NDT Advance Access originally published online on April 25, 2009
Nephrology Dialysis Transplantation 2009 24(8):2584-2590; doi:10.1093/ndt/gfp192
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Moderate-to-severe early-onset hyperuricaemia: a prognostic marker of long-term kidney transplant outcome
1 Department of Surgery, Seoul National University College of Medicine 2 Department of Surgery, Konkuk University College of Medicine, Seoul 3 Department of Surgery, Gachon University of Medicine and Science, Incheon 4 Department of Internal Medicine, Seoul National University College of Medicine 5 Transplantation Research Institute, Seoul National University Medical Research Center, Seoul, Korea
Correspondence and offprint requests to: Jongwon Ha; E-mail: jwhamd{at}snu.ac.kr
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Abstract |
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Background. Hyperuricaemia commonly occurs in renal transplant recipients (RTRs), but the effects of post-transplant hyperuricaemia on kidney transplant outcome have not been clearly established. This work was designed to explore the impact of hyperuricaemia on renal transplant outcome.
Methods. The authors examined this issue by analysing the clinical outcome of 281 RTRs. Hyperuricaemia (defined as UA > 7.0 mg/dl in men and >6.0 mg/dl in women for at least two consecutive tests, n = 121) was classified as early onset (within 1 year of transplant, n = 90) or late onset (n = 31). Graft function was estimated using the MDRD Study Equation 7 (eGFRMDRD).
Results. As late-onset hyperuricaemia was found to be induced by a progressive decline in the graft function (P < 0.01), data from early-onset hyperuricaemic recipients were used. Early-onset moderate-to-severe hyperuricaemia (defined as UA 
8.0 mg/dl) was found to be a significant risk factor for chronic allograft nephropathy (P = 0.035) and a poorer graft survival (P = 0.026) by multivariate analysis, whereas mild hyperuricaemia was not. The impact of moderate-to-severe hyperuricaemia on renal transplant survival was dependent on the duration of exposure. Likewise, the detrimental effect of early-onset hyperuricaemia on the graft function was dependent on UA levels and exposure time. After control of the baseline graft function by analysis of only recipients with a good graft function at 1 year post-transplantation (eGFRMDRD > 60 ml/min), moderate-to-severe early-onset hyperuricaemia was also found to be a marker of long-term graft dysfunction and failure.
Conclusion. Moderate-to-severe early-onset hyperuri- caemia may be a prognostic marker of the long-term graft outcome in RTRs, which needs further investigation.
Keywords: chronic allograft nephropathy; graft function; graft survival; hyperuricaemia; renal transplantation
Received for publication: 15.12.08
Accepted in revised form: 1. 4.09