Objective

Serum uric acid (SUA) level is associated with the progression of chronic kidney disease (CKD). However, little is known about the predictive value of SUA variability for postoperative CKD in patients with renal cell carcinoma after radical nephrectomy. We aimed to investigate the association of SUA variability with postoperative CKD in this population.

Method

85 patients with preoperative estimated glomerular filtration rate (eGFR)≥60 ml/min/1.73 m² were enrolled in this single-center retrospective study and followed up for at least 6 months. Intra-individual SUA variability was defined as the standard deviation (SD) of SUA and the patients were stratified into three groups according to the tertiles of SUA SD (the lower, middle and upper tertile). The association of SUA variability with postoperative CKD, defined as an eGFR<60 ml/min/1.73m², was analyzed by Cox proportional hazard models and Kaplan-Meier analyses.

Results

After a median follow-up time of 24(10–43) months, 44(51.7%) patients developed postoperative CKD. Kaplan-Meier curves showed that patients in the lower tertile had a longer CKD-free survival time [median CKD-free survival time 74(52.2–95.8) months] than those in the middle tertile [38(19.2-56.8) months] and upper tertile [21(17.9–24.1) months] (overall generalized Wilcoxon test: P=0.001; lower vs middle tertile: P=0.001; lower vs upper tertile: P<0.001). Adjusted Cox analyses indicated that increasing SUA SD tertiles were associated with a higher risk of postoperative CKD independent of baseline SUA, mean SUA during follow-up and other confounding variables. Compared with patients in the lower tertile, the risk for developing CKD increased by 4.6-fold for patients in the middle tertile and 7.9-fold in the upper tertile, respectively.

Conclusion

Increasing SUA variability was associated with an increased risk of postoperative CKD in patients with renal cell carcinoma after radical nephrectomy.

中文翻译：

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血清尿酸变异增加根治性肾切除术后肾细胞癌患者术后慢性肾脏病的风险

客观的

血清尿酸 (SUA) 水平与慢性肾脏病 (CKD) 的进展有关。然而，关于 SUA 变异性对根治性肾切除术后肾细胞癌患者术后 CKD 的预测价值知之甚少。我们旨在调查该人群中 SUA 变异性与术后 CKD 的关联。

方法

85 名术前估计肾小球滤过率 (eGFR) ≥60 ml/min/1.73 m ^{2 的}患者参加了这项单中心回顾性研究，并随访了至少 6 个月。个体内 SUA 变异性定义为 SUA 的标准差 (SD)，根据 SUA SD 的三分位数（下、中和上三分位数）将患者分为三组。SUA 变异性与术后 CKD（定义为 eGFR<60 ml/min/1.73m ^{2 ）的}关联通过 Cox 比例风险模型和 Kaplan-Meier 分析进行分析。

结果

中位随访 24（10-43）个月后，44（51.7%）名患者出现术后 CKD。Kaplan-Meier 曲线显示，低三分位数患者的 CKD-free 生存时间 [中位 CKD-free 生存时间 74(52.2-95.8) 个月] 比中三分位数 [38(19.2-56.8) 个月] 和上三分位数 [21(17.9–24.1) 个月]（总体广义 Wilcoxon 检验：P=0.001；下三分位数与中三分位数：P=0.001；下三分位数与上三分位数：P<0.001)。调整后的 Cox 分析表明，增加 SUA SD 三分位数与术后 CKD 的较高风险相关，独立于基线 SUA、随访期间的平均 SUA 和其他混杂变量。与下三分位数的患者相比，中三分位数的患者发生 CKD 的风险分别增加了 4.6 倍，上三分位数的患者发生 CKD 的风险分别增加了 7.9 倍。

结论

在根治性肾切除术后肾细胞癌患者中，增加 SUA 变异性与术后 CKD 风险增加有关。