A Comparative Study on Progression of Kidney in Stage 3–4 Chronic Kidney Disease Patients with Symptomatic and Asymptomatic Hyperuricemia in Uttaradit Hospital

Abstract

ABSTRACT
Background: Chronic kidney disease (CKD) is a major global public health problem affecting over 10% of the population. Without appropriate care, CKD can progress to end-stage kidney disease requiring renal replacement therapy. Hyperuricemia is common and associated with several non-communicable diseases, including CKD. While symptomatic hyperuricemia may influence kidney disease progression, the effect of asymptomatic hyperuricemia remains debated. Clarifying this association is essential to inform effective treatment strategies.
Objective: To compare kidney disease progression between CKD patients with symptomatic versus asymptomatic hyperuricemia.
Methods: We identified 2,515 adults with hyperuricemia using ICD-10 codes M1099 and E790 between 1 January 2020 and 1 September 2024. Using fixed-sample sequential sampling, 622 records were reviewed; 200 patients with CKD stage 3–4 met eligibility criteria and were included. We compared clinical risk factors for kidney function decline and analyzed data using descriptive and inferential statistics.
Results: Of 200 CKD stage 3–4 patients with hyperuricemia, 107 were symptomatic and 93 asymptomatic. Baseline characteristics were comparable between groups: most patients were male (p=0.861), mean age was 73 years (p=0.344), and mean serum uric acid was 8.5 mg/dL (p=0.802). Colchicine use was more frequent in the symptomatic group (90.65% vs 35.48%, p < 0.001). Higher serum uric acid was associated with lower eGFR (β = –1.67, p = 0.001). Male sex (β = 3.99, p = 0.030), dyslipidemia (β = 6.67, p=0.044), and use of renin–angiotensin–aldosterone system inhibitors (RAAS inhibitors) (β = 5.07, p=0.003) were associated with higher eGFR. After adjusting for comorbidities and relevant medications, the difference in eGFR decline between symptomatic and asymptomatic hyperuricemia was not statistically significant (p = 0.162)
Conclusions: Among patients with CKD stage 3–4, kidney function trajectories did not differ significantly between symptomatic and asymptomatic hyperuricemia (p = 0.162). These findings underscore the ongoing uncertainty regarding the impact of asymptomatic hyperuricemia on CKD progression and highlight the need for targeted studies to guide management.