eISSN: 1897-4295
ISSN: 1734-9338
Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej
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vol. 14
Original paper

Uric acid and contrast-induced nephropathy: an updated review and meta-regression analysis

Francesco Pelliccia, Vincenzo Pasceri, Giuseppe Patti, Giuseppe Marazzi, Giuseppe De Luca, Gaetano Tanzilli, Nicola Viceconte, Giulio Speciale, Enrico Mangieri, Carlo Gaudio

Adv Interv Cardiol 2018; 14, 4 (54): 399–412
Online publish date: 2018/12/11
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Previous studies have suggested a relationship between serum uric acid and contrast-induced nephropathy (CIN).

We performed an updated review and a meta-regression analysis to assess whether serum uric acid is associated with CIN or there exists any relationship between serum uric acid and other risk factors for CIN.

Material and methods
We searched PubMed, Embase and Cochrane databases and reviewed cited references up to July 31, 2018 to identify relevant studies.

A total of 6,705 patients from 10 clinical studies were included. CIN occurred in 774 of the 6,705 (12%) patients. Baseline uric acid levels were significantly higher in those who developed CIN (6.51 vs. 5.67 mg/dl; 95% CI: 0.55–1.22, p = 0.00001). Comparison of clinical features showed that patients with CIN were significantly older (69 vs. 63 years; p < 0.00001) and more often had diabetes (42% vs. 32%; p = 0.002) and hypertension (67% vs. 59%; p = 0.03). Also, patients who developed CIN had lower hemoglobin (12.5 vs. 13.6 mg/dl; p < 0.00001) and higher levels of baseline creatinine (1.27 vs. 1.01 mg/dl; p < 0.0001), but had similar levels of glycemia, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglyceride. Also, they showed a lower ejection fraction (45% vs. 50%; p < 0.00001). Meta-regression analysis revealed that uric acid related only to age (r = 0.13, p = 0.03).

Our investigation indicates that uric acid is significantly associated with CIN. Uric acid correlated significantly with age only, and not with other major predictors of CIN. Further studies are therefore needed to verify the potential of uric acid to improve CIN risk stratification.


angiography, contrast-induced nephropathy, percutaneous coronary intervention, uric acid

Mehran R, Nikolsky E. Contrast-induced nephropathy: definition, epidemiology, and patients at risk. Kidney Int Suppl 2006; 69: S11e5.
Gleeson TG, Bulugahapitiya S. Contrast-induced nephropathy. Am J Roentgenol 2004; 183: 1673-89.
Gami AS, Garovic VD. Contrast nephropathy after coronary angiography. Mayo Clin Proc 2004; 79: 211-9.
Lepor NE. Radiocontrast nephropathy: the dye is not cast. Rev Cardiovasc Med 2000; 1: 43-54.
Zuo T, Jiang L, Mao S, et al. Hyperuricemia and contrast-induced acute kidney injury: a systematic review and meta-analysis. Int J Cardiol 2016; 224: 286-94.
Xu X, Hu J, Song N, et al. Hyperuricemia increases the risk of acute kidney injury: a systematic review and meta-analysis. BMC Nephrology 2017; 18: 27.
Kanbay M, Solak Y, Afsar B. Serum uric acid and risk for acute kidney injury following contrast. Angiology 2017; 68: 132-44.
Stroup DF, Berlin JA, Morton SC, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA 2000; 283: 2008-12.
Moher D, Cook DJ, Eastwood S, et al. Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement. Quality of reporting of meta-analyses. Lancet 1999; 354: 1896-900.
Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 2009; 339: b2700.
von Elm E, Altman DG, Egger M, et al.; STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 2007; 370: 1453-7.
Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ 2003; 327: 557-60.
Colditz GA, Burdick E, Mosteller F. Heterogeneity in meta-analysis of data from epidemiologic studies: a commentary. Am J Epidemiol 1995; 142: 371-82.
van Houwelingen HC, Arends LR, Stijnen T. Advanced methods in meta-analysis: multivariate approach and meta-regression. Stat Med 2002; 21: 589-624.
Rucker G, Schwarzer G, Carpenter J. Arcsine test for publication bias in meta-analysis with binary outcomes. Stat Med 2008; 27: 746-63.
Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics 1994; 50: 1088-101.
Thompson SG, Higgins JP. How should meta-regression analyses be undertaken and interpreted? Stat Med 2002; 21: 1559-73.
Pakfetrat M, Nikoo MH, Malekmakan L, et al. Risk factors for contrast-related acute kidney injury according to risk, injury, failure, loss, and end-stage criteria in patients with coronary interventions. Iran J Kidney Dis 2010; 4: 116-22.
Okino S, Fukuzawa S, Inagaki M, et al. Hyperuricemia as a risk factor for progressive renal insufficiency after coronary intervention in patients with chronic kidney disease. Cardiovasc Interv Ther 2010; 25: 105-11.
Ma G, Yu D, Cai Z, et al. Contrast-induced nephropathy in postmenopausal women undergoing percutaneous coronary intervention for acute myocardial infarction. Tohoku J Exp Med 2010; 221: 211-9.
Park SH, Shin WY, Lee EY, et al. The impact of hyperuricemia on in-hospital mortality and incidence of acute kidney injury in patients undergoing percutaneous coronary intervention. Circ J 2011; 75: 692-7.
Kurtul A, Duran M, Yarlioglues M, et al. Association between N-terminal pro-brain natriuretic peptide levels and contrast-induced nephropathy in patients undergoing percutaneous coronary intervention for acute coronary syndrome. Clin Cardiol 2014; 37: 485-92.
Elbasan Z, Şahin DY, Gür M, et al. Contrast-induced nephropathy in patients with ST elevation myocardial infarction treated with primary percutaneous coronary intervention. Angiology 2014; 65: 37-42.
Saritemur M, Turkeli M, Kalkan K, et al. Relation of uric acid and contrast-induced nephropathy in patients undergoing primary percutaneous coronary intervention in the ED. Am J Emerg Med 2014; 32: 119-23.
Ji L, Su X, Qin W, et al. Novel risk score of contrast-induced nephropathy after percutaneous coronary intervention. Nephrology 2015; 20: 544-51.
Barbieri L, Verdoia M, Schaffer A, et al. Uric acid levels and the risk of contrast induced nephropathy in patients undergoing coronary angiography or PCI. Nutr Metab Cardiovasc Dis 2015; 25: 181-6.
Karabulut A, Sahin I, Ilker Avci I, et al. Impact of serum alkaline phosphatase level on the pathophysiologic mechanism of contrast-induced nephropathy. Kardiol Pol 2014; 72: 977-82.
Richette P, Bardin T. Gout. Lancet 2010; 375: 318-28.
Ficociello LH, Rosolowsky ET, Niewczas MA, et al. High-normal serum uric acid increases risk of early progressive renal function loss in type 1 diabetes: results of a 6-year follow-up. Diabetes Care 2010; 33: 1337-43.
Hovind P, Rossing P, Tarnow L, et al. Serum uric acid as a predictor for development of diabetic nephropathy in type 1 diabetes: an inception cohort study. Diabetes 2009; 58: 1668-71.
Chen JH, Chuang SY, Chen HJ, et al. Serum uric acid level as an independent risk factor for all-cause, cardiovascular, and ischemic stroke mortality: a Chinese cohort study. Arthritis Rheum 2009; 61: 225-32.
Ho WJ, Tsai WP, Yu KH, et al. Association between endothelial dysfunction and hyperuricaemia. Rheumatology 2010; 49: 1929-34.
Postlethwaite AE, Kelley WN. Uricosuric effect of radiocontrast agents. A study in man of four commonly used preparations. Ann Intern Med 1971; 74: 845-52.
Mudge GH. Uricosuric action of cholecystographic agents: possible nephrotoxicity. N Engl J Med 1971; 284: 929-33.
Kang DH, Nakagawa T. Uric acid and chronic renal disease: possible implication of hyperuricemia on progression of renal disease. Semin Nephrol 2005; 25: 43-9.
Murakami R, Hayashi H, Sugizaki K, et al. Contrast-induced nephropathy in patients with renal insufficiency undergoing contrast-enhanced MDCT. Eur Radiol 2012; 22: 2147-52.
Shacham Y, Gal-Oz A, Flint N, et al. Serum uric acid levels and renal impairment among ST-segment elevation myocardial infarction patients undergoing primary percutaneous intervention. Cardiorenal Med 2016; 6: 191-7.
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