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Table 1 Characteristics of studies included in the meta-analysis

From: Hyperuricemia increases the risk of acute kidney injury: a systematic review and meta-analysis

Authors (year)

Study period

Country

Study design

Sample size

Mean age (y)

Percentage of Male (%)

Inclusion criteria

Definition of hyperuricemia or grouping according to SUA

Definition of AKI

Mean baseline eGFR in HUA group (ml/min/1.73 m2)

Conclusions

Shacham, et al. (2016) [48]

2008–2015

Israel

Retrospective cohort

1372

62 ± 12

85

Acute STEMI patients requiring PCI

<4.7 mg/dl, 4.8–5.6 mg/dl, 5.7–6.6 mg/dl, >6.7 mg/dl

A rise in sCr >0.3 mg/d above the admission sCr within 48 h

79 ± 19, 75 ± 17, 70 ± 11, 63 ± 20 for 4 groups respectively

Elevated UA levels are an independent predictor of AKI

Cheungpasitporn, et al. (2016) [49]

2011–2013

USA

Retrospective cohort

1435

62 ± 16

60.3

All hospitalized adult patients without ESRD and AKI at presentation and trauma

<3.4 mg/dl, 3.4–4.5 mg/dl, 4.5–5.8 mg/dl, 5.8–7.6 mg/dl, 7.6–9.4 mg/dl, >9 mg/dl

An increase in sCr ≥0.3 mg/dL within 48 h or ≥1.5 times baseline within 7 days after admission date

89.5 ± 20.6, 88.1 ± 21.9, 79.3 ± 24.5, 71.7 ± 24.8, 58.6 ± 22.3, 53.2 ± 21.8 for 6 groups respectively

Elevated admission SUA was associated with an increased risk for in-hospital AKI

Otomo, et al. (2015) [6]

1981–2011

Japan

Retrospective cohort

59,219

58.6 ± 17.9

48.4

All hospitalized patients

The first stratum: SUA ≤2.0 mg/dL; the 12th stratum: SUA >7.0 mg/dL, with SUA levels in each succeeding stratum increasing by increments of 0.5 mg/dL

An increase ≥0.3 mg/dL in the sCr level within 48 h; or ≥1.5 times baseline within the prior 7 days; or urine volume of 0.5 mL/kg/h within 6 h

102 ± 50, 99 ± 44, 96 ± 45, 93 ± 38, 88 ± 31, 86 ± 34, 81 ± 28, 79 ± 29, 76 ± 28, 73 ± 28, 70 ± 27, 59 ± 34 for 6 groups respectively

SUA level could be an independent risk factor for AKI development in hospitalized patients

Liang, et al. (2015) [50]

2009–2014

China

Prospective cohort

59

37.3 ± 10.6

NR

Severe burn

NR

An absolute anincrease in sCr > 0.3 mg/dl from baseline within 48 h after injury

NR

Elevated SUA after injury due to hypoxia is closely correlated with early AKI after severe burns

Lee, et al. (2015) [7]

2006–2011

Korea

Retrospective cohort

2,185

63.6 ± 9.1

74.7

All patients undergoing CABG

NR

An increase in sCr of ≥0.3 mg/dL or ≥150% from baseline within the first 48 h after operation

NR

Preoperatively Elevated SUA was significantly associated with AKI and improved the ability to predict the development of AKI in patients undergoing CABG

Lazzeri, et al. (2015) [51]

2006–2013

Italy

Prospective cohort

329

77.2 ± 10.0

53.8

STEMI patients submitted to primary PCI

SUA ≤ 5.9 mg/dl, 6.0–7.4 mg/dl, >7.4 mg/dl

An absolute increase in sCr level of 0.3 mg/dl or more, or a relative increase in sCr level of 50% or more during the ICCU stay

42.8 ± 14.3, 42.5 ± 13.4, 40.8 ± 12.2 for 3 groups respectively

Uric acid helps in identifying a subset of patients at a higher risk of AKI and 1-year mortality.

Gaipov, et al. (2015) [52]

2011–2012

Turkey

Prospective cohort

60

56.7 ± 16.4

70.0

Patients undergoing cardiac surgery

NR

An increase in sCr by 0.3 mg/dL within 48 h or increase in sCr to 1.5 times baseline

NR

Uric acid seems to predict the progression of AKI and RRT requirement in patients underwent cardiac surgery better than NGAL

Barbieri, et al. (2015) [8]

2007–2011

Italy

Retrospective cohort

1,950

72.1 ± 8.7

NR

Patients undergoing coronary angiography and /or angioplasty with GFR ≤ 89 ml/min

SUA ≤ 5.5 mg/dL; 5.6–7.0 mg/dL; ≥7.0 mg/dL

An absolute ≥0.5 mg/dl or a relative ≥25% increase in the sCr level at 24 or 48 h after the procedure

NR

Elevated SUA level is independently associated with an increased risk of CIN

Guo, et al. (2015) [53]

2010–2013

China

Prospective cohort

1772

64.43 ± 11.35

76.5

Patients who underwent PCI

SUA > 7 mg/dL (417 μmol/L) in males and >6 mg/dL (357 μmol/L) in females.

an increase in sCr of >0.5 mg/dL from the baseline within 48–72 h of contrast exposure

71.08 ± 24.70

Hyperuricemia is associated with a risk of CI-AKI. Long-term mortality after PCI was higher in those with hyperuricemia than with normouricemia after adjusting.

Joung, et al. (2014) [54]

2011–2012

Korea

Retrospective cohort

1,094

63.0

62.2

Patients undergoing cardiovascular surgery

SUA > 6.5 mg/dL (preoperative) (6.0 mg/dL in women and 7.0 mg/dL in men)

An increase ≥0.3 mg/dL in the sCr level or ≥1.5 times baseline within 48 h

NR

Preoperative elevated serum uric acid is an independent risk factor for AKI in patients undergoing cardiovascular surgery.

Xu, et al. (2014) [55]

2005–2011

China

Retrospective cohort

936

65.2 ± 4.2

54.3

Old patients (≥60 years) undergoing CPB

SUA ≤ 384.65; 384.66–476.99; ≥477.00 μmol/L (males) SUA ≤ 354.00; 354.01–437.96; ≥437.97 μmol/L (females)

An increase in sCr ≥150% from baseline within the first 7 days after operation

73.8 ± 17.2, 69.3 ± 14.2, 61.5 ± 15.8 for 3 groups respectively

Pre-operative elevated uric acid is an independent risk factor of AKI after cardiac surgery in elderly patients

Liu, et al. (2013) [56]

2010–2011

China

Prospective cohort

788

62.8 ± 11.3

78.6

Patients undergoing PCI

SUA >7 mg/dL in males and >6 mg/dL in females

An increase in sCr of ≥ 0.5 mg/dL above the baseline value within 48–72 h after PCI

*Creatinine Clearance: 65 ± 24 ml/min

Hyperuricemia was significantly associated with the risk of CI-AKI in patients with relatively normal serum creatinine after PCI

Lapsia, et al. (2012) [57]

2004–2008

USA

Retrospective cohort

190

63.9 ± 0.9

62.1

Patients undergoing cardiovascular surgery

SUA ≥7 mg/dL

An absolute increase in sCr of ≥ 0.3 mg/dL from baseline within 48 h after surgery

47.6 ± 1.8

Preoperative SUA was associated with increased incidence and risk for AKI

Ejaz, et al. (2012) [58]

NR

USA

Prospective cohort

100

61.4 ± 1.4

60

Patients undergoing cardiac surgery with eGFR > 30 ml/min/1.73 m2

SUA < 4.53 mg/dL, 4.53–5.77 mg/dL, > 5.77 mg/dL

An absolute increase in sCr ≥ 0.3 mg/dL from baseline within 48 h after surgery

NR

Post-operative SUA is associated with an increased risk for AKI and compares well to conventional markers of AKI

Park, et al. (2011) [59]

2006–2009

Korea

Retrospective cohort

1,247

64.3 ± 11.9

62.3

Patients undergoing PCI

SUA ≥7.0 mg/dl for males and ≥ 6.5 mg/dl for females.

An increase in sCr of ≥0.5 mg/dl or ≥50% over baseline within 7 days of PCI

NR

Hyperuricemia is independently associated with an increased risk of in-hospital mortality and AKI in patients treated with PCI

Kim, et al. (2011) [60]

2007–2008

Korea

Retrospective cohort

247

46.1 ± 13.7

52

Acute PQ intoxication

SUA ≥7.3 mg/dL in men or ≥5.3 mg/dL in women

An increase in sCr of ≥0.3 mg/dL or ≥150% from baseline within 48 h after admission

NR

Baseline serum uric acid level might be a good clinical marker for patients at risk of mortality and AKI after acute PQ intoxication

Ben-Dov, I. Z., et al. (2011) [61]

1976–1979

Israel

Retrospective cohort

2449

58.8

50 ± 6

Patients in Lipid Research Clinic cohort

>6.5 mg/dL in men and >5.3 mg/dL in women

NR

93 ± 18 in men and women

SUA was found to be a strong predictor of acute renal failure

Toprak et al. (2006) [62]

2004–2005

Turkey

Prospective cohort

266

58.9 ± 7.4

61%

Nonemergency diagnostic coronary angiography with Scr > 1.2 mg/dl

>7 mg/dl in men and 6.5 mg/dl in women.

An increase of ≥25% in sCr over baseline within 48 h of coronary angiography

55.26 ± 13.7

Patients with hyperuricemia are at risk of developing CIN.

  1. Abbreviations: SUA serum uric acid, sCr serum creatintine, AKI acute kidney injury, CABG Coronary Artery Bypass Grafting, STEMI ST-elevation myocardial infarction, PCI percutaneous coronary intervention, NGAL neutrophil gelatinase-associated lipocalin, GFR glomerular filtration rate, eGFR estimated glomerular filtration rate, CIN contrast-induced nephropathy, CI-AKI contrast-induced acute kidney injury, PQ paraquat, NR not reported