Hyperuricemia and metabolic syndrome: associations with chronic kidney disease.

The effects of serum uric acid (SUA) and metabolic syndrome on chronic kidney disease (CKD) remain controversial. This study grouped subjects according to a combination of their uric acid and metabolic syndrome status and investigated the association between these groups and CKD to clarify the relationships of SUA and metabolic syndrome to CKD. This survey analyzed data from 81,799 adults (45,148 men and 36,651 women) who underwent health examinations at Chang Gung Memorial Hospital, in northern Taiwan, from 2000 through 2007. Hyperuricemia was defined as an SUA greater than 7.7 mg/dL in men or greater than 6.6 mg/dL in women. Patients were classified by uric acid-metabolic syndrome status as follows: A = no hyperuricemia and no metabolic syndrome, B = presence of metabolic syndrome but not hyperuricemia, C = presence of hyperuricemia but no metabolic syndrome, and D = presence of both hyperuricemia and metabolic syndrome. Kidney function was assessed in terms of the estimated glomerular filtration rate (eGFR) by using the Modification of Diet in Renal Disease Study equation modified for Chinese. CKD was defined as an eGFR <60 mL/min/1.73 m(2). The prevalences of hyperuricemia, metabolic syndrome, and CKD were 22.8% (26.3% in men and 18.6% in women), 13.5% (15.0% in men and 11.6% in women), and 2.2% (2.1% in men and 2.2% in women), respectively. In men, the age-adjusted odds ratios for CKD, with group A as reference, were 1.95 for group B, 4.86 for group C, and 5.85 for group D. In women, the age-adjusted odds ratios were 1.96 for group B, 6.66 for group C, and 9.01 for group D. Hyperuricemia is strongly associated with CKD, independent of the presence of metabolic syndrome.

Comparison of the efficacy of parecoxib versus ketorolac combined with morphine on patient-controlled analgesia for post-cesarean delivery pain management.

BACKGROUND: we compared the clinical efficacy and safety between a new injectable cyclooxygenase-2 selective inhibitor, parecoxib, and an old nonselective, ketorolac combined with morphine in patient-controlled analgesia (PCA) for management of post-cesarean delivery pain. METHODS: in this randomized, open-label study, 66 parturients undergoing cesarean section were divided into two groups: In Group P the patients received an initial intravenous bolus of 40mg parecoxib as a loading dose post-operatively and then two bolus doses of 20mg parecoxib were subsequently given at intervals of 24h. Morphine was basically used in PCA manner during the 3-day study course; and in Group K patients received an intravenous loading bolus of 30mg ketorolac post-operatively and then 90mg ketorolac combined with morphine in PCA fashion throughout the study course. Efficacy was evaluated by Verbal ranking scale (0-10) for pain intensity, Ramsay sedation score (1-6), profile of mood state (0-3) and quality of sleep (0-3), and patient satisfaction (0-4) with the analgesia. Efficacy evaluations and adverse effects were recorded every 24h and at 72h after initial loading boluses. The duration of hospital stay and total dose of morphine used throughout the study were also recorded. RESULTS: there were no significant differences of sedation scale, mood state, quality of sleep and satisfaction between two groups, except patients of Group P had a lower pain scores than those of the Group K at 24h (3.1, range 0-5 vs. 4.3, range 0-8, p = 0.005) and 72h (1.1, range 0-3 vs. 1.9, range 0-4, p = 0.005). Moreover, there were also no significant differences in the duration of hospital stay, but there was a lower total morphine requirement (22% reduction) in Group P in comparison with Group K (43.5 ± 19.2 vs. 55.5 ± 21.5, p = 0.02). Regarding adverse effects, there were no statistical differences between two groups. CONCLUSIONS: we noted that parecoxib with PCA morphine can be used for post-cesarean delivery analgesia with the same efficacy as ketorolac for an opioid-sparing effect.

Serum uric acid is independently associated with metabolic syndrome in subjects with and without a low estimated glomerular filtration rate.

OBJECTIVE: The relationship among serum uric acid (SUA), metabolic syndrome, and chronic kidney disease (CKD) is unclear. We examined whether SUA level is an independent risk factor for chronic kidney disease and whether the association between SUA and metabolic syndrome is affected by kidney function. METHODS: We analyzed 28,745 subjects (17,478 men, 11,267 women, age 20-49 yrs) who underwent health examinations at this hospital between 2000 and 2007. Hyperuricemia was defined as SUA level > 7.7 mg/dl in men or > 6.6 mg/dl in women. Kidney function was assessed by estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease Study equation modified for Chinese subjects. Impaired renal function with low GFR was defined as eGFR < 90 ml/min/1.73 m(2). The UA-low GFR groups were defined according to the observed combination of hyperuricemia and low GFR: Group A (absence of both hyperuricemia and low GFR); Group B (presence of low GFR but no hyperuricemia); Group C (presence of hyperuricemia but not low GFR); and Group D (presence of both hyperuricemia and low GFR). RESULTS: The prevalence of hyperuricemia, metabolic syndrome, and impaired kidney function with low GFR was 20.3% (27.6% in men, 8.9% in women), 7.6% (10.6% in men, 3.0% in women), and 9.9% (11.6% in men, 7.1% in women), respectively. The Pearson correlation between SUA and eGFR was only -0.26 (-0.21 in men, -0.22 in women; p < 0.001). In men, the age-adjusted odds ratio (OR) of metabolic syndrome was 1.41 (Group B), 2.45 (Group C), and 2.58 (Group D) in comparison with Group A. In women, the age-adjusted OR of metabolic syndrome was 0.83 (Group B), 5.47 (Group C), and 3.31 (Group D) in comparison with Group A. CONCLUSION: Hyperuricemia is prevalent in the Taiwan population. Hyperuricemia is only weakly associated with renal function, but is strongly associated with metabolic syndrome with or without a low eGFR.