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Hayfron-Benjamin CF, van den Born BJ, Amoah AGB, et al. Associations of Serum Uric Acid Levels With Macrovascular and Renal Microvascular Dysfunction Among Individuals From Sub-Saharan Africa. JAMA Netw Open. 2021;4(10):e2128985doi: 10.1001/jamanetworkopen.2021.28985.
Hayfron-Benjamin, C. F., van den Born, B. J., Amoah, A. G. B., Maitland-van der Zee, A. H., Meeks, K. A. C., Beune, E. J. A. J., Klipstein-Grobusch, K., & Agyemang, C. (2021). Associations of Serum Uric Acid Levels With Macrovascular and Renal Microvascular Dysfunction Among Individuals From Sub-Saharan Africa. JAMA network open, 4(10), e2128985. https://doi.org/10.1001/jamanetworkopen.2021.28985
Hayfron-Benjamin, Charles F, et al. "Associations of Serum Uric Acid Levels With Macrovascular and Renal Microvascular Dysfunction Among Individuals From Sub-Saharan Africa." JAMA network open vol. 4,10 (2021): e2128985. doi: https://doi.org/10.1001/jamanetworkopen.2021.28985
Hayfron-Benjamin CF, van den Born BJ, Amoah AGB, Maitland-van der Zee AH, Meeks KAC, Beune EJAJ, Klipstein-Grobusch K, Agyemang C. Associations of Serum Uric Acid Levels With Macrovascular and Renal Microvascular Dysfunction Among Individuals From Sub-Saharan Africa. JAMA Netw Open. 2021 Oct 01;4(10):e2128985. doi: 10.1001/jamanetworkopen.2021.28985. PMID: 34648008; PMCID: PMC8517747.
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JAMA Netw Open. 2021 Oct 01;4(10):e2128985. doi: 10.1001/jamanetworkopen.2021.28985.

Associations of Serum Uric Acid Levels With Macrovascular and Renal Microvascular Dysfunction Among Individuals From Sub-Saharan Africa.

JAMA network open

Charles F Hayfron-Benjamin, Bert-Jan van den Born, Albert G B Amoah, Anke H Maitland-van der Zee, Karlijn A C Meeks, Erik J A J Beune, Kerstin Klipstein-Grobusch, Charles Agyemang

Affiliations

  1. Department of Public Health, Amsterdam University Medical Centre (UMC), University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands.
  2. Department of Internal and Vascular Medicine, Amsterdam UMC, University of Amsterdam, Cardiovascular Sciences, Amsterdam, the Netherlands.
  3. Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
  4. Department of Physiology, University of Ghana Medical School, Accra, Ghana.
  5. Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland.
  6. Department of Medicine and Therapeutics, University of Ghana Medical School, Ghana.
  7. Department of Anaesthesia, Korle Bu Teaching Hospital, Accra, Ghana.
  8. Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
  9. Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.

PMID: 34648008 PMCID: PMC8517747 DOI: 10.1001/jamanetworkopen.2021.28985

Abstract

IMPORTANCE: Serum uric acid (SUA) level is associated with vascular dysfunction in Eurasian populations, but little is known about this association in individuals from sub-Saharan Africa, who have a high prevalence of both relatively high SUA levels and vascular dysfunction.

OBJECTIVES: To assess the associations of SUA levels with macrovascular and kidney microvascular dysfunction in individuals of sub-Saharan African ancestry and evaluate potential factors that could mediate these associations.

DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional analyses of baseline data from the multicenter Research on Obesity and Diabetes Among African Migrants study, conducted from 2012 to 2015, were performed from January to March 2021. The population included Ghanaian individuals living in Ghana and Europe.

EXPOSURE: Abnormal SUA levels.

MAIN OUTCOMES AND MEASURES: Logistic regression was used to examine the associations of SUA level quartiles with microvascular (albuminuria) and macrovascular (peripheral artery disease and coronary artery disease) dysfunction, with adjustments for age, sex, estimated glomerular filtration rate, site of residence, socioeconomic status, alcohol, smoking, diabetes, hypertension, waist-hip ratio, and total cholesterol level. Mediation analysis was performed to assess whether the association was via elevated blood pressure, hemoglobin A1c, and high-sensitivity C-reactive protein levels or via weight-hip ratio. The research questions were formulated after data collection.

RESULTS: A total of 4919 Ghanaian individuals (3047 [61.9%] women) aged 25-75 years (mean [SD], 46.26 [11.08] years) were included. There was a significant positive association between SUA quartiles and albuminuria, but not coronary artery disease or peripheral artery disease, after adjustment for covariates. After full adjustment, individuals in the fourth SUA quartile had higher odds of albuminuria (adjusted odds ratio [aOR], 1.54; 95% CI, 1.07-2.21), but not peripheral artery disease (aOR, 1.35; 95% CI, 0.87-2.08) or coronary artery disease (aOR, 1.09; 95% CI, 0.77-1.55), compared with individuals in the first quartile. After full adjustment, systolic and diastolic blood pressure significantly mediated the association between SUA concentrations and albuminuria, accounting for 19.4% of the total association for systolic and 17.2% for diastolic blood pressure; hemoglobin A1c, high-sensitivity C-reactive protein, and waist-hip ratio did not mediate this association.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study among a sub-Saharan African population, elevated SUA levels were significantly associated with kidney microvascular dysfunction and mediated partly through elevated blood pressure. These findings suggest that individuals from sub-Saharan Africa with elevated SUA levels may benefit from periodic screening for kidney microvascular dysfunction to aid early detection or treatment.

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