Impact of Hyperuricemia on Outcomes of Kidney Transplantation: Analysis of the FAVORIT (Folic Acid for Vascular Outcome Reduction in Transplantation) Trial, The
Medicine, University of Iowa, Iowa City
College of Public Health, University of North Carolina, Chapel Hill
Medicine, University of Maryland, Baltimore
Medicine, Ohio State University, Columbus
Brigham and Women's Hospital, Boston
Meeting: 2013 American Transplant Congress
Abstract number: 124
Elevated uric acid (UrAc) levels are associated with higher rates of cardiovascular (CV) morbidity and mortality in the general population. Single center studies suggest an association between UrAc levels and transplant outcomes. We tested the hypothesis that higher UrAc levels predict risk of CV events and graft survival in stable kidney transplant recipents in the FAVORIT Trial.
FAVORIT participants with a measured baseline UrAc level and data for risk adjustment were included (3,526 of 4,110 enrolled patients). Primary endpoints were ESRD and adjudicated CV events (fatal/non-fatal MI, CVA, new-onset angina). Traditional risk factors included in the different statistical models were: Age, sex, race, type of donor, serum creatinine, BMI, lipid levels, country of origin (USA, Canada and Brazil), presence of DM, history of CAD, BP, eGFR, graft vintage, and UrAc levels. UrAc levels were analyzed both as a linear or non-linear (spline) variable. Cox proportional hazard models were employed to examine whether UrAc levels predicted primary endpoints independently after risk adjustment. Over a mean follow-up pf 46.3±19.6 months, a total of 274 study participants returned to dialysis, and 543 experienced a primary CV event. For every 1 mg/dl increase in UrAc at baseline, there was a 16% [95% CI: 13-19%] increase in chance of graft loss (P<0.0001); however, this relationship was no longer significant in multivariable models (P=0.40). In models examining CV events, each 1 mg higher UrAc level in the univariate analysis was associated with a 5% increase in CV events [95% CI: 1-8%], (P=0.019), but this relationship was also attenuated in the multivariable model (P=0.08).
UrAc levels were not independently associated with graft survival or CV events in stable kidney transplants recipients in the FAVORIT Trial. Possible explanations include the strong association between UrAc levels with traditional risk factors, the high prevalence of pre-transplant CAD, and immunosuppression. These results do not exclude the possibility of a pathogenic role of hyperuricemia in earlier kidney and CV disease.
To cite this abstract in AMA style:
Kalil R, Campbell S, Carpenter M, Weir M, Pesavento T, Pfeffer M, Solomon S, Haynes W, Hunsicker L. Impact of Hyperuricemia on Outcomes of Kidney Transplantation: Analysis of the FAVORIT (Folic Acid for Vascular Outcome Reduction in Transplantation) Trial, The [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/impact-of-hyperuricemia-on-outcomes-of-kidney-transplantation-analysis-of-the-favorit-folic-acid-for-vascular-outcome-reduction-in-transplantation-trial-the/. Accessed May 14, 2025.« Back to 2013 American Transplant Congress