位よりも高かった。
RESULTS: Among the 143,762 participants, 0.2% (n = 272) developed ESRD. The hazard ratio (HR) of ESRD was higher in the highest (adjusted HR, 2.13; 95% confidence interval [CI], 1.18-3.84) and lowest (adjusted HR, 1.90; 95% CI, 1.02-3.51) SUA quintiles than in the middle SUA quintile in males and the highest SUA quintile in females (adjusted HR, 2.31; 95% CI, 1.10-4.84). Four-point three percent (n = 6,215) of participants died during a mean follow-up period of 157 months. The hazard ratio (HR) of all-cause mortality was higher in the highest SUA quintile than in the middle SUA quintile in males (adjusted HR, 1.15; 95% CI, 1.03-1.28) and females (adjusted HR, 1.17; 95% CI, 1.01-1.35).
結論:
SUA値の上昇は、両性においてESRDと全死因死亡のリスク上昇と関連していた。SUAのレベルが低いと、男性のみがU字型の関連を示し、ESRDと死亡に関連している可能性がある。我々の所見は、SUAレベルとESRDの発症および死亡率との間に性差があることを示唆している。
CONCLUSION: Elevated levels of SUA are associated with increased risk for ESRD and all-cause mortality in both sexes. Low levels of SUA might be related to ESRD and death only in males, showing U-shaped associations. Our findings suggest sex-specific associations between SUA levels and ESRD development and mortality.
© 2020 The Korean Academy of Medical Sciences.