Letter to the Editor Received: July 25, 2013 Accepted: July 25, 2013 Published online: October 26, 2013

Cardiology 2014;127:25 DOI: 10.1159/000355002

Uric Acid Level in Patients with Kidney Disease Sevket Balta Mustafa Demir Sait Demirkol Ugur Kucuk Murat Unlu Zekeriya Arslan Department of Cardiology, Gulhane Medical Academy, Ankara, Turkey

We read the article ‘Predictive value of serum uric acid levels on mortality in acute coronary syndrome patients with chronic kidney disease after drug-eluting stent implantation’ written by Yin et al. [1] with great interest. They demonstrated that high serum uric acid (UA) levels are associated with all-cause, cerebral and other-cause mortality rates in acute coronary syndrome patients with chronic kidney disease after drug-eluting stent implantation. Studies in the past decade have displayed that hyperuricemia can injure endothelial function and cause a rapid decrease in residual renal function; these are risk factors for cardiovascular events [2]. There is increasing evidence that UA may play a major role in cardiovascular risk factors, especially in hypertension and hypertension-related comorbidities [3]. Several clinical studies have confirmed that UA is an independent risk factor for the development of renal disease in the normal popula-

tion as well as in patients with previous kidney disease [4]. Serum UA has received increased attention due to its role as an independent prognostic factor for hypertension, diabetes and heart failure [5]. Increased UA is a common indicator of the atherosclerotic involvement of the vascular structure indicating coronary artery disease, cerebrovascular disease, chronic respiratory disease, chronic liver disease and peripheral arterial disease [6]. It can also be affected by atherosclerotic risk factors such as smoking, alcohol consumption, hypercholesterolemia, hypothyroidism and advanced age. Furthermore, some medications such as antihypertensive treatment including angiotensin-converting enzyme inhibitors, angiotensin receptor blocker and statins may influence the level of UA. However, Yin et al. [1] did not mention some other factors affecting UA level including smoking, alcohol consumption, hypothyroidism, cerebrovascular disease

and peripheral arterial disease. The etiology of chronic kidney disease is also an important factor for predicting mortality and morbidity. In a previous study, the authors concluded that hypertensive nephropathy was related to higher mortality in patients with kidney disease [2]. If the authors had taken kidney disease etiology into consideration, their results might have been different. In conclusion, UA levels are high in acute coronary syndrome patients with chronic kidney disease. Higher UA levels are associated with all-cause mortality during follow-up, mainly cerebral and othercause mortality, rather than cardiac and renal mortality as presented in Yin et al. [1]. However, UA levels are influenced by many conditions. We believe that future studies should consider these related factors when researchers are evaluating the link between serum UA and other conditions.

3 Kanbay M, Segal M, Afsar B, Kang D-H, Rodriguez-Iturbe B, Johnson RJ: The role of uric acid in the pathogenesis of human cardiovascular disease. Heart (British Cardiac Society) 2013;99:759–766. 4 Kaya MG: Hyperuricemia and cardiovascular disease: is this relationship independent of the etiology of hyperuricemia? Cardiology 2013; 125:201–203.

5 Demirkol S, Balta S, Cakar M, Kurt O, Dinc M: Is there any correlation between serum uric acid levels and right ventricular function parameters in patients with cardiovascular risk factors? Int J Cardiol 2013, E-pub ahead of print. 6 Cakar M, Sarlak H, Balta S, Unlu M, Demirbas S, Demirkol S: Serum uric acid still carries controversies about its role in endothelial dysfunction. J Clin Hypertens (Greenwich) 2013;15:296.

1 Yin Z, Fang Z, Yang M, Du X, Nie B, Gao K: Predictive value of serum uric acid levels on mortality in acute coronary syndrome patients with chronic kidney disease after drugeluting stent implantation. Cardiology 2013; 125:204–212. 2 Park JT, Kim DK, Chang TI, Kim HW, Chang JH, Park SY, et al: Uric acid is associated with the rate of residual renal function decline in peritoneal dialysis patients. Nephrol Dial Transplant 2009;24:3520–3525.

© 2013 S. Karger AG, Basel 0008–6312/14/1271–0025$39.50/0 E-Mail [email protected] www.karger.com/crd

Dr. Sevket Balta Department of Cardiology Gulhane School of Medicine, Tevfik Saglam St., TR–06018 Etlik-Ankara (Turkey) E-Mail drsevketb @ gmail.com

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Uric acid level in patients with kidney disease.

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