Association Between Hyperuricemia And Target Organ Damage In Children

BackgroundIn recent years,the number of patients with hyperuricemia(HUA)has continued to expand,which has been attracting attention.At the primary of 20th century,the prevalence of HUA was about 1.3%.However,data from the 2015 Nutritional Status and Health Transition of Chinese Residents project found that the prevalence of HUA was as high as 9.8%.Since HUA is asymptomatic in children,HUA in children tends to be ignored easily.A survey based on 3690 children and adolescents aged 6-17 years in urban and rural Shandong Province showed that the prevalence of HUA was 17.4%.Another survey conducted among 1039 children and adolescents aged 4-15 years in Tangshan City,Hebei Province showed that the prevalence of HUA was 13.5%.However,The 7th Korea National Health and Nutrition Examination indicated that the prevalence of HUA was 9.4%in Korean children and adolescents.The prevalence of HUA among Chinese children is relatively high.Various studies indicated that HUA was associated with hypertension,metabolic disorder of blood glucose and lipid,kidney damage,atherosclerosis,and coronary heart disease in adult.However,there are limited data on the associations of HUA and estimated glomerular filtration rate(eGFR),left ventricular mass index(LVMI),and carotid intima-media thickness(cIMT)in children.In addition,how overweight and obesity play a role in the association of childhood HUA with eGFR,LVMI and cIMT levels is still unclear.Therefore,based on the baseline survey of "Huantai Childhood Cardiovascular Health Cohort study",this study aimed to evaluate the association of HUA with eGFR,LVMI,and cIMT in children,and to explore the effect of overweight and obesity on the relationship between HUA and eGFR,LVMI and cIMT levels in children,providing the theoretical evidence to prevent and control renal and cardiovascular structural damage in children.Objectives1.To analyze the association of HU A with eGFR levels in children.2.To analyze the association of HUA with LVMI levels in children.3.To analyze the association of HUA with cIMT levels in children.4.To analyze the effect of overweight and obesity on the association of HUA with eGFR,LVMI,and cIMT levels in children.Subjects and methodsThe study population was obtained from the "Huantai Childhood Cardiovascular Health Cohort Study" conducted in Huantai county,Zibo city,Shandong province.A total of 1515 children aged 6 to 11 years old were examined by physical examination,questionnaire survey,blood biochemical test,and ultrasound examination.After excluding those with missing study variables,a total of 1344 children aged 6 to 11 years with complete information were included in this study.Serum uric acid(SUA)and creatinine(Cr)were collected by blood biochemical test.LVMI and cIMT levels were assessed by ultrasound examination.Based on the"Zhufutang Practical Pediatrics",HUA in chilidren was defined as SUA ≥416 μmol/L.eGFR was calculated using the Schwartz formula as eGFR(ml/min/1.73m2)=49 × height(cm)/Cr(μmol/L).All analyses were performed using SAS 9.4 software.Two-sided P values less than 0.05 were considered statistically significant.Covariance analysis was used to assess the differences in eGFR,LVMI and cIMT levels between children with or without HUA.Adjusted covariates included age,sex,sleep duration,screen time,consumption of fruits and vegetables,carbonated drinks,physical activity,elevated blood pressure,high Fasting Blood Glucose(FBG),high Triglycerides(TG),low High-Density Lipoprotein Cholesterol(HDL-C),and overweight and obesity.Multiple linear regression models were used to examine the asso ciations of HUA with eGFR,LVMI,and cIMT levels.When analyze the effect of overweight and obesity on the relationship between HUA and eGFR,LVMI,and cIMT levels in children,covariance analysis and multiple linear regression were performed stratified by Body Mass Index(BMI)(normal weight vs.overweight and obesity).Results1.Association of HUA with eGFR levels in children.A total of 1344 children aged 6-11 years were included in this study.The level of SUA was(296.3±84.7)μmol/L.The detection rate of HUA was 9.4%,and the level of eGFR was(168.9±26.7)ml/min/1.73m2.After adjusting for potential covariates including age,sex,sleep duration,screen time,consumption of fruit and vegetables,carbontaed drinks,physical activity,elevated blood pressure,high FBG,high TG,low HDL-C,and overweight and obesity,covariance analysis showed that children with HUA(156.9±26.8 ml/min/1.73m2)had a lower eGFR levels than those without HUA(170.2±25.2 ml/min/1.73m2),and the difference was statistically significant(P<0.001).Multiple linear regression analysis found that,HUA was negatively associated with eGFR levels in children(β=-13.30,P<0.001).2.Association of HUA with LVMI levels in children.The level of LVMI was(28.4±4.8)g/m2.7.After adjusting for potential covariates,covariance analysis showed that children with HUA(29.6±4.6 g/m2.7)had a higher LVMI levels than those without HUA(28.2±4.3 g/m2.7),and the difference was statistically significant(P<0.05).Multiple linear regression analysis found that,HUA was positively associated with LVMI levels in children(β=1.37,P=0.002).3.Association of HUA with cIMT levels in children.The level of cIMT was(469.2±79.6)μm.After adjusting for potential covariates,covariance analysis showed that children with HUA(481.9±44.7 μm)had a higher cIMT levels than children without HUA(467.9±42.1 μm),and the difference was statistically significant(P<0.001);Multiple linear regression analysis found that,HUA was positively associated with cIMT levels in children(β=14.03,P<0.001).4.The effect of overweight and obesity on the association of HUA with eGFR,LVMI,and cIMT levels in children.After adjusting for potential covariates,covariance analysis showed that,among normal weight children,children with HUA(154.5±25.1 ml/min/1.73m2)had a lower eGFR levels than children without HUA(169.9±24.7 ml/min/1.73m2),and the difference was statistically significant(P=0.001).The level of LVMI(26.2±3.5 g/m2.7 vs.26.9±3.4 g/m2.7)and cIMT(450.5±36.9 μm vs.450.0±36.4 μm)of HUA children had no significant difference from children without HUA(all P>0.05).Among overweight and obese children,children with HUA had lower eGFR(158.9±27.1 ml/min/1.73m2 vs.170.4±25.7 ml/min/1.73m2),higher LVMI(31.6±5.4 g/m2.7 vs.30.1±5.1 g/m2.7)and cIMT(508.5±50.8 μm vs.493.7±48.2 μm)levels than children without HUA,and the difference were all statistically significant(all P<0.05).Multiple linear regression analysis found that,among normal weight children,HUA was negatively associated with eGFR levels(β=-15.26,P=0.001),and we had failed to find the association of HUA with LVMI(β=-0.79,P=0.234)and cIMT levels(β=-0.50,P=0.943).Among overweight and obese children,HUA was negatively associated with eGFR levels(β=-11.56,P<0.001),and positively associated with LVMI(β=1.44,P=0.018)and cIMT levels(β=14.80,P=0.010).Conclusions1.HUA was associated with eGFR,LVMI and cIMT levels in children.Compared to children without HUA,children with HUA had lower eGFR,and higher LVMI and cIMT levels.2.In both normal weight and overweight and obese children,children with HUA had lower eGFR levels,whereas only overweight and obese children with HUA had higher LVMI and cIMT levels.