Uric acid levels and metabolic shifts in hypertensive patients with moderate excretory dysfunction
- 作者: Zhloba A.A.1, Subbotina T.F.1
-
隶属关系:
- Academician I.P. Pavlov First St. Petersburg State Medical University
- 期: 卷 69, 编号 7 (2024)
- 页面: 79-90
- 栏目: Original Study Articles
- ##submission.datePublished##: 27.08.2024
- URL: https://kld-journal.fedlab.ru/0869-2084/article/view/634171
- DOI: https://doi.org/10.17816/cld634171
- ID: 634171
如何引用文章
详细
BACKGROUND: Development of hyperuricemia — elevated level of uric acid — is often associated with arterial hypertension. Owing to the widespread prevalence of hyperuricemia in Russia, additional diagnostic markers and pathogenetic correlations between uric acid and other metabolic markers should be studied. In contrast to uric acid, homocysteine, citrulline, and homoarginine content in the blood depends on transmembrane transport and enzymatic reactions in kidney tissue.
AIM: To study the correlation between uric acid levels and metabolic dysfunction markers in hypertensive patients under moderate impairment of excretory function.
MATERIALS AND METHODS: The levels of uric acid, citrulline, homoarginine, total homocysteine, methionine, and other clinical and laboratory parameters were determined for 115 patients with arterial hypertension, with a median age and interquartile range of 64 [54–71] years and an estimated glomerular filtration rate of 45 ml/min/1.73 m2.
RESULTS: In 57 (50%) patients, the uric acid level exceeded the threshold value of 360 μM, indicating an increased risk of cardiovascular complications. Reduced metabolic functions of the kidneys under decreased citrulline, total homocysteine, methionine, and homoarginine levels in the entire group of patients and separately in subgroups of men and women were observed significantly more often than an elevated uric acid level or decreased estimated glomerular filtration rate. The uric acid level was positively correlated with markers of carbohydrate-lipid metabolism: triglycerides (Rs=0.334, p=0.018), glucose (Rs=0.252, p=0.046), and body mass index (Rs=0.396, p=0.001). Similar to uric acid, the homoarginine level showed a positive relationship with body mass index (Rs=0.302, p=0.003). After adjusting for gender and estimated glomerular filtration rate, an association analysis regarding the role of body mass index was performed. It was found that the close correlation between uric acid level and body mass index was significant over others (r=0.421, p=0.0011). In predicting uric acid levels, the relative contribution of estimated glomerular filtration rate and body mass index was equivalent according to multiple regression analysis, that is, an increase in uric acid levels is associated with both renal dysfunction and accumulation of adipose tissue.
CONCLUSION: Renal metabolic insufficiency with hyperuricemia under the initial stages of hypertension is asymptomatic, thus, additional markers have been proposed for the evaluation of remodeling of tissue metabolism in the kidneys, including citrulline, homoarginine, and total homocysteine.
全文:
作者简介
Aleksandr Zhloba
Academician I.P. Pavlov First St. Petersburg State Medical University
编辑信件的主要联系方式.
Email: zhlobaaa@1spbgmu.ru
ORCID iD: 0000-0003-0605-7617
SPIN 代码: 6096-2117
Scopus 作者 ID: 7004465896
MD, Dr. Sci. (Medicine), Professor
俄罗斯联邦, 6-8 L. Tolstoy Str., bldg. 3, St. Petersburg, 197022Tatiana Subbotina
Academician I.P. Pavlov First St. Petersburg State Medical University
Email: subbotina2002@mail.ru
ORCID iD: 0000-0002-2278-8391
SPIN 代码: 9691-2123
Scopus 作者 ID: 6701446219
MD, Dr. Sci. (Medicine), Assistant Professor
俄罗斯联邦, 6-8 L. Tolstoy Str., bldg. 3, St. Petersburg, 197022参考
- Chazova IE, Zhernakova YuV, et al. Clinical guidelines. Diagnosis and treatment of arterial hypertension. Systemic Hypertension. 2019,16(1):6–31. doi: 10.26442/2075082X.2019.1.190179
- Borghi C, Tykarski A, Widecka K, et al. Expert consensus for the diagnosis and treatment of patient with hyperuricemia and high cardiovascular risk. Cardiol. J. 2018,25(5):545–563. doi: 10.5603/CJ.2018.0116
- Shalnova SA, Deev AD, Artamonov GV, et al. Hyperuricemia and its correlates in the Russian population (results of ESSE-RF epidemiological study). Rational Pharmacotherapy in Cardiology. 2014,10(2):153–159. doi: 10.20996/1819-6446-2014-10-2-153-159
- Chazova IE, Zhernakova JV, Kisliak OA, et al. Consensus on patients with hyperuricemia and high cardiovascular risk treatment. Systemic Hypertension. 2019,16(4):8–21. doi: 10.26442/2075082X.2019.4.190686.53
- Wen S, Arakawa H, Tamai I. Uric acid in health and disease: From physiological functions to pathogenic mechanisms. Pharmacol. Ther. 2024,256:108615. doi: 10.1016/j.pharmthera.2024.108615
- Bi M, Feng A, Liu Y, Tian S. U-shaped association of serum uric acid with cardiovascular disease risk scores and the modifying role of sex among Chinese adults. Nutr. Metab. Cardiovasc. Dis. 2023,33(5):1066–1076. doi: 10.1016/j.numecd.2023.02.025
- Roman YM. The role of uric acid in human health: insights from the uricase gene. J. Pers. Med. 2023,13(9):1409. doi: 10.3390/jpm13091409
- Sharaf El Din UAA, Salem MM, Abdulazim DO. Uric acid in the pathogenesis of metabolic, renal, and cardiovascular diseases: A review. J. Adv. Res. 2017,8(5):537–548. doi: 10.1016/j.jare.2016.11.004
- Girigoswami K, Arunkumar R, Girigoswami A. Management of hypertension addressing hyperuricaemia: introduction of nano-based approaches. Ann. Med. 2024,56(1):2352022. doi: 10.1080/07853890.2024.2352022
- Dwyer KM, Kishore BK, Robson SC. Conversion of extracellular ATP into adenosine: a master switch in renal health and disease. Nat. Rev. Nephrol. 2020,16(9):509–524. doi: 10.1038/s41581-020-0304-7
- Zhloba AA, Subbotina TF. The evaluation of folate status using total homocysteine in hypertensive patients. Medical Journal of the Russian Federation. 2019,25(3):158–165. doi: 10.18821/0869-2106-2019-25-3-158-165
- Zhloba AA, Subbotina TF, Reypolskaya TYu. The level of blood citrulline in hypertensive patients with abnormal renal excretory function. Russian Clinical Laboratory Diagnostics. 2023,68(3):133–140. doi: 10.51620/0869-2084-2023-68-3-133-140
- Zhloba AA, Subbotina TF. The evaluation of homoarginine and folic acid in patients with arterial hypertension. Russian Clinical Laboratory Diagnostics. 2020,65(8):474–481. doi: 10.18821/0869-2084-2020-65-8-474-481
- Patent RUS № 2609873/ 06.02.2017. Zhloba AA, Subbotina TF, Shipaeva KA. Method of determining homoarginine content in blood plasma and other human biological fluids. Available from: https://www.elibrary.ru/download/elibrary_38258690_29790170.pdf EDN: FTKBFA
- Zhloba AA, Subbotina TF. evaluation of homocysteine binding with a fraction of plasma proteins associated with vascular remodeling. Arterial Hypertension. 2013,19(2):184–188. doi: 10.18705/1607-419X-2013-19-2-184-188
- Tietz NW, editor. Clinical guide to laboratory tests. Moscow: Meditsina, 1986.
- Sakaguchi YM, Wiriyasermkul P, Matsubayashi M, et al. Identification of three distinct cell populations for urate excretion in human kidneys. J. Physiol. Sci. 2024 74(1):1. doi: 10.1186/s12576-023-00894-0
- Boban M, Kocic G, Radenkovic S, et al. Circulating purine compounds, uric acid, and xanthine oxidase/dehydrogenase relationship in essential hypertension and end stage renal disease. Ren. Fail. 2014,36(4):613–618. doi: 10.3109/0886022X.2014.882240
- D'Elia L, Masulli M, Cirillo P, et al. Serum uric acid/serum creatinine ratio and cardiovascular mortality in diabetic individuals-the uric acid right for heart health (URRAH) project. Metabolites. 2024,14(3):164. doi: 10.3390/metabo14030164
- Khasun MH, Rumyantsev ASh, Galkina OV, Korosteleva NYu. Urine uromodulin and angiotensin converting enzyme inhibitors: is there a relationship? Nephrology (Saint-Petersburg). 2022,26(1):69–74. doi: 10.36485/1561-6274-2022-26-1-69-74
- Iakovleva AV, Vertov NA, Zaleskiy MG, et al. A pathogenetic role of posttranslational isoforms of uromodulin. Biofizika. 2023,68(3):609–615. doi: 10.31857/S0006302923030225
- Gadaev AG, Dadabayeva RK. Assessment of the role of albuminuria and uromodulin in the early diagnosis of renal function disorders in some types of obesity phenotypes. Nephrology (Saint-Petersburg). 2024,28(1):72–79. doi: 10.36485/1561-6274-2024-28-1-72-79