URIC ACID AND CARDIOVASCULAR DISEASE: A RETROSPECTIVE ANALYSIS IN ESRD

Abstract

BACKGROUND

Chronic kidney disease has become rampant among the present Indian population, mainly due to progressively increasing numbers of non-insulin-dependent diabetes mellitus. While hypertension, diabetes mellitus, and obesity increase susceptibility, hypoalbuminemia and hyperuricemia represent indicators of susceptibility and progression of CKD, which, along with nephrotoxins, lead to end-stage renal disease (ESRD).^[1] In this study, we intend to analyze uric acid levels along with renal function parameters to predict cardiovascular involvement due to ESRD. Cardiovascular dysfunctions contribute to major causes of mortality in ESRD when it forms as a renal-cardiac syndrome that affects both systolic and diastolic functions of the heart.

AIMS AND OBJECTIVES

1. To evaluate uric acid level as a co-marker of cardiovascular dysfunction in ESRD.


2. To derive left ventricular dysfunction from echocardiographic parameters and compare it with uric acid levels.


3. To evaluate left atrial diameter as an indicator of severe cardiac dysfunction in ESRD.

MATERIALS AND METHODS

Material: All renal transplant recipients who were carefully evaluated and recommended for renal transplantation, who attended the pre-anesthetic clinic, were taken up for the study. PAC charts and investigation reports were taken up retrospectively. All patients underwent successful renal transplantation.

Study Type: Retrospective Analysis

Study Period: October 2024 to February 2025

Study Place: D.S.M.C.H, Siruvachur.

METHODS

The pre-anesthetic evaluation charts and investigation reports, both biochemistry and echocardiogram, were noted for 30 renal transplant recipients. The above-mentioned parameters were tabulated and analyzed.

PARAMETERS

Age, Gender, Creatinine, Uric Acid, Ejection Fraction, Left Atrial Diameter.

RESULTS

Age distribution was from 25 to 64 years, with the maximum number of patients between 34 and 42 years. The creatinine levels in males ranged from 3 to 13 mg/dl, whereas in females, it ranged from 5 to 9 mg/dl. Ejection fraction ranged from 35% to 65%, with most patients having an EF between 45% and 55%. Females had a better EF than males. Among the 30 patients, only 6 were female. Uric acid levels ranged from 3 to 10 mg/dl and were consistently high in all females. Uric acid and creatinine showed an R-value of 0.5. Uric acid levels greater than 6 mg/dl were associated with an ejection fraction of less than 45%. The left atrial diameter showed variable uric acid levels. A direct correlation between left atrial end-systolic diameter and uric acid levels was observed in only 8 out of 30 cases.

CONCLUSION

In order to differentiate between normal and abnormal biological processes to predict adverse outcomes, standard biomarkers are indicated in CKD progression.^[2] In addition to conventional biomarkers such as albuminuria, serum albumin, and anemia, serum uric acid appears to be a co-marker for CKD progression, with high levels associated with poor ejection fraction. Though novel biomarkers such as plasma asymmetric dimethyl arginine^[3] are under research, simple routine tests like serum uric acid may provide insights into cardiovascular dysfunction, a major cause of mortality in end-stage renal disease. However, larger studies are needed to substantiate the relationship between uric acid levels and cardiac dysfunction.