ArticleFrontiers in nutrition2026
Serum uric acid variability and short-term mortality in chronic kidney disease: a retrospective cohort study with independent replication in MIMIC-IV.
Article in Frontiers in nutrition, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Inroduction: Within-person variation in serum uric acid (SUA) may reflect clinical instability, but its association with outcomes in chronic kidney disease (CKD) is uncertain. Methods: We studied 10,556 adults with EHR-defined CKD and at least three SUA measurements during a 365-day baseline window across a nine-hospital consortium. Variability was quantified primarily by the coefficient of variation (CV); the primary outcome was all-cause mortality, and secondary outcomes were a composite kidney endpoint and major adverse cardiovascular events (MACE). Cox models adjusted for demographics, comorbidities, baseline laboratory values, mean SUA, measurement number and medication use. Reproducibility of the short-term mortality association was assessed in MIMIC-IV. Results: During a median follow-up of 0.62 years, 649 deaths, 676 kidney events and 3,172 first MACE occurred. Higher SUA CV was associated with mortality in the fully adjusted model (hazard ratio [HR] per 1-SD increase 1.24, 95% CI 1.15-1.32; highest versus lowest tertile 1.87, 95% CI 1.50-2.33), whereas adjusted associations with kidney events (HR 1.01, 95% CI 0.93-1.10) and MACE (HR 1.02, 95% CI 0.98-1.05) were null. Of all deaths, 495 (76.3%) occurred within 90 days. In a post-90-day landmark analysis of 6,784 participants with more than 90 days of follow-up, the mortality association was not observed (154 deaths; HR 1.02, 95% CI 0.86-1.21). Results were similar after daily aggregation of SUA measurements and additional adjustment for urate-lowering therapy, colchicine and sodium-glucose cotransporter-2 inhibitors. In MIMIC-IV ( Discussion: Greater SUA variability was associated with mortality during short follow-up; the concentration of deaths within 90 days and the null post-90-day landmark estimate suggest that the exposure may primarily mark near-term clinical deterioration rather than a causal or durable long-term prognostic mechanism.
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