An Epidemiological Study On The Prevalence Of Hyperuricemia And Its Relationship To Kidney Disease In The Urban Community Residents Of Zhuhai

Background:Hyperuricemia is metabolic disease caussed by the disorder of purine metabolism, which lead to increased production of uric acid and (or) excretion decreased. The criterion of the diagnosis of hyperuricemia:serum uric acid levels>420umol/L for men, women>360umol/L. Nowadays, Hyperuricemia poses a huge threat to human health and gets more and more people’s attention. The current study confirmed that hyperuricemia, as an independent risk factor for cardiovascular disease, is closely associated with hypertension, coronary heart disease and other cardiovascular diseases. Pathophysiological changes caused by hyperuricemia is the main source of its clinical manifestations. The majority of people with hyperuricemia generally without clinical manifestations. Clinical symptoms are sometimes seen like recurrent gouty arthritis.Uric acid is the final product of purine metabolism, which is generated under the action of xanthine oxidase (XO), hypoxanthine, xanthine. Purine nucleotide is the most important intermediate product in the aspects of uric acid production. Uric acid metabolism includes guanine nucleotide, inosinic acid and adenine nucleotide. It is Currently known that purine nucleotide comes from two ways:the one is that the RNA phosphate, amino acids and other small molecules are synthesized step by step under the action of enzymes in the body; The other one is from the decomposition of nucleic acid. It requires the participation of a variety of enzymes, including the phosphoribosyl pyrophosphate amide converting enzyme (PRPP), hypoxanthine guanine the ribose converting enzyme (HGPRT), hypoxanthine purine xanthine oxidase (XO) in the process of Purine nucleotide metabolism generating uric acid process. These enzymes play coordinating role in uric acid metabolism in the body,which produce the productions pouring out of the body through the kidney. In the end it can maintain the body’s normal levels of uric acid.Hyperuricemia generation includes two aspects:increasd formation and discharge reduction. First, generation increased:endogenous and exogenous sources of uric acid in the human body, exogenous uric acid mainly comes from the food, accounting for20%of the uric acid sources; endogenous uric acid produces from the body amino acids, ribose and other synthesis of small molecules and nucleic acid catabolism, accounting for80%of the sources of uric acid. Wherein lack of the enzyme in the purine metabolism is the main reason for the increased production of uric acid, such as the phosphoribosyl pyrophosphate synthetase activity is too high, hypoxanthine-guanine phosphoribosyl transferase activity decrease, adenine ribose transfer activity decrease and XO increased activity, so that the increased synthesis of purine nucleotide catabolism increased, resulting in generating a large number of uric acid. Uric acid excretion decrease:uric acid esist in form of uric acid salt in normal human blood. the urate itself was filtrated by glomerulus and then reabsorbed by renal tubular secretion and secreted after the reabsorption. Urate glomerular filtration is almost entirely reabsorbed by the renal proximal tubule tube, and then secreted. So renel tubule is an important part of affecting uric acid excretion. The study has found that renal tubule containing important transporters involved the main transporters in the excretion of uric acid, including human urate the the salt anion transporter (human urate-anion tansporter-1hURATl) urate transporter (human urate transporter, hUAT), organic anion transporter (human organic-anion transporter hOAT)), multidrug resistance protein4(multidrug resistance protein4), prop-Huo protein (Tamm-Horsfall protein), through their coordinating role in tubular reabsorption and secretion maintain normal levels of uric acid in the body.With the socio-economic development and the improvement of people’s living standards as well as raising the level of awareness, the diagnosis of hyperuricemia(HUA) and the prevalence of hyperuricemia (HUA) showed a gradually increasing trend in recent years.2037population study in1998In Shanghai found that the total prevalence of people with hyperuricemia(HUA) was10.1%,14.2%of men,7.1%of women. In Qingdao Community in2008,1706Older age groups of men and women standardized morbidity rates was respectively29.5%and20.5%, the total prevalence rate of23.3%.2007-2009Guilin, an epidemiological survey of adult residents of the Guilin area showed that the prevalence of hyperuricemia was23.5%, in which male and female prevalence rates were28.4%and19.7%. Hyperuricemia is considered as a sign of gout. According to statistics, about5%to12%of hyperuricemia population ultimately develop into gout. In recent years, researches has shown that hyperuricemia is not only the most important biochemical foundation of gout, but also closely associates with the metabolic syndrome (including insulin resistance, high blood pressure, diabetes or glucose intolerance, hyperlipidemia, obesity), which has become a killer, threating to human health.The chronic kidney disease (CKD) diagnosis standard:according to the diagnostic criteria of clinical practice guidelines (K/DOQI) standard, kidney damage or kidney function decline continued for3months or more for the diagnosis of CKD.Namely GFR/ml applying simplification MDRD formula estimating that minor ball of kidney filters fault rates (GFR). GFR/ml min-1(1.73m2)-1=186×Scr (mg/dl)-1.154×(age, years)-0.203x0.742(female):to estimate the GFR<60Ml Min-1(1.73m2) or ACR>30mg/g and lasted for3months or all above diagnosing CKD. Chronic kidney disease (CKD) has two major characteristics:high morbidity and mortality.Morbidity being hit by the chronic kidney disease (CKD) in investigation of the general population in developed countries is6.50%-10.00%,in the United States of America adult chronic kidney disease (CKD) morbidity is13.20%, statistics show because of chronic kidney disease (CKD) in patients with chronic renal failure induced by (chronic renal failure, CRF) mortality and induced by ESRD rate of5-9in the death cause spectrum..Have a report without exception our country everywhere.. Investigation of2006Shi jingshan District to Beijing2310people over the age of40, showed that the morbidity of CKD was9.99%.2008on the investigation of Urumqi Tianshan District2131people over the age of35in Zhengzhou city in four communities in20over the age of1855celebrities swarm and2010, results showed that the morbidity of CKD were13.63%and9.40%, Collection of China CKD many epidemiologic survey results show that:Chinese chronic kidney disease (CKD) morbidity is about10%, then worked in Chinese chronic kidney disease (CKD) patients is about more than110000000, every year because of chronic renal failure (CRF) and the deaths of about500000.The2008equal Obrador GT in Mexico and Jalisco, hypertension, family history of diabetes population survey revealed chronic kidney disease (CKD) morbidity is22%and33%respectively.The chronic kidney disease (CKD) returns to now that the various disease damage factor is also that the various disease arouses the nephropathy intimateness rotating,, especially cardiovascular disease (cardiovascular disease, CVD) has the characteristics of high incidence rate of complication, mortality is high. The United States National Kidney Foundation data show that:the cardiovascular disease (CVD) is a chronic kidney disease (CKD) cause the leading cause of death in patients with various complications. So the early screening for chronic kidney disease (CKD) patients is significant, and the comprehensive intervention of risk factors of the object or clear diagnosis of CKD for drug treatment, if necessary, to delaying chronic kidney disease (CKD) in the occurrence and development of ESRD, slow to the probability of students.The relationship between hyperuricemia and chronic kidney diseases, is the hot spot studying currently, and various research there exists a lot of dispute in conclusionObjective:To investigate the prevalence of hyperuricemia and its relationship to chronic kidney disease (CKD) in the urban community residents of Zhuhai, according to the screening in Wangzai community, Zhuhai city.Methods:The community residents over aged18years old(n=2135) in Wangzai community of Zhuhai, where the original inhabitants is relatively concentrated, were randomly choosed. Related data was obtained by recording health information and physical examination. Fasting blood and urine samples were collected to detect blood glucose, serum uricimia, serum creatinine, lipid, urine albumin, urine creatinine, etc, the urine albumin-creatinine urine(ACR) was calculated, and GFR was estimated by the application of simplified MDRD formula.Results: The prevalence of hyperuricemia in the community residents was32.35%, which the prevalence in males was higher than in females and had statistical significance (P<0.01). The prevalence of CKD was15.89%, which the prevalence in male (15.16%) was similar to the prevalence of female (16.16%). CKD detection rate in hyperuricemia (HUA) population (23.89%) was significantly higher than in normal uric acid crowd (11.96%) and the difference was statistically significant (P<0.01). Multivariate logistic regression analysis showed that uric acid, age, gender, systolic blood pressure, fasting glucose, high sensitivity C-reactive protein levels were independently associated with CKD incidence (P<0.05).Conclusions:The prevalence of hyperuricemia and CKD in community residents of Zhuhai city were both higher than reports of other areas in China and the results done in same area7years ago. High uric acid is an independent risk factor for CKD incidence.