RESUMEN
Objective: To determine the nationwide prevalence of hyperuricemia in China and evaluate its trends and associated risk factors. Methods: Using a multi-stage, stratified, cluster-randomized sampling design, two cross-sectional surveys (representative of national and provincial information) were conducted in 31 provinces (autonomous regions and municipalities) in mainland China, with 166, 861 Chinese adults in 2015-16 and 168, 351 in 2018-19. Serum uric acid (SUA) levels of all participants were measured after a >10-hour overnight fast. Hyperuricemia (HUA) was defined when SUA was >420 µmol/L. Prevalence estimates were weighted to represent the total population considering the complex sampling design. Multivariable logistic regression models was used to estimate factors associated with HUA. Results: The overall hyperuricemia prevalence in the Chinese adult population was 11.1% (95% confidence interval 10.3% to 11.8%) in 2015-16 and 14.0% (13.1% to 14.8%) in 2018-19; an alarming rise was observed in the three years. Hyperuricemia was more common in men with 19.3% (17.9% to 20.7%) in 2015-16 and 24.4% (23.0% to 25.8%) in 2018-19, although the prevalence also escalated from 2.8% (2.5% to 3.0%) in 2015-16 to 3.6% (3.2% to 4.0%) in 2018-19 in women. The hyperuricemia risk factors include the urban culture, settlement in the East, Zhuang descent, high education, heavy or frequent beer drinking, high red meat intake, physical inactivity, high body mass index, central obesity, hypertension, hyperlipidemia, and low glomerular filtration rate. Conclusion: The estimated hyperuricemia prevalence among Chinese adults was 14.0% in 2018-19; significant escalating trends were observed between 2015-16 and 2018-19.
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Hiperuricemia , Adulto , China/epidemiología , Estudios Transversales , Femenino , Humanos , Hiperuricemia/epidemiología , Masculino , Prevalencia , Ácido ÚricoRESUMEN
BACKGROUND: Serum uric acid (UA, mg/dl) levels associate with the pathophysiology and prognosis in patients with chronic heart failure. PURPOSE: To clarify the clinical significance of hyperuricemia (HUA, UA>7.0) in Fontan patients. METHODS AND RESULTS: We prospectively measured UA in 197 child and 102 adult Fontan patients and compared the results with the clinical variables, including hemodynamics, exercise capacity, and plasma levels of norepinephrine (NE) and brain natriuretic peptide, and unscheduled hospitalization (USH), including all-cause mortality. The mean UA was 5.8 ± 1.7 and 66 patients (22%, 34% in the adults) showed HUA. HUA was associated with lower peak oxygen uptake only in adults (r = -0.35, p < 0.0001). In children the use of diuretics, central venous pressure, liver enzymes, NE, and plasma creatinine (Cr) independently associated with UA. Of those, in addition to hypoxia, the use of diuretics and Cr independently predicted HUA (p < 0.05-0.001). In adults, hypoxia, plasma levels of sodium and Cr independently determined UA. Of those, hypoxia and hyponatremia independently predicted HUA (p < 0.05-0.001). During a follow-up of 49 ± 27 months, 67 USH, including 17 deaths, occurred. In all patients, on univariate analysis, HUA predicted mortality (hazard ratio: 3.2, 95% confidence interval: 1.2-8.6, p = 0.0193). HUA predicted USH in all, adult and child Fontan patients (p<0.05-0.0001), however, these prognostic values, including for mortality, were not independent in the multivariate analyses. CONCLUSIONS: UA reflects global postoperative Fontan pathophysiology, including the prognosis, with some differences between child and adult patients. However, the prognostic value of HUA may be limited in multivariate models in this particular cohort.
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Procedimiento de Fontan/mortalidad , Insuficiencia Cardíaca/sangre , Insuficiencia Cardíaca/mortalidad , Hiperuricemia/sangre , Hiperuricemia/mortalidad , Ácido Úrico/sangre , Adolescente , Adulto , Biomarcadores/sangre , Niño , Femenino , Estudios de Seguimiento , Procedimiento de Fontan/tendencias , Insuficiencia Cardíaca/cirugía , Humanos , Masculino , Morbilidad , Mortalidad/tendencias , Estudios Prospectivos , Adulto JovenRESUMEN
BACKGROUND: Kidney function progressively deteriorates in patients with familial juvenile hyperuricemiac nephropathy (FJHN, OMIN 162000) and chronic renal disease is commonly associated to dyslipidemia. We report for the first time abrupt renal insufficiency in a patient with FJHN and hypertrygliceridemia following fenofibrate administration. CASE REPORT: A 53-year-old man was diagnosed clinically with FJHN at age 24 years which was subsequently confirmed by genotypic analysis of the UMOD gene at age 40 years. His mother and two brothers suffered the disease. At that time, renal size and function were normal, as was his blood pressure and serum lipids. At age 34 years, serum urate was 8.5 mg/dL and creatinine 1.7 mg/dL (GFR, 58 mL/min/1.73 m2). He was treated with allopurinol, losartan, and lovastatin. Serum TG levels ranged between 150 and 250 mg/dL. At age 52 years, serum urate was 4.1 mg/dL, creatinine 3.2 mg/dL, LDLc 99 mg/dL (atorvastatin 40 mg/d), and TG 275 mg/dL. Fenofibrate (160 mg/d) was added. One month later, serum creatinine increased to 4.2 mg/dL and TG decreased to 125 mg/dL. He did not complain of muscle pain, weakness, or changes in urinary frequency or color and rabdomyolysis was discarded. Fenofibrate was withheld and three months later serum creatinine decreased to baseline levels (3.2 mg/dL) and TG increased to 197 mg/dL. CONCLUSION: To our knowledge, this is the first patient with FJHN in whom fenofibrate administration was associated to a further impairment in renal function not attributable to rabdomyolysis.