Tsai CW, et al. - Whether longitudinal serum uric acid (SUA) trajectories are associated with the risk of end-stage renal disease (ESRD) and all-cause mortality among chronic kidney disease (CKD) patients, was determined in a prospective cohort study. Findings demonstrated the association of elevated SUA trajectories with accelerated kidney failure and all-cause mortality.

• Researchers performed a prospective cohort study from a 13-year multidisciplinary pre-ESRD care registry.
• A total of 5090 CKD patients aged 20–90 years were included between 2003 and 2015.
• An individual’s SUA trajectory was defined by group-based trajectory modeling in 4 distinct patterns: high, moderate-high, moderate and low.
• Using multiple Cox regression, they analyzed time to ESRD and death.

• Occurrence of a total of 948 ESRD events and 472 deaths was reported, with incidence rates being 57.9 and 28.7 per 1000 person-years, respectively.
• Findings demonstrated that compared with those with a low SUA trajectory, the adjusted hazard ratio of patients for incident ESRD was in a dose–response manner as follows: moderate, 1.89 [95% confidence interval (CI), 1.37–2.60]; moderate-high, 2.49 (1.75–3.55); and high, 2.84 (1.81–4.47); after considering the competing risk of death.
• Researchers noted that for all-cause mortality, the corresponding risk estimate of the same SUA trajectory was 1.38 (95% CI, 0.89–2.12), 1.95 (1.22–3.10) and 4.52 (2.48–8.26), respectively.
• Data showed differentially higher unfavorable effect of elevated SUA trajectories on progression to ESRD among CKD patients without using urate-lowering agents at baseline (P for interaction = 0.018).