| Objective:The aim of this study was to investigate the relationship among serum uric acid and mineral metabolic disorders and vascular calcification in patients with chronic kidney disease(CKD)without dialysis.Method:In this study,we choose 670 non-dialysis patients with chronic kidney disease in the First hospital of Jilin university from January 2017 to March 2019,to calculate estimated glomerular filtration rate according to the simplified formula of MDRD,the patients were divided into five groups,their general clinical data and clinical indicators were collected and sorted out,and the relationship between serum uric acid and related factors in each group of chronic kidney disease was analyzed.According to the level of serum uric acid,patients were divided into normal serum uric acid group and hyperuricemia group,the clinical data and the factors affecting the level of serum uric acid were analyzed.The patients were divided into vascular calcification group and non-calcification group by CT scan of chest,multivariate logistic regression was used to study the independent risk factors of vascular calcification.Results:1.General data analysis of 670 patients with CKD: the age of the patients was19-92 years,406 males(60.60%)and 264 females(39.40%).190 cases(28.36%)in normal uric acid group and 480 cases(71.64%)in hyperuricemia group.407(60.75%)patients with vascular(aorta and/or coronary)calcification and 263(39.25%)patients without vascular calcification.There were 249 patients with diabetes history(37.16%)and 500 patients with hypertension history(74.63%).2.Primary disease analysis: 223 cases of chronic glomerulonephritis(33.28%)including 151 cases of hyperuricemia(67.71%)and 100 cases of vascular calcification(44.84%),197 cases of diabetic nephropathy(29.40%)including 142 cases of hyperuricemia(72.08%)and 150 cases of vascular calcification(76.14%),139 cases of hypertensive nephropathy(20.75%)including 116 cases of hyperuricemia(83.45%),and 95 cases(68.35%)of vascular calcification,111 cases(16.75%)of other primary disease analysis [including secondary glomerular diseases(ANCA-related renal injury,lupus nephritis,purpura nephritis,hepatitis B-related nephropathy,tumor-related glomerulopathy,dry syndrome),interstitial nephritis,polycystic kidney,congenital diseases(single kidney absence,horseshoe kidney)]including 71 cases of hyperuricemia.(63.96%)and 62 cases(55.86%)of vascular calcification.Chronic glomerulonephritis is still the main primary disease of CKD,followed by diabetic nephropathy and hypertensive nephropathy.The incidence of hyperuricemia and vascular calcification is higher in diabetic nephropathy and hypertensive nephropathy than in chronic glomerulonephritis and other primary diseases.3.Distribution of hyperuricemia and vascular calcification in patients with CKD: according to e GFR,patients were divided into 5 groups,62 patients in CKD1group(9.25%)were divided into hyperuricemia 19 cases(30.65%)and vascular calcification 16 cases(25.80%).46 patients in CKD2 group(6.87%)were divided into hyperuricemia 21 cases(45.65%)and vascular calcification 22 cases(47.83%).84 patients in CKD3 group(12.53%)were divided into hyperuricemia 58 cases(69.05%)and vascular calcification 46 cases(54.76%).126 patients in CKD4 group(18.81%)were divided into hyperuricemia 91 cases(72.22%)and vascular calcification 92cases(73.02%).352 cases in CKD5 group(52.54%)were divided into hyperuricemia291 cases(82.43%)and 231 cases(65.63%)of vascular calcification.With the progress of CKD,the number of patients with hyperuricemia and vascular calcification increased gradually,and the proportion of patients with hyperuricemia in CKD1-5 was gradually increased.4.Correlation analysis of hyperuricemia in all stages of CKD: 191 female patients with hyperuricemia were enrolled in the study,of which the average level of serum uric acid in CKD1 was 455.80 umol/L and the increase percentage of serum uric acid was 27%.The average level of serum uric acid in CKD2 was 414.00 umol/L and the increase percentage of serum uric acid was 15%.The average level of serum uric acid in CKD3 was 478.00 umol/L and the increase percentage of serum uric acidwas 33%.The average level of serum uric acid in CKD4 was 465.56 umol/L,the increase percentage of serum uric acid was 29%.The average of serum uric acid in CKD5 was 513.56 umol/L,and the increase percentage of serum uric acid was 43%.Among 289 males,the average level of serum uric acid was 506.64 umol/L in CKD1 stage,and the increase percentage of serum uric acid was 21%.The average level of serum uric acid in CKD2 stage was 488.61 umol/L and the increase percentage of serum uric acid was 16%.The average level of serum uric acid in CKD3 stage was505.00 umol/L and the increase percentage of serum uric acid was 20%.The average level of serum uric acid in CKD4 stage was 526.16 umol/L and the increase percentage of serum uric acid was 25%.The average level of serum uric acid in CKD5 stage was 557.01 umol/L,and the increase percentage of serum uric acid was33%.5.Analysis of clinical indicators of CKD patients in different stages showed that urea nitrogen,serum creatinine,e GFR,serum uric acid,serum phosphorus,PTH,alkaline phosphatase,albumin,total cholesterol,total triglyceride,LDL-C,HDL-C,hemoglobin,corrected calcium,age,history of hypertension,history of diabetes mellitus and vascular calcification had significant differences(P < 0.05).Especially CKD5 stage has higher levels of urea nitrogen,serum creatinine,serum uric acid,serum phosphorus,alkaline phosphatase and PTH,lower levels of corrected calcium,hemoglobin and HDL-C.6.Relationship between serum uric acid level and glomerular filtration rate:serum uric acid level was negatively correlated with glomerular filtration rate,the difference was statistically significant(rs =-0.363,P < 0.001).With the progress of CKD and the decrease of glomerular filtration rate,the level of serum uric acid increased gradually.7.Analysis of clinical indicators in normal uric acid group and hyperuricemia group: the general data and clinical indicators of the two groups were compared and found that significant differences in urea nitrogen,serum creatinine,e GFR,serum phosphorus,PTH,serum albumin,total cholesterol,LDL-C,HDL-C,hemoglobin,corrected calcium,history of hypertension and vascular calcification(P < 0.05),the incidence of arterial calcification in hyperuricemia group was higher than that innormal uric acid group.Multivariate logistic regression analysis showed that history of hypertension(OR=3.190)and albumin(OR=1.102)were independent risk factors for hyperuricemia in CKD patients.8.The correlation between serum uric acid and mineral metabolism disorders in patients with CKD: it was found that serum uric acid level was negatively correlated with serum corrected calcium,and positively correlated with serum phosphorus and PTH(P < 0.05),there was no significant correlation between serum uric acid level and alkaline phosphatase level.9.Relevant analysis of arterial calcification: the patients were divided into vascular calcification group and non-calcification group,the comparison of each index between the two groups showed that urea nitrogen,serum creatinine,e GFR,serum phosphorus,PTH,serum albumin,hemoglobin,corrected calcium,age,history of hypertension,history of diabetes mellitus were found to be significantly different(P < 0.05).Multivariate logistic regression analysis showed that age(OR=3.407),history of hypertension(OR=2.732),history of diabetes mellitus(OR=1.809),serum phosphorus(OR=1.522)were the independent risk factors for vascular calcification in patients with CKD.The proportion of vascular calcification in the hyperuricemia group was higher than that in the normal uric acid group,and serum uric acid was positively correlated with serum phosphorus,and serum phosphorus was an independent risk factor for vascular calcification,therefore,serum uric acid could accelerate vascular calcification by promoting disorders of calcium and phosphorus metabolism,but it was not found that serum uric acid was a factor of vascular calcification.Conclusions:1.The levels of serum uric acid in CKD patients without dialysis were negatively correlated with corrected calcium,and positively correlated with serum phosphorus and PTH2.Serum uric acid can accelerate vascular calcification in non-dialysis patients with CKD by promoting disorders of calcium and phosphorus metabolism3.Serum uric acid plays a role in CKD-MBD... |
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