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 Jun;71(6):851-865. doi: 10.1053/j.ajkd.2017.12.009. Epub 2018 Feb 27.


Urate is a cause of gout, kidney stones, and acute kidney injury from tumor lysis syndrome, but its relationship to kidney disease, cardiovascular disease, and diabetes remains controversial. A scientific workshop organized by the National Kidney Foundation was held in September 2016 to review current evidence. Cell culture studies and animal models suggest that elevated serum urate concentrations can contribute to kidney disease, hypertension, and metabolic syndrome. Epidemiologic evidence also supports elevated serum urate concentrations as a risk factor for the development of kidney disease, hypertension, and diabetes, but differences in methodologies and inpacts on serum urate concentrations by even subtle changes in kidney function render conclusions uncertain. Mendelian randomization studies generally do not support a causal role of serum urate in kidney disease, hypertension, or diabetes, although interpretation is complicated by nonhomogeneous populations, a failure to consider environmental interactions, and a lack of understanding of how the genetic polymorphisms affect biological mechanisms related to urate. Although several small clinical trials suggest benefits of urate-lowering therapies on kidney function, blood pressure, and insulin resistance, others have been negative, with many trials having design limitations and insufficient power. Thus, whether uric acid has a causal role in kidney and cardiovascular diseases requires further study.

Keywords: Uric acid; cardiovascular disease (CVD); chronic kidney disease (CKD); diabetes; gout; hypertension; hyperuricemia; kidney function; review; serum urate; xanthine oxidoreductase.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Acute Kidney Injury / blood
  • Acute Kidney Injury / epidemiology*
  • Acute Kidney Injury / physiopathology
  • Age Factors
  • Cardiovascular Diseases / blood
  • Cardiovascular Diseases / epidemiology*
  • Cardiovascular Diseases / physiopathology
  • Comorbidity
  • Education / organization & administration*
  • Female
  • Humans
  • Hypertension / blood
  • Hypertension / epidemiology*
  • Hypertension / physiopathology
  • Hyperuricemia / blood
  • Hyperuricemia / epidemiology*
  • Hyperuricemia / physiopathology
  • Male
  • Prevalence
  • Prognosis
  • Randomized Controlled Trials as Topic
  • Risk Assessment
  • Severity of Illness Index
  • Sex Factors
  • Survival Analysis
  • United States