DOI QR코드

DOI QR Code

Relationship between Albuminuria and Uric Acid to High-Density Lipoprotein Cholesterol Ratio in Korean Adults

대한민국 성인에서 알부민뇨와 요산 대 고밀도 지단백 콜레스테롤 비율의 관련성

  • Hyun YOON (Department of Clinical Laboratory Science, Wonkwang Health Science University)
  • 윤현 (원광보건대학교 임상병리과)
  • Received : 2023.07.10
  • Accepted : 2023.08.11
  • Published : 2023.09.30

Abstract

This study assesses the urine microalbumin to urine creatinine ratio (uACR) with uric acid and the association with the high-density lipoprotein cholesterol (UA/HDL-C) ratio in Korean adults. Data from the 2019 Korean National Health and Nutrition Examination Survey was procured and included 5,845 adults aged 20 years or older. Several key findings were obtained in the present study. After adjusting for the related variables (age, gender, hypertension, obesity, type 2 diabetes mellitus, and chronic kidney disease), the uACR was found to be positively associated with the quartiles of the UA/HDL-C ratio (P=0.002). Moreover, after adjusting for related variables, the odds ratio (OR) of albuminuria (uACR≥30.0 mg/g) was not significant in quartile 2 (Q2) (OR, 1.015; 95% confidence interval [CI], 0.757~1.361) and Q3 (OR, 1.090; 95% CI, 0.811~1.465) but was significantly higher in Q4 (OR, 1.416; 95% CI, 1.044~1.921) as compared to Q1 of the UA/HDL-C ratio. We conclude that since the UA/HDL-C ratio is positively associated with albuminuria in Korean adults, an increased UA/HDL-C ratio could be applied as a useful measure to assess albuminuria in Korean adults.

본 연구는 한국 성인에서 요산 대 고밀도 지단백 콜레스테롤(uric acid to high density lipoprotein cholesterol, UA/HDL-C) 비율과 요 중 마이크로알부민 대 크레아티닌 비율(uACR)의 연관성을 평가하기 위해 수행되었다. 2019년 국민건강영양조사 자료를 이용하여 20세 이상 성인 5,845명을 대상으로 연구를 수행하였다. 본 연구에서 몇 가지 중요한 발견이 있었다. 첫째, 관련 변수(연령, 성별, 고혈압, 비만, 제2형 당뇨병 및 만성 신장 질환)를 조정한 후, UA/HDL-C ratio의 사분위수가 증가함에 따라 uACR수준이 증가하였다(P=0.002). 둘째, 관련 변수를 조정한 후, UA/HDL-C ratio의 사분위수 1 (Q1)과 비교하여 알부민뇨(uACR≥30.0 mg/g)의 odd ratio (OR)은 Q2(OR, 1.015; 95% confidence interval [CI], 0.757~1.361)와 Q3 (OR, 1.090; 95% CI, 0.811~1.465)에서는 유의하지 않았다. 그러나 Q4 (OR, 1.416; 95% CI, 1.044~1.921)에서 알부민뇨의 발생률은 Q1에 비하여 유의하게 높았다. 한국 성인에서 UA/HDL-C ratio는 알부민뇨와 양의 상관관계가 있었고, UA/HDL-C ratio는 대한민국 성인에서 알부민뇨를 평가하는 유용한 지표로 사용될 수 있을 것으로 사료된다.

Keywords

Acknowledgement

This paper was supported by Wonkwang Health Science University in 2023.

References

  1. Seong JM, Park CE, Gi MY, Sun KS, Kim YJ, Yoon H. The relationship between pulse pressure, the estimated glomerular filtration rate, and urine microalbumin/creatinine ratio in Korean adults. Kidney Blood Press Res. 2017;42:816-826. https://doi.org/10.1159/000484381
  2. Koroshi A. Microalbuminuria, is it so important? Hippokratia. 2007;11:105-107.
  3. Jung HH. Albuminuria, estimated glomerular filtration rate, and traditional predictors for composite cardiovascular and kidney outcome: a population-based cohort study in Korea. Kidney Res Clin Pract. 2022;41:567-579. https://doi.org/10.23876/j.krcp.22.005
  4. Levey AS, de Jong PE, Coresh J, El Nahas M, Astor BC, Matsushita K, et al. The definition, classification, and prognosis of chronic kidney disease: a KDIGO Controversies Conference report. Kidney Int. 2011;80:17-28. https://doi.org/10.1038/ki.2010.483 Erratum in: Kidney Int. 2011;80:1000.
  5. Johnson RJ, Bakris GL, Borghi C, Chonchol MB, Feldman D, Lanaspa MA, et al. Hyperuricemia, acute and chronic kidney disease, hypertension, and cardiovascular disease: report of a scientific workshop organized by the National Kidney Foundation. Am J Kidney Dis. 2018;71:851-865. https://doi.org/10.1053/j.ajkd.2017.12.009
  6. Zuo T, Liu X, Jiang L, Mao S, Yin X, Guo L. Hyperuricemia and coronary heart disease mortality: a meta-analysis of prospective cohort studies. BMC Cardiovasc Disord. 2016;16:207. https://doi.org/10.1186/s12872-016-0379-z
  7. Kawachi K, Kataoka H, Manabe S, Mochizuki T, Nitta K. Low HDL cholesterol as a predictor of chronic kidney disease progression: a cross-classification approach and matched cohort analysis. Heart Vessels. 2019;34:1440-1455. https://doi.org/10.1007/s00380-019-01375-4
  8. Femlak M, Gluba-Brzozka A, Cialkowska-Rysz A, Rysz J. The role and function of HDL in patients with diabetes mellitus and the related cardiovascular risk. Lipids Health Dis. 2017;16:207. https://doi.org/10.1186/s12944-017-0594-3
  9. Liu R, Peng Y, Wu H, Diao X, Ye H, Huang X, et al. Uric acid to high-density lipoprotein cholesterol ratio predicts cardiovascular mortality in patients on peritoneal dialysis. Nutr Metab Cardiovasc Dis. 2021;31:561-569. https://doi.org/10.1016/j.numecd.2020.10.005
  10. Levey AS, Stevens LA. Estimating GFR using the CKD Epidemiology Collaboration (CKD-EPI) creatinine equation: more accurate GFR estimates, lower CKD prevalence estimates, and better risk predictions. Am J Kidney Dis. 2010;55:622-627. https://doi.org/10.1053/j.ajkd.2010.02.337
  11. Park SM, Gi MY, Cha JA, Sung HH, Park SY, Park CH, et al. The relationship between anemia and hyperuricemia and hypertension in Korean adults: the Korea National Health and Nutrition Examination Survey 2016-2018. Curr Med Res Opin. 2023;39:819-825. https://doi.org/10.1080/03007995.2023.2213004
  12. Seong JM, Gi MY, Cha JA, Sung HH, Park SY, Park CH, et al. Gender difference in the association of hyperuricemia with insulin resistance and beta-cell function in nondiabetic Korean adults: the 2019 Korea National Health and Nutrition Examination Survey. Endocr Res. 2023;48:1-8. https://doi.org/10.1080/07435800.2022.2142239
  13. Redon J, Selma-Soriano E, Cortes R. Insights into glomerular filtration and albuminuria. N Engl J Med. 2021;385:477-478. https://doi.org/10.1056/nejmc2108129
  14. Fangel MV, Nielsen PB, Kristensen JK, Larsen TB, Overvad TF, Lip GY, et al. Albuminuria and risk of cardiovascular events and mortality in a general population of patients with type 2 diabetes without cardiovascular disease: a Danish cohort study. Am J Med. 2020;133:e269-e279. https://doi.org/10.1016/j.amjmed.2019.10.042
  15. Saran R, Robinson B, Abbott KC, Agodoa LYC, Bragg-Gresham J, Balkrishnan R, et al. US Renal Data System 2018 Annual Data Report: epidemiology of kidney disease in the United States. Am J Kidney Dis. 2019;73(3 Suppl 1):A7-A8. https://doi.org/10.1053/j.ajkd.2019.01.001
  16. Lima WG, Martins-Santos ME, Chaves VE. Uric acid as a modulator of glucose and lipid metabolism. Biochimie. 2015;116:17-23. https://doi.org/10.1016/j.biochi.2015.06.025
  17. Borghi C, Agabiti-Rosei E, Johnson RJ, Kielstein JT, Lurbe E, Mancia G, et al. Hyperuricaemia and gout in cardiovascular, metabolic and kidney disease. Eur J Intern Med. 2020;80:1-11. https://doi.org/10.1016/j.ejim.2020.07.006
  18. Kronenberg F. HDL in CKD-the devil is in the detail. J Am Soc Nephrol. 2018;29:1356-1371. https://doi.org/10.1681/asn.2017070798
  19. Kocak MZ, Aktas G, Erkus E, Sincer I, Atak B, Duman T. Serum uric acid to HDL-cholesterol ratio is a strong predictor of metabolic syndrome in type 2 diabetes mellitus. Rev Assoc Med Bras (1992). 2019;65:9-15. https://doi.org/10.1590/1806-9282.65.1.9
  20. Zhu W, Liang A, Shi P, Yuan S, Zhu Y, Fu J, et al. Higher serum uric acid to HDL-cholesterol ratio is associated with onset of non-alcoholic fatty liver disease in a non-obese Chinese population with normal blood lipid levels. BMC Gastroenterol. 2022;22:196. https://doi.org/10.1186/s12876-022-02263-4
  21. Cheng Y, Zhang H, Zheng H, Yin H, Wang Y, Wang H, et al. Association between serum uric acid/HDL-cholesterol ratio and chronic kidney disease: a cross-sectional study based on a health check-up population. BMJ Open. 2022;12:e066243. https://doi.org/10.1136/bmjopen-2022-066243
  22. Aktas G, Kocak MZ, Bilgin S, Atak BM, Duman TT, Kurtkulagi O. Uric acid to HDL cholesterol ratio is a strong predictor of diabetic control in men with type 2 diabetes mellitus. Aging Male. 2020; 23:1098-1102. https://doi.org/10.1080/13685538.2019.1678126