Elevated uric acid predicts increased coronary artery calcification risk in advanced chronic kidney disease: a cross-sectional study

Background Cardiovascular disease is the primary cause of morbidity and mortality in chronic kidney disease (CKD) patients, with vascular calcifications being a key predictor. Elevated serum uric acid (UA) has been implicated in vascular health, but its link with coronary artery calcification (CAC) in CKD is underexplored. This study evaluates the association between serum UA levels and CAC in predialysis CKD patients. Patients and methods This cross-sectional study at Mansoura University, Egypt, included 100 predialysis CKD patients aged over 40 years with more than 1 year of disease. Exclusion criteria included significant cardiovascular disease, pregnancy, heavy smoking, or high parathyroid hormone levels. Serum UA and other biomarkers were measured, and CAC was assessed using multislice spiral coronary computed tomography to calculate Agatston scores. Results The median age was significantly higher in the CAC>0 group (62 years) compared to the CAC=0 group (55 years; P =0.017). Serum UA levels showed a borderline significant association with CAC in patients with an estimated glomerular filtration rate (eGFR) less than 30 ml/min/1.73 m 2 (odds ratio: 1.26, 95% confidence interval: 1.01–1.61, P =0.051), but no significant association was found in those with moderate kidney impairment (eGFR 30–59 ml/min/1.73 m 2 ). Conclusion Elevated serum UA levels are associated with an increased risk of CAC in CKD patients, particularly in those with severe renal impairment (eGFR<30 ml/min/1.73 m 2 ). This suggests that serum UA may contribute to this population’s pathogenesis of vascular calcification.