The Clinico-Pathologic Profiles of Patients with Incidental Hyperuricemia Post Renal Transplant at the Kenyatta National Hospital

The Clinico-Pathologic Profiles of Patients with Incidental Hyperuricemia Post Renal Transplant at the Kenyatta National Hospital | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Clinico-Pathologic Profiles of Patients with Incidental Hyperuricemia Post Renal Transplant at the Kenyatta National Hospital Zoya Adam, Joshua Kayima, Ahmed Sokwala This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5282858/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract BACKGROUND: Following a renal transplant hyperuricemia is a common complication, but its clinical and prognostic significance is controversial. Evidence is accumulating indicating a role for uric acid in causing graft dysfunction and hence decreasing survival of the graft. This study was conducted to determine the clinical characteristics, graft function and outcomes of hyperuricemic renal transplant recipients at the Kenyatta national hospital METHODOLOGY: The study population comprised all renal transplant recipients between January 2011 to June 2021 being seen at the Kenyatta National Hospital transplant clinic .Patients were above 18 years of age with at least 2 consecutive uric acid assays that were consistently high or normal. As many files as available, that met the inclusion criteria were analysed by consecutive sampling. The clinical characteristics, the graft function at the end of 1 year, 3 years and at the end of 5 years, as well as the outcomes were recorded RESULTS: All the patients were Black Africans and had received a kidney from a living allograft donor. 82 (65.6%) of the 125 patients were Male and 43 (34.4%) were Female. The mean age of the patients was 44.2 (SD 14.4) years. The prevalence of hyperuricemia was 30.4%.9 (23.7%) of the 38 patients with hyperuricemia had Diabetes as a comorbidity and all the 38(100%) patients had hypertension as a comorbidity. Most of the patients 25(65.8%) were of normal BMI. The majority 23 (60.5%) had been transplanted 5 or more years ago. None of the patients with hyperuricemia had pre-transplant hyperuricemia. 29 (76.3%) were on Tacrolimus while 9 (23.7%) were on Cyclosporine. Only 1 (2.6%) of the patients with hyperuricemia was on a Thiazide diuretic. Overall, there were no factors that were found to be independently associated with hyperuricemia, except the EGFR at 1, 3 and 5 years which were all significantly lower in the hyperuricemic group. CONCLUSION: Hyperuricemia was common in our transplant recipients and was seen more among males. All patients with hyperuricemia had hypertension but not diabetes and most had a normal BMI. No significant transplant associated risk factors among those with hyperuricemia, were found. However, among patients with hyperuricemia the EGFR was significantly lower at the end of 1, 3 and 5 years when compared to those with normal uric acid levels. INTRODUCTION Evidence is accumulating indicating a role for uric acid in the genesis and progression of kidney disease, and a few studies are beginning to show a possible beneficial effect of urate-lowering therapy. Whether this holds true for renal allograft recipients is not clear.( 1 ) Hyperuricemia is a common complication in organ transplant recipients particularly kidney transplant recipients and frequently is associated with chronic cyclosporine immunosuppressive therapy.( 2 ) .Its clinical and prognostic significance is not known.. The effect of hyperuricemia in patient and graft survival is not clear because uric acid is not considered a common risk factor for cardiovascular disease that may affect graft and patient survival. Little data are available regarding the effect of uric acid (UA) and hyperuricemia on graft function and survival following renal transplantation. Some studies have suggested that an increased serum uric acid (SUA) level is a prognostic factor for the development of renal allograft impairment. ( 3 ) ( 4 ). There have been small studies that have suggested that control of uric acid levels contributes to recovery of renal function and an improvement in GFR in renal transplant recipients. ( 5 ) In Africa in general and in particular in Kenya we have no data on the burden of hyperuricemia post renal transplant and therefore we also don’t have data on the clinical characteristics, graft function and outcomes of patients with hyperuricemia. METHODOLOGY It is a retrospective descriptive cohort study The study was undertaken at the Renal Unit within the Kenyatta National Hospital, which is Kenya’s major teaching and referral Centre. It is a public funded tertiary hospital and serves Nairobi and its environs. Kenyatta national hospital also serves as the largest referral centre in Kenya. The renal department has one of the busiest transplant programs in Kenya, conducting on average 25–30 renal transplants a year. In this study Hospital case notes from the medical records department at KNH were used. Records for the duration of January 2011 to June 2021 (inclusive) were analysed. All available files that met the inclusion criteria were analysed. Data was entered into a data collection sheet for hyperuricemic patients and a separate one for normouricemic patients. The clinical characteristics that were recorded were age, gender, Body mass index at time of transplant, Presence/absence of Diabetes, presence/absence of hypertension, presence/absence of pretransplant hyperuricemia, thiazide diuretic used, type of CNI used, duration since transplant, two consecutively high or normal serum uric acid levels within 5 years of transplant, signs and symptoms of hyperuricemia- gout, chronic tophi, asymptomatic. The graft function was recorded at the end of 1 year, at the end of 3 years and at the end of 5 years. The outcomes recorded at the time of analysis were whether the patient is dead or alive, and whether the patient returned to dialysis or not. Consecutive sampling was done and sample size was calculated using Fisher’s formula Data was checked for completeness and free of error prior to entry to the Microsoft Excel 2019 Spread sheet. Thereafter it was transferred to the Statistical Package for Social Sciences version 24.0 for analysis. Demographic and clinical characteristics of the patients were analysed and presented as means with standard deviations or as medians with interquartile range for continuous data and as frequencies with percentages for categorical data. The clinic-pathologic manifestations among patients with hyperuricemia were analysed and presented as frequencies and percentages. The graft function at 1, 3 and 5 years post transplant among patients with post-transplant hyperuricemia was analysed and presented as means with standard deviations, as well as frequencies and percentages. The outcomes amongst patients with post-transplant hyperuricemia were analysed and presented as frequencies and percentages. The association between hyperuricemia and selected transplant related factors was analysed with the use of Pearson chi-square tests and Independents students t-test. Odds ratio as well as their 95% confidence interval were calculated. All statistical tests were considered significant where the p-value was < 0.05. This study entailed analysis of hospital notes and was Retrospective in nature, therefore obtaining consent was not possible. This study was conducted after approval by the Department of Clinical medicine and Therapeutics, University of Nairobi, The renal department East African kidney Institute and the University of Nairobi Ethics and research review committee. RESULTS 200 files were available between January 2011 and June 2021. Of the 200 files, 75 files were excluded because they had missing data (they lacked 2 serum uric acid results). Eventually 125 files were retrospectively analyzed. All the patients were Black Africans who had received a kidney from a living allograft donor. 82 (65.6%) of the 125 patients were Male and 43 (34.4%) were Female. The mean age of the patients was 44.2 (SD 14.4) years, where the minimum age was 18.0 years and the maximum age recorded was 72.0 years. The median age was 44.0 (IQR 33.0–58.0) years. In terms of comorbidities, 35 (28%) of the cohort were Diabetic and 121 (96.8%) were Hypertensive. Most of the patients,98 (78.4%) were on Tacrolimus (Calcineurin inhibitor) and 27 (21.6%) were on Cyclosporine. 27 (21.6%) had a been transplanted 1–2 years ago, 29 (23.2%) had been transplanted 3–4 years ago while 69 (55.2%) were transplanted 5 or more years ago. Among the cohort 15 (12%) had returned to dialysis. 22 (17.6%) were dead. Table 1 A: Overall Patient characteristics Overall Normouricemic Hyperuricemic Age (years) , n (%) < 20 7 (5.6) 5 (5.7) 2 (5.3) 20–29 14 (11.2) 12 (13.8) 2 (5.3) 30–39 29 (23.2) 23 (26.4) 6 (15.8) 40–49 26 (20.8) 15 (17.2) 11 (28.9) 50–59 29 (23.2) 17 (19.5) 12 (31.6) 60+ 20 (16.0) 15 (17.2) 5 (13.2) Gender , n (%) Male 82 (65.6) 55 (63.2) 27 (71.1) Female 43 (34.4) 32 (36.8) 11 (28.9) DM , n (%) Yes 35 (28.0) 26 (29.9) 9 (23.7) No 90 (72.0) 61 (70.1) 29 (76.3) HTN , n (%) Yes 121 (96.8) 83 (95.4) 38 (100.0) No 4 (3.2) 4 (4.6) 0 (0.0) BMI , n (%) < 18.5 (underweight) 10 (8.0) 9 (10.3) 1 (2.6) 18.5–24.9 (normal) 82 (65.6) 57 (65.5) 25 (65.8) 25.0–29.9 (overweight) 18 (14.4) 12 (13.8) 6 (15.8) ≥ 30.0 (obese) 15 (12.0) 9 (10.3) 6 (15.8) Duration since transplant (years) , n (%) 1–2 27 (21.6) 18 (20.7) 9 (23.7) 3–4 29 (23.2) 23 (26.4) 6 (15.8) ≥ 5 69 (55.2) 46 (52.9) 23 (60.5) CNI , n (%) Tacrolimus 98 (78.4) 69 (79.3) 29 (76.3) Cyclosporine 27 (21.6) 18 (20.7) 9 (23.7) Thiazide diuretic use , n (%) Yes 9 (7.2) 8 (9.2) 1 (2.6) No 116 (92.8) 79 (90.8) 37 (97.4) Dialysis , n (%) Yes 15 (12.0) 8 (9.2) 7 (18.4) No 110 (88.0) 79 (90.8) 31 (81.6) Status , n (%) Alive 103 (82.4) 73 (83.9) 30 (78.9) Dead 22 (17.6) 14 (16.1) 8 (21.1) Among the cohort of patients EGFR was calculated using MDRD formulae at the end of 1 year, at the end of 3 years and at the end of 5 years. Any individual who hadn’t reached the said year or passed away before the said year was not included. All patients (n = 125) had an EGFR calculated at the end of 1 year and the mean EGFR was 80 ± 23.8ml/min. By the end of 3 years after transplant 97 patients had their EGFR calculated and the mean was 71.5 ± 21.3ml/min. Finally at the end of 5 years 70 patients had their EGFR calculated and the mean was 62.4 ± 31.2ml/min. Transplant factors associated with hyperuricemia Hyper Normo OR (95% CI) p-value Age (years) , n (%) < 20 2 (5.3) 5 (5.7) 1.2 (0.2–8.2) 0.853 20–29 2 (5.3) 12 (13.8) 0.5 (0.1–3.0) 0.452 30–39 6 (15.8) 23 (26.4) 0.8 (0.2–3.0) 0.723 40–49 11 (28.9) 15 (17.2) 2.2 (0.6–7.9) 0.226 50–59 12 (31.6) 17 (19.5) 2.1 (0.6–7.4) 0.241 60+ 5 (13.2) 15 (17.2) Reference Gender , n (%) Male 27 (71.1) 55 (63.2) 1.4 (0.6–3.3) 0.397 Female 11 (28.9) 32 (36.8) Reference BMI , n (%) < 18.5 1 (2.6) 9 (10.3) Reference 18.5–24.9 25 (65.8) 57 (65.5) 3.9 (0.5–32.8) 0.204 25.0–29.9 6 (15.8) 12 (13.8) 4.5 (0.5–44.3) 0.197 ≥ 30.0 6 (15.8) 9 (10.3) 6.0 (0.6–60.4) 0.128 DM , n (%) Yes 9 (23.7) 26 (29.9) 0.7 (0.3–1.8) 0.479 No 29 (76.3) 61 (70.1) Reference HTN , n (%) Yes 38 (100.0) 83 (95.4) - No 0 (0.0) 4 (4.6) Duration since transplant (years) , n (%) 1–2 9 (23.7) 18 (20.7) 1.0 (0.4–2.6) 1.000 3–4 6 (15.8) 23 (26.4) 0.5 (0.2–1.5) 0.215 ≥ 5 23 (60.5) 46 (52.9) Reference CNI , n (%) Tacrolimus 29 (76.3) 69 (79.3) 0.8 (0.3–2.1) 0.708 Cyclosporine 9 (23.7) 18 (20.7) Reference Thiazide diuretic use , n (%) Yes 1 (2.6) 8 (9.2) 0.3 (0.03–2.2) 0.221 No 37 (97.4) 79 (90.8) Reference Dialysis , n (%) Yes 7 (18.4) 8 (9.2) 2.2 (0.7–6.7) 0.152 No 31 (81.6) 79 (90.8) Reference Status , n (%) Alive 30 (78.9) 73 (83.9) 0.7 (0.3–1.9) 0.504 Dead 8 (21.1) 14 (16.1) Reference In the group of patients who had Hyperuricemia the average EGFR at 1 year was 71.8 ± 20.8 ml/min and in the group that had normouricemia the average EGFR at 1 year was 83.6 ± 24.2 ml/min. When a comparison was made there was a statistically significant difference in the EGFR at 1 year between those who had Hyperuricemia and those who were normouricemic. (p = 0.01) The average EGFR at 3 years among the Hyperuricemic group was 59.7 ± 22.0 ml/min while in the normouricemic group the average EGFR at 3 years was 76.5 ± 19.0 ml/min. When a comparison was made there was a statistically significant lower EGFR at 3 years among the Hyperuricemic patients compared to the normouricemic patients (p = 0.001) The average EGFR at 5 years among the patients who had Hyperuricemia was 52.0 ± 32.8 ml/min while among those with normouricemia it was 67.2 ± 29.4 ml/min. When a comparison was made there was a statistically significant difference in the EGFR at 5 years between the Hyperuricemic and Normouricemic patients. (p = 0.05) DISCUSSION Hyperuricemia was a common problem among our patients and the prevalence of hyperuricemia among the patient files we analyzed was 30.4%. The reported prevalence of post-transplant hyperuricemia has ranged from between 15.5–84% in multiple studies.( 6 ) This may be due to the fact that the definition of hyperuricemia has remained controversial and different studies adopted different definitions. It is generally accepted that levels of serum uric acid > 7mg/dl in men and > 6 mg/dl in women defines hyperuricemia. In the study by Numakura et al the prevalence of hyperuricemia post-transplant was found to be 38% and they used a definition of serum uric acid > 7mg/dl in both males and females to defines hyperuricemia. ( 6 ) In the study by Gores et al the prevalence of hyperuricemia was 80% however in this study the definition of hyperuricemia was > 8mg/dl in both males and females.( 7 ). Einollahi et al used a definition similar to our study and found a prevalence of 32% which is fairly similar to our study.( 4 ) The other reason for a variation in the prevalence of hyperuricemia, maybe due to the reason that various studies have explored hyperuricemia among CNI users and Non CNI users and also between different CNI’s. In our study all the patients were on a CNI as is protocol in our unit. However 76.3%were on Tacrolimus and 23.7% were on Cyclosporine. The literature and multiple studies have suggested that Cyclosporine is strongly associated with the development of hyperuricemia post-transplant ( 4 ), ( 8 ). The exact pathogenesis of hyperuricemia in this setting is complex and not fully elucidated. It is postulated that the intra-renal vasoconstriction and decreased coefficient of glomerular ultrafiltration due to acute CsA nephrotoxicity would cause enhanced tubular urate reabsorption whereas the reduced renal mass associated with chronic CsA nephrotoxicity would eventually lead to a reduction in urate secretion. ( 4 ) The data on prevalence of hyperuricemia post-transplant among patients on Tacrolimus is scarce. However one study that did assess this was Numakura et al who found the prevalence to be 38% among patients on Tacrolimus.( 6 ) This is quite similar to the prevalence in our study and demonstrates that hyperuricemia following the use of Tacrolimus is not unusual. In the cohort of patients we examined, none of the patients who developed hyperuricemia after transplant had a history of pre transplant hyperuricemia. In the literature it has often been stated that the preexistence of hyperuricemia is a risk factor for the development of hyperuricemia after transplant.( 1 ), Indeed in our study we noted that among the patients who post renal transplant developed hyperuricemia, majority of them were on Tacrolimus (76.3%) while the minority of them were on Cyclosporine (23.7%). According to the odds ratio it seems that patients on tacrolimus were less likely to develop hyperuricemia (OR 0.8) but again this was not statistically significant. Over the past few years the protocol in our unit changed and most patients are put on Tacrolimus as the choice of Calcineurin Inhibitor. Studies have for a long time documented Cyclosporine use as being one of the strongest risk factors for the development of hyperuricemia.( 7 ),( 8 ) Since Cyclosporine came into wide clinical use, it has been recognized to be one of the greatest risk factors for the development of Hyperuricemia. Often following the withdrawal of the drug the hyperuricemia resolves.( 4 ) Studies with regards to Tacrolimus causing hyperuricemia are scarce despite Tacrolimus having ideally replaced cyclosporine as the calcineurin inhibitor of choice. ( 6 ) By virtue of extension the low glomerular filtration rate and enhanced tubular reabsorption seen with Cyclosporine maybe the same mechanism by which Tacrolimus causes hyperuricemia albeit at a lower frequency. Our study clearly shows that hyperuricemia is not uncommon among those using Tacrolimus. CONCLUSION In conclusion Hyperuricemia after transplant is not an uncommon phenomenon. The prevalence of hyperuricemia after a transplant in our patients at the Kenyatta National Hospital is 30.4%. None of the patients who developed hyperuricemia had pre- transplant hyperuricemia and most of them had been transplanted 5 or more years ago. Those who developed hyperuricemia were mostly on Tacrolimus as this is the calcineurin inhibitor of choice according to protocols in our unit. Most of those with high uric acid levels were not on a thiazide diuretic. Majority of the patients who had hyperuricemia were not symptomatic and only a minority had gout or chronic Tophaceous disease. In terms of the graft function at 1, 3 and 5 years among those who developed hyperuricemia it was found that it progressively declines and is significantly lower in patients with hyperuricemia than those without This study should form the basis for larger studies to determine whether hyperuricemia has any effect on graft function and whether treatment of hyperuricemia can prevent graft loss. Declarations ETHICS APPROVAL AND CONSENT FOR PUBLICATION: This study was conducted after approval by the Department of Clinical medicine and Therapeutics, University of Nairobi, The renal department East African kidney Institute and the University of Nairobi Ethics and research review committee. Availability of data and material - Available for 5 years at the renal department East African Kidney Institute Competing interests - None Funding - None AUTHORS CONTRIBUTIONS: DR ZOYA ADAM (The Nairobi hospital) [email protected] , Proposal writing, collecting data, analysing data, manuscript writing PROFESSOR JOSHUA KAYIMA (university of Nairobi ) [email protected] Proposal review, analysing data, manuscript review PROFESSOR AHMED SOKWALLA (Aga Khan university hospital) [email protected] Proposal review , analysing data, manuscript writing ACKNOWLEDGEMENTS: I would like to thank Dr Mehreen Adam for her continuous assistance in collection and analyses of data in this study. References Bellomo G. Asymptomatic hyperuricemia following renal transplantation. World J Nephrol. 2015;4(3):324–9. Einollahi B, Einollahi H, Nafar M, Rostami Z. Prevalence and risk factors of hyperuricemia among kidney transplant recipients. Indian J Nephrol. 2013;23(3):201–5. Gerhardt U, Grosse Hüttmann M, Hohage H. Influence of hyperglycemia and hyperuricemia on long-term transplant survival in kidney transplant recipients. Clin Transpl. 1999;13(5):375–9. Armstrong KA, Johnson DW, Campbell SB, Isbel NM, Hawley CM. Does uric acid have a pathogenetic role in graft dysfunction and hypertension in renal transplant recipients? Transplantation. 2005;80(11):1565–71. Mazzali M. Uric acid and transplantation. Semin Nephrol. 2005;25(1):50–5. Numakura K, Satoh S, Tsuchiya N, Saito M, Maita S, Obara T, et al. Hyperuricemia at 1 Year After Renal Transplantation, Its Prevalence, Associated Factors, and Graft Survival. Transplantation. 2012;94(2):145–51. Gores PF, Fryd DS, Sutherland DER, Najarian JS, Simmons RL. Hyperuricemia after renal transplantation. Am J Surg. 1988;156(5):397–400. Lin HY, Rocher LL, McQuillan MA, Schmaltz S, Palella TD, Fox IH. Cyclosporine-Induced Hyperuricemia and Gout. N Engl J Med. 1989;321(5):287–92. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5282858","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":373842143,"identity":"008d352f-6ca4-43ce-b9de-5220b22b66c4","order_by":0,"name":"Zoya Adam","email":"","orcid":"","institution":"Kenyatta National Hospital","correspondingAuthor":false,"prefix":"","firstName":"Zoya","middleName":"","lastName":"Adam","suffix":""},{"id":373842144,"identity":"703388f5-cfd9-4e0b-926e-40e7e52d5de5","order_by":1,"name":"Joshua Kayima","email":"","orcid":"","institution":"Kenyatta National Hospital","correspondingAuthor":false,"prefix":"","firstName":"Joshua","middleName":"","lastName":"Kayima","suffix":""},{"id":373842145,"identity":"813db1cf-562e-4eec-a547-708d8476de76","order_by":2,"name":"Ahmed Sokwala","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA20lEQVRIiWNgGAWjYDCCAwwMjA0MDDIM7ECSwcCCeC08DDwHQFokSNEikQDiEqGF7/bxhw9nttnx8M98fnXDjwIJBv727gS8WiTP5RgbbmxL5pG4nVN2swfoMIkzZzfg1WJwhodN8uE2Zh6G2zlpN3iAWgwkcglpYX8G1FLPI3/zTNrNP8RpYTCT3LjtMI/BDfZjt4myRfIMj7HhzH/HeQzP5LDdljGQ4CHoF74z7A8f9pyplpM7fvzZzTd/bOT423vxa0ECPAZgkljlIMD+gBTVo2AUjIJRMIIAABEaSZ1SDIN0AAAAAElFTkSuQmCC","orcid":"","institution":"Aga Khan University Hospital Nairobi","correspondingAuthor":true,"prefix":"","firstName":"Ahmed","middleName":"","lastName":"Sokwala","suffix":""}],"badges":[],"createdAt":"2024-10-17 12:38:21","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5282858/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5282858/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":72145905,"identity":"e14d0ee2-3e01-4fbc-b639-788cbf214097","added_by":"auto","created_at":"2024-12-23 07:24:28","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":535669,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5282858/v1/ebcc168b-a520-479f-8501-9f97fc08576d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eThe Clinico-Pathologic Profiles of Patients with Incidental Hyperuricemia Post Renal Transplant at the Kenyatta National Hospital\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eEvidence is accumulating indicating a role for uric acid in the genesis and progression of kidney disease, and a few studies are beginning to show a possible beneficial effect of urate-lowering therapy. Whether this holds true for renal allograft recipients is not clear.(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eHyperuricemia is a common complication in organ transplant recipients particularly kidney transplant recipients and frequently is associated with chronic cyclosporine immunosuppressive therapy.(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) .Its clinical and prognostic significance is not known.. The effect of hyperuricemia in patient and graft survival is not clear because uric acid is not considered a common risk factor for cardiovascular disease that may affect graft and patient survival. Little data are available regarding the effect of uric acid (UA) and hyperuricemia on graft function and survival following renal transplantation. Some studies have suggested that an increased serum uric acid (SUA) level is a prognostic factor for the development of renal allograft impairment. (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). There have been small studies that have suggested that control of uric acid levels contributes to recovery of renal function and an improvement in GFR in renal transplant recipients. (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eIn Africa in general and in particular in Kenya we have no data on the burden of hyperuricemia post renal transplant and therefore we also don\u0026rsquo;t have data on the clinical characteristics, graft function and outcomes of patients with hyperuricemia.\u003c/p\u003e"},{"header":"METHODOLOGY","content":"\u003cp\u003eIt is a retrospective descriptive cohort study The study was undertaken at the Renal Unit within the Kenyatta National Hospital, which is Kenya\u0026rsquo;s major teaching and referral Centre. It is a public funded tertiary hospital and serves Nairobi and its environs. Kenyatta national hospital also serves as the largest referral centre in Kenya. The renal department has one of the busiest transplant programs in Kenya, conducting on average 25\u0026ndash;30 renal transplants a year.\u003c/p\u003e \u003cp\u003eIn this study Hospital case notes from the medical records department at KNH were used.\u003c/p\u003e \u003cp\u003eRecords for the duration of January 2011 to June 2021 (inclusive) were analysed.\u003c/p\u003e \u003cp\u003eAll available files that met the inclusion criteria were analysed. Data was entered into a data collection sheet for hyperuricemic patients and a separate one for normouricemic patients.\u003c/p\u003e \u003cp\u003eThe clinical characteristics that were recorded were age, gender, Body mass index at time of transplant, Presence/absence of Diabetes, presence/absence of hypertension, presence/absence of pretransplant hyperuricemia, thiazide diuretic used, type of CNI used, duration since transplant, two consecutively high or normal serum uric acid levels within 5 years of transplant, signs and symptoms of hyperuricemia- gout, chronic tophi, asymptomatic.\u003c/p\u003e \u003cp\u003eThe graft function was recorded at the end of 1 year, at the end of 3 years and at the end of 5 years.\u003c/p\u003e \u003cp\u003eThe outcomes recorded at the time of analysis were whether the patient is dead or alive, and whether the patient returned to dialysis or not.\u003c/p\u003e \u003cp\u003eConsecutive sampling was done and sample size was calculated using Fisher\u0026rsquo;s formula\u003c/p\u003e \u003cp\u003eData was checked for completeness and free of error prior to entry to the Microsoft Excel 2019 Spread sheet. Thereafter it was transferred to the Statistical Package for Social Sciences version 24.0 for analysis. Demographic and clinical characteristics of the patients were analysed and presented as means with standard deviations or as medians with interquartile range for continuous data and as frequencies with percentages for categorical data. The clinic-pathologic manifestations among patients with hyperuricemia were analysed and presented as frequencies and percentages. The graft function at 1, 3 and 5 years post transplant among patients with post-transplant hyperuricemia was analysed and presented as means with standard deviations, as well as frequencies and percentages. The outcomes amongst patients with post-transplant hyperuricemia were analysed and presented as frequencies and percentages.\u003c/p\u003e \u003cp\u003eThe association between hyperuricemia and selected transplant related factors was analysed with the use of Pearson chi-square tests and Independents students t-test. Odds ratio as well as their 95% confidence interval were calculated. All statistical tests were considered significant where the p-value was \u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003cp\u003eThis study entailed analysis of hospital notes and was Retrospective in nature, therefore obtaining consent was not possible. This study was conducted after approval by the Department of Clinical medicine and Therapeutics, University of Nairobi, The renal department East African kidney Institute and the University of Nairobi Ethics and research review committee.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003e200 files were available between January 2011 and June 2021. Of the 200 files, 75 files were excluded because they had missing data (they lacked 2 serum uric acid results). Eventually 125 files were retrospectively analyzed.\u003c/p\u003e \u003cp\u003eAll the patients were Black Africans who had received a kidney from a living allograft donor.\u003c/p\u003e \u003cp\u003e82 (65.6%) of the 125 patients were Male and 43 (34.4%) were Female.\u003c/p\u003e \u003cp\u003eThe mean age of the patients was 44.2 (SD 14.4) years, where the minimum age was 18.0 years and the maximum age recorded was 72.0 years. The median age was 44.0 (IQR 33.0\u0026ndash;58.0) years.\u003c/p\u003e \u003cp\u003eIn terms of comorbidities, 35 (28%) of the cohort were Diabetic and 121 (96.8%) were Hypertensive. Most of the patients,98 (78.4%) were on Tacrolimus (Calcineurin inhibitor) and 27 (21.6%) were on Cyclosporine.\u003c/p\u003e \u003cp\u003e27 (21.6%) had a been transplanted 1\u0026ndash;2 years ago, 29 (23.2%) had been transplanted 3\u0026ndash;4 years ago while 69 (55.2%) were transplanted 5 or more years ago.\u003c/p\u003e \u003cp\u003eAmong the cohort 15 (12%) had returned to dialysis. 22 (17.6%) were dead.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eA: Overall Patient characteristics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOverall\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNormouricemic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHyperuricemic\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge (years)\u003c/b\u003e, \u003cem\u003en (%)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7 (5.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (5.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (5.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20\u0026ndash;29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14 (11.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (13.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (5.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e30\u0026ndash;39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e29 (23.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23 (26.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (15.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e40\u0026ndash;49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e26 (20.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (17.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11 (28.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e50\u0026ndash;59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e29 (23.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17 (19.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 (31.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e60+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20 (16.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (17.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (13.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e, \u003cem\u003en (%)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e82 (65.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55 (63.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27 (71.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e43 (34.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32 (36.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11 (28.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDM\u003c/b\u003e, \u003cem\u003en (%)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e35 (28.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26 (29.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9 (23.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e90 (72.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61 (70.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29 (76.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHTN\u003c/b\u003e, \u003cem\u003en (%)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e121 (96.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e83 (95.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38 (100.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4 (3.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (4.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBMI\u003c/b\u003e, \u003cem\u003en (%)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;18.5\u0026nbsp;(underweight)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10 (8.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (10.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (2.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18.5\u0026ndash;24.9\u0026nbsp;(normal)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e82 (65.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57 (65.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25 (65.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25.0\u0026ndash;29.9\u0026nbsp;(overweight)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18 (14.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (13.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (15.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;30.0\u0026nbsp;(obese)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15 (12.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (10.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (15.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDuration since transplant (years)\u003c/b\u003e, \u003cem\u003en (%)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u0026ndash;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27 (21.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (20.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9 (23.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u0026ndash;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e29 (23.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23 (26.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (15.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e69 (55.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46 (52.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23 (60.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCNI\u003c/b\u003e, \u003cem\u003en (%)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTacrolimus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e98 (78.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69 (79.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29 (76.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCyclosporine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27 (21.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (20.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9 (23.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eThiazide diuretic use\u003c/b\u003e, \u003cem\u003en (%)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9 (7.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (9.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (2.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e116 (92.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e79 (90.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37 (97.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDialysis\u003c/b\u003e, \u003cem\u003en (%)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15 (12.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (9.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (18.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e110 (88.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e79 (90.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31 (81.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eStatus\u003c/b\u003e, \u003cem\u003en (%)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e103 (82.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e73 (83.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30 (78.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDead\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22 (17.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (16.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (21.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAmong the cohort of patients EGFR was calculated using MDRD formulae at the end of 1 year, at the end of 3 years and at the end of 5 years. Any individual who hadn\u0026rsquo;t reached the said year or passed away before the said year was not included.\u003c/p\u003e \u003cp\u003eAll patients (n\u0026thinsp;=\u0026thinsp;125) had an EGFR calculated at the end of 1 year and the mean EGFR was 80\u0026thinsp;\u0026plusmn;\u0026thinsp;23.8ml/min. By the end of 3 years after transplant 97 patients had their EGFR calculated and the mean was 71.5\u0026thinsp;\u0026plusmn;\u0026thinsp;21.3ml/min. Finally at the end of 5 years 70 patients had their EGFR calculated and the mean was 62.4\u0026thinsp;\u0026plusmn;\u0026thinsp;31.2ml/min.\u003c/p\u003e\n\u003ch3\u003eTransplant factors associated with hyperuricemia\u003c/h3\u003e\n\u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHyper\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNormo\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge (years)\u003c/b\u003e, \u003cem\u003en (%)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2 (5.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5 (5.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.2 (0.2\u0026ndash;8.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.853\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20\u0026ndash;29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2 (5.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12 (13.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.5 (0.1\u0026ndash;3.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.452\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e30\u0026ndash;39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6 (15.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23 (26.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.8 (0.2\u0026ndash;3.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.723\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e40\u0026ndash;49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11 (28.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15 (17.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.2 (0.6\u0026ndash;7.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.226\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e50\u0026ndash;59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12 (31.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17 (19.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.1 (0.6\u0026ndash;7.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.241\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e60+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5 (13.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15 (17.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e, \u003cem\u003en (%)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27 (71.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e55 (63.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.4 (0.6\u0026ndash;3.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.397\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11 (28.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32 (36.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBMI\u003c/b\u003e, \u003cem\u003en (%)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;18.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (2.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9 (10.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18.5\u0026ndash;24.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25 (65.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e57 (65.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.9 (0.5\u0026ndash;32.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.204\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25.0\u0026ndash;29.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6 (15.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12 (13.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.5 (0.5\u0026ndash;44.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.197\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;30.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6 (15.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9 (10.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.0 (0.6\u0026ndash;60.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.128\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDM\u003c/b\u003e, \u003cem\u003en (%)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9 (23.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26 (29.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.7 (0.3\u0026ndash;1.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.479\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e29 (76.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e61 (70.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHTN\u003c/b\u003e, \u003cem\u003en (%)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e38 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e83 (95.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4 (4.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDuration since transplant (years)\u003c/b\u003e, \u003cem\u003en (%)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u0026ndash;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9 (23.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18 (20.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.0 (0.4\u0026ndash;2.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u0026ndash;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6 (15.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23 (26.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.5 (0.2\u0026ndash;1.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.215\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e23 (60.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e46 (52.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCNI\u003c/b\u003e, \u003cem\u003en (%)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTacrolimus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e29 (76.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e69 (79.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.8 (0.3\u0026ndash;2.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.708\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCyclosporine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9 (23.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18 (20.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eThiazide diuretic use\u003c/b\u003e, \u003cem\u003en (%)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (2.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8 (9.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.3 (0.03\u0026ndash;2.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.221\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e37 (97.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e79 (90.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDialysis\u003c/b\u003e, \u003cem\u003en (%)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7 (18.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8 (9.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.2 (0.7\u0026ndash;6.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.152\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e31 (81.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e79 (90.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eStatus\u003c/b\u003e, \u003cem\u003en (%)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e30 (78.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e73 (83.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.7 (0.3\u0026ndash;1.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.504\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDead\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8 (21.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14 (16.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn the group of patients who had Hyperuricemia the average EGFR at 1 year was 71.8\u0026thinsp;\u0026plusmn;\u0026thinsp;20.8 ml/min and in the group that had normouricemia the average EGFR at 1 year was 83.6\u0026thinsp;\u0026plusmn;\u0026thinsp;24.2 ml/min. When a comparison was made there was a statistically significant difference in the EGFR at 1 year between those who had Hyperuricemia and those who were normouricemic. (p\u0026thinsp;=\u0026thinsp;0.01)\u003c/p\u003e \u003cp\u003eThe average EGFR at 3 years among the Hyperuricemic group was 59.7\u0026thinsp;\u0026plusmn;\u0026thinsp;22.0 ml/min while in the normouricemic group the average EGFR at 3 years was 76.5\u0026thinsp;\u0026plusmn;\u0026thinsp;19.0 ml/min. When a comparison was made there was a statistically significant lower EGFR at 3 years among the Hyperuricemic patients compared to the normouricemic patients (p\u0026thinsp;=\u0026thinsp;0.001)\u003c/p\u003e \u003cp\u003eThe average EGFR at 5 years among the patients who had Hyperuricemia was 52.0\u0026thinsp;\u0026plusmn;\u0026thinsp;32.8 ml/min while among those with normouricemia it was 67.2\u0026thinsp;\u0026plusmn;\u0026thinsp;29.4 ml/min. When a comparison was made there was a statistically significant difference in the EGFR at 5 years between the Hyperuricemic and Normouricemic patients. (p\u0026thinsp;=\u0026thinsp;0.05)\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eHyperuricemia was a common problem among our patients and the prevalence of hyperuricemia among the patient files we analyzed was 30.4%. The reported prevalence of post-transplant hyperuricemia has ranged from between 15.5\u0026ndash;84% in multiple studies.(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThis may be due to the fact that the definition of hyperuricemia has remained controversial and different studies adopted different definitions. It is generally accepted that levels of serum uric acid\u0026thinsp;\u0026gt;\u0026thinsp;7mg/dl in men and \u0026gt;\u0026thinsp;6 mg/dl in women defines hyperuricemia. In the study by Numakura et al the prevalence of hyperuricemia post-transplant was found to be 38% and they used a definition of serum uric acid\u0026thinsp;\u0026gt;\u0026thinsp;7mg/dl in both males and females to defines hyperuricemia. (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e) In the study by Gores et al the prevalence of hyperuricemia was 80% however in this study the definition of hyperuricemia was \u0026gt;\u0026thinsp;8mg/dl in both males and females.(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Einollahi et al used a definition similar to our study and found a prevalence of 32% which is fairly similar to our study.(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThe other reason for a variation in the prevalence of hyperuricemia, maybe due to the reason that various studies have explored hyperuricemia among CNI users and Non CNI users and also between different CNI\u0026rsquo;s. In our study all the patients were on a CNI as is protocol in our unit. However 76.3%were on Tacrolimus and 23.7% were on Cyclosporine. The literature and multiple studies have suggested that Cyclosporine is strongly associated with the development of hyperuricemia post-transplant (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e), (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). The exact pathogenesis of hyperuricemia in this setting is complex and not fully elucidated. It is postulated that the intra-renal vasoconstriction and decreased coefficient of glomerular ultrafiltration due to acute CsA nephrotoxicity would cause enhanced tubular urate reabsorption whereas the reduced renal mass associated with chronic CsA nephrotoxicity would eventually lead to a reduction in urate secretion. (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) The data on prevalence of hyperuricemia post-transplant among patients on Tacrolimus is scarce. However one study that did assess this was Numakura et al who found the prevalence to be 38% among patients on Tacrolimus.(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e) This is quite similar to the prevalence in our study and demonstrates that hyperuricemia following the use of Tacrolimus is not unusual.\u003c/p\u003e \u003cp\u003eIn the cohort of patients we examined, none of the patients who developed hyperuricemia after transplant had a history of pre transplant hyperuricemia. In the literature it has often been stated that the preexistence of hyperuricemia is a risk factor for the development of hyperuricemia after transplant.(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e),\u003c/p\u003e \u003cp\u003eIndeed in our study we noted that among the patients who post renal transplant developed hyperuricemia, majority of them were on Tacrolimus (76.3%) while the minority of them were on Cyclosporine (23.7%). According to the odds ratio it seems that patients on tacrolimus were less likely to develop hyperuricemia (OR 0.8) but again this was not statistically significant. Over the past few years the protocol in our unit changed and most patients are put on Tacrolimus as the choice of Calcineurin Inhibitor. Studies have for a long time documented Cyclosporine use as being one of the strongest risk factors for the development of hyperuricemia.(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e),(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e) Since Cyclosporine came into wide clinical use, it has been recognized to be one of the greatest risk factors for the development of Hyperuricemia. Often following the withdrawal of the drug the hyperuricemia resolves.(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) Studies with regards to Tacrolimus causing hyperuricemia are scarce despite Tacrolimus having ideally replaced cyclosporine as the calcineurin inhibitor of choice. (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e) By virtue of extension the low glomerular filtration rate and enhanced tubular reabsorption seen with Cyclosporine maybe the same mechanism by which Tacrolimus causes hyperuricemia albeit at a lower frequency. Our study clearly shows that hyperuricemia is not uncommon among those using Tacrolimus.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eIn conclusion Hyperuricemia after transplant is not an uncommon phenomenon. The prevalence of hyperuricemia after a transplant in our patients at the Kenyatta National Hospital is 30.4%.\u003c/p\u003e \u003cp\u003eNone of the patients who developed hyperuricemia had pre- transplant hyperuricemia and most of them had been transplanted 5 or more years ago.\u003c/p\u003e \u003cp\u003eThose who developed hyperuricemia were mostly on Tacrolimus as this is the calcineurin inhibitor of choice according to protocols in our unit. Most of those with high uric acid levels were not on a thiazide diuretic.\u003c/p\u003e \u003cp\u003eMajority of the patients who had hyperuricemia were not symptomatic and only a minority had gout or chronic Tophaceous disease.\u003c/p\u003e \u003cp\u003eIn terms of the graft function at 1, 3 and 5 years among those who developed hyperuricemia it was found that it progressively declines and is significantly lower in patients with hyperuricemia than those without\u003c/p\u003e \u003cp\u003eThis study should form the basis for larger studies to determine whether hyperuricemia has any effect on graft function and whether treatment of hyperuricemia can prevent graft loss.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eETHICS APPROVAL AND CONSENT FOR PUBLICATION:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted after approval by the Department of Clinical medicine and Therapeutics, University of Nairobi, The renal department East African kidney Institute and the University of Nairobi Ethics and research review committee.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material\u003c/strong\u003e-\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAvailable for 5 years at the renal department East African Kidney Institute\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e-\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNone\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e-\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNone\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAUTHORS CONTRIBUTIONS:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDR ZOYA ADAM \u0026nbsp;(The Nairobi hospital) [email protected] ,\u003c/p\u003e\n\u003cp\u003eProposal writing, collecting data, analysing data, manuscript writing\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePROFESSOR JOSHUA KAYIMA (university of Nairobi ) \u0026nbsp;[email protected]\u003c/p\u003e\n\u003cp\u003eProposal review, analysing data, manuscript review\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePROFESSOR AHMED SOKWALLA (Aga Khan university hospital) [email protected]\u003c/p\u003e\n\u003cp\u003eProposal review , analysing data, manuscript writing\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eACKNOWLEDGEMENTS:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eI would like to thank Dr Mehreen Adam for her continuous assistance in collection and analyses of data in this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBellomo G. Asymptomatic hyperuricemia following renal transplantation. World J Nephrol. 2015;4(3):324\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEinollahi B, Einollahi H, Nafar M, Rostami Z. Prevalence and risk factors of hyperuricemia among kidney transplant recipients. Indian J Nephrol. 2013;23(3):201\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGerhardt U, Grosse H\u0026uuml;ttmann M, Hohage H. Influence of hyperglycemia and hyperuricemia on long-term transplant survival in kidney transplant recipients. Clin Transpl. 1999;13(5):375\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eArmstrong KA, Johnson DW, Campbell SB, Isbel NM, Hawley CM. Does uric acid have a pathogenetic role in graft dysfunction and hypertension in renal transplant recipients? Transplantation. 2005;80(11):1565\u0026ndash;71.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMazzali M. Uric acid and transplantation. Semin Nephrol. 2005;25(1):50\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNumakura K, Satoh S, Tsuchiya N, Saito M, Maita S, Obara T, et al. Hyperuricemia at 1 Year After Renal Transplantation, Its Prevalence, Associated Factors, and Graft Survival. Transplantation. 2012;94(2):145\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGores PF, Fryd DS, Sutherland DER, Najarian JS, Simmons RL. Hyperuricemia after renal transplantation. Am J Surg. 1988;156(5):397\u0026ndash;400.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLin HY, Rocher LL, McQuillan MA, Schmaltz S, Palella TD, Fox IH. Cyclosporine-Induced Hyperuricemia and Gout. N Engl J Med. 1989;321(5):287\u0026ndash;92.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-5282858/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5282858/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBACKGROUND:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFollowing a renal transplant hyperuricemia is a common complication, but its clinical and prognostic significance is controversial. Evidence is accumulating indicating a role for uric acid in causing graft dysfunction and hence decreasing survival of the graft. This study was conducted to determine the clinical characteristics, graft function and outcomes of hyperuricemic renal transplant recipients at the Kenyatta national hospital\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eMETHODOLOGY:\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe study population comprised all renal transplant recipients between January 2011 to June 2021 being seen at the Kenyatta National Hospital transplant clinic .Patients were above 18 years of age with at least 2 consecutive uric acid assays that were consistently high or normal. As many files as available, that met the inclusion criteria were analysed by consecutive sampling. The clinical characteristics, the graft function at the end of 1 year, 3 years and at the end of 5 years, as well as the outcomes were recorded\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eRESULTS:\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAll the patients were Black Africans and had received a kidney from a living allograft donor. 82 (65.6%) of the 125 patients were Male and 43 (34.4%) were Female. The mean age of the patients was 44.2 (SD 14.4) years.\u003cem\u003e\u003cstrong\u003e \u003c/strong\u003e\u003c/em\u003eThe prevalence of hyperuricemia was 30.4%.9 (23.7%) of the 38 patients with hyperuricemia had Diabetes as a comorbidity and all the 38(100%) patients had hypertension as a comorbidity. Most of the patients 25(65.8%) were of normal BMI.\u003c/p\u003e\n\u003cp\u003eThe majority 23 (60.5%) had been transplanted 5 or more years ago. None of the patients with hyperuricemia had pre-transplant hyperuricemia. 29 (76.3%) were on Tacrolimus while 9 (23.7%) were on Cyclosporine. Only 1 (2.6%) of the patients with hyperuricemia was on a Thiazide diuretic.\u003c/p\u003e\n\u003cp\u003eOverall, there were no factors that were found to be independently associated with hyperuricemia, except the EGFR at 1, 3 and 5 years which were all significantly lower in the hyperuricemic group.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eCONCLUSION:\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eHyperuricemia was common in our transplant recipients and was seen more among males. All patients with hyperuricemia had hypertension but not diabetes and most had a normal BMI. No significant transplant associated risk factors among those with hyperuricemia, were found. However, among patients with hyperuricemia the EGFR was significantly lower at the end of 1, 3 and 5 years when compared to those with normal uric acid levels.\u003c/p\u003e","manuscriptTitle":"The Clinico-Pathologic Profiles of Patients with Incidental Hyperuricemia Post Renal Transplant at the Kenyatta National Hospital","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-11-05 16:16:38","doi":"10.21203/rs.3.rs-5282858/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b25c86fd-6ab3-403f-803d-3bd628589f06","owner":[],"postedDate":"November 5th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-12-23T07:24:13+00:00","versionOfRecord":[],"versionCreatedAt":"2024-11-05 16:16:38","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5282858","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5282858","identity":"rs-5282858","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}