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Effect of Uric Acid on the Development of Chronic Kidney Disease: The Korean Multi-Rural Communities Cohort Study
Kwang Ho Mun, Gyeong Im Yu, Bo Youl Choi, Mi Kyung Kim, Min-Ho Shin, Dong Hoon Shin
J Prev Med Public Health. 2018;51(5):248-256.   Published online September 7, 2018
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  • 173 Download
  • 10 Crossref
AbstractAbstract PDF
Several studies have investigated the effects of serum uric acid (SUA) levels on chronic kidney disease (CKD), with discrepant results. The effect of SUA levels on CKD development was studied in the Korean rural population.
A total of 9695 participants aged ≥40 years were recruited from 3 rural communities in Korea between 2005 and 2009. Of those participants, 5577 who participated in the follow-up and did not have cerebrovascular disease, myocardial infarction, cancer, or CKD at baseline were studied. The participants, of whom 2133 were men and 3444 were women, were grouped into 5 categories according to their quintile of SUA levels. An estimated glomerular filtration rate of <60 mL/min/1.73 m2 at the time of follow-up was considered to indicate newly developed CKD. The effects of SUA levels on CKD development after adjusting for potential confounders were assessed using Cox proportional hazard models.
Among the 5577 participants, 9.4 and 11.0% of men and women developed CKD. The hazard ratio (HR) of CKD was higher in the highest quintile of SUA levels than in the third quintile in men (adjusted HR, 1.60; 95% confidence interval [CI], 1.02 to 2.51) and women (adjusted HR, 1.56; 95% CI, 1.14 to 2.15). Furthermore, CKD development was also more common in the lowest quintile of SUA levels than in the third quintile in men (adjusted HR, 1.83; 95% CI, 1.15 to 2.90). The effect of SUA was consistent in younger, obese, and hypertensive men.
Both high and low SUA levels were risk factors for CKD development in rural Korean men, while only high levels were a risk factor in their women counterparts.


Citations to this article as recorded by  
  • Serum Uric Acid Levels and Nephrosclerosis in a Population-Based Autopsy Study: The Hisayama Study
    Kenji Maki, Jun Hata, Satoko Sakata, Emi Oishi, Yoshihiko Furuta, Toshiaki Nakano, Yoshinao Oda, Takanari Kitazono, Toshiharu Ninomiya
    American Journal of Nephrology.2022; 53(1): 69.     CrossRef
  • Clinical features suggesting renal hypouricemia as the cause of acute kidney injury: a case report and review of the literature
    Tommaso Mazzierli, Luigi Cirillo, Viviana Palazzo, Fiammetta Ravaglia, Francesca Becherucci
    Journal of Nephrology.2022; 36(3): 651.     CrossRef
  • U-shaped relationship between serum uric acid level and decline in renal function during a 10-year period in female subjects: BOREAS-CKD2
    Kazuma Mori, Masato Furuhashi, Marenao Tanaka, Keita Numata, Takashi Hisasue, Nagisa Hanawa, Masayuki Koyama, Arata Osanami, Yukimura Higashiura, Masafumi Inyaku, Megumi Matsumoto, Norihito Moniwa, Hirofumi Ohnishi, Tetsuji Miura
    Hypertension Research.2021; 44(1): 107.     CrossRef
  • Sex-Specific Association of Uric Acid and Kidney Function Decline in Taiwan
    Po-Ya Chang, Yu-Wei Chang, Yuh-Feng Lin, Hueng-Chuen Fan
    Journal of Personalized Medicine.2021; 11(5): 415.     CrossRef
  • Detailed association between serum uric acid levels and the incidence of chronic kidney disease stratified by sex in middle-aged adults
    Shingo Nakayama, Michihiro Satoh, Yukako Tatsumi, Takahisa Murakami, Tomoko Muroya, Takuo Hirose, Takayoshi Ohkubo, Takefumi Mori, Atsushi Hozawa, Hirohito Metoki
    Atherosclerosis.2021; 330: 107.     CrossRef
  • Association between Serum Uric Acid Level and ESRD or Death in a Korean Population
    Kipyo Kim, Suryeong Go, Hyung Eun Son, Ji Young Ryu, Hajeong Lee, Nam Ju Heo, Ho Jun Chin, Jung Hwan Park
    Journal of Korean Medical Science.2020;[Epub]     CrossRef
  • Renal effects of uric acid: hyperuricemia and hypouricemia
    Jung Hwan Park, Yong-Il Jo, Jong-Ho Lee
    The Korean Journal of Internal Medicine.2020; 35(6): 1291.     CrossRef
  • Hyperuricemia Predicts Residual Diuresis Decline in Peritoneal Dialysis Patients
    Natalia Stapanova, Lyudmyla Snisar, Larysa Lebid
    Electronic Journal of General Medicine.2020; 18(1): em270.     CrossRef
  • Genetically Elevated Serum Uric Acid and Renal Function in an Apparently Healthy Population
    Ji-Yong Ge, Yuan Ji, Zhen-Yan Zhu, Xun Li
    Urologia Internationalis.2020; 104(3-4): 277.     CrossRef
  • Threshold Effects of Serum Uric Acid on Chronic Kidney Disease in US Women without Hypertension and Diabetes: A Cross-Sectional Study
    Guiping Hu, Yi Bai, Tian Chen, Shichuan Tang, Lihua Hu
    Kidney and Blood Pressure Research.2019; 44(5): 1036.     CrossRef
Serum Uric Acid Level and the Incidence of Metabolic Syndrome in Middle-aged Korean Men: A 5-Year Follow-up Study
Jong-Keun Lee, Jae-Hong Ryoo, Joong-Myung Choi, Sung Keun Park
J Prev Med Public Health. 2014;47(6):317-326.   Published online November 4, 2014
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  • 89 Download
  • 5 Crossref
AbstractAbstract PDF
Elevated serum uric acid (UA) has been known to be associated with the prevalence of metabolic syndrome (MetS). However, no prospective studies have examined whether serum UA levels are actually associated with the development of MetS. We performed a prospective study to evaluate the longitudinal effects of baseline serum UA levels on the development of MetS.
A MetS-free cohort of 14 906 healthy Korean men, who participated in a medical check-up program in 2005, was followed until 2010. MetS was defined according to the Joint Interim Statement of the International Diabetes Federation Task Force on Epidemiology and Prevention. Cox proportional hazards models were performed.
During 52 466.1 person-years of follow-up, 2428 incident cases of MetS developed between 2006 and 2010. After adjusting for multiple covariates, the hazard ratios (95% confidence intervals) for incident MetS for the second, the third, and the fourth quartile to the first quartile of serum UA levels were 1.09 (0.92-1.29), 1.22 (1.04-1.44), and 1.48 (1.26-1.73), respectively (p for trend <0.001). These associations were also significant in the clinically relevant subgroup analyses.
Elevated serum UA levels were independently associated with future development of MetS in Korean men during the 5-year follow-up period.


Citations to this article as recorded by  
  • Which Clusters of Metabolic Syndrome Are the Most Associated with Serum Uric Acid?
    Jurgita Mikolaitytė, Jolita Badarienė, Roma Puronaitė, Alma Čypienė, Irma Rutkauskienė, Jolanta Dadonienė, Aleksandras Laucevičius
    Medicina.2022; 58(2): 297.     CrossRef
  • Association between serum uric acid and metabolic syndrome: a cross-sectional study in Bangladeshi adults
    Nurshad Ali, Rakib Miah, Mahmudul Hasan, Zitu Barman, Ananya Dutta Mou, Jaasia Momtahena Hafsa, Aporajita Das Trisha, Akibul Hasan, Farjana Islam
    Scientific Reports.2020;[Epub]     CrossRef
  • Association between uric acid and metabolic syndrome in elderly women
    Hui-Juan Wang, Lei-Zhi Shi, Cun-Fei Liu, Shi-Min Liu, Song-Tao Shi
    Open Medicine.2018; 13(1): 172.     CrossRef
  • The Associations of Serum Uric Acid with Obesity-Related Acanthosis nigricans and Related Metabolic Indices
    Cuiling Zhu, Ran Cui, Mingming Gao, Sharvan Rampersad, Hui You, Chunjun Sheng, Peng Yang, Hui Sheng, Xiaoyun Cheng, Le Bu, Shen Qu
    International Journal of Endocrinology.2017; 2017: 1.     CrossRef
  • Association between Serum Uric Acid and Mortality among Chinese Patients with Coronary Artery Disease
    Qing Li, Yuan Zhang, Ding Ding, Yunou Yang, Qian Chen, Chaoqun Liu, Xinrui Li, Changjiang Hong, Wenhua Ling
    Cardiology.2016; 134(3): 347.     CrossRef
Association Between Serum Uric Acid Level and Metabolic Syndrome
Ju-Mi Lee, Hyeon Chang Kim, Hye Min Cho, Sun Min Oh, Dong Phil Choi, Il Suh
J Prev Med Public Health. 2012;45(3):181-187.   Published online May 31, 2012
  • 16,064 View
  • 173 Download
  • 52 Crossref
AbstractAbstract PDF

Serum uric acid levels have been reported to be associated with a variety of cardiovascular conditions. However, the direct association between uric acid levels and metabolic syndrome remains controversial. Thus, we evaluated the association of serum uric acid levels and metabolic syndrome in a community-based cohort study in Korea.


We performed cross-sectional analysis of baseline data of 889 males and 1491 females (aged 38 to 87) who participated in baseline examinations of the Korean Genome and Epidemiology Study: Kanghwa study. Blood samples were collected after at least an 8 hour fast. Uric acid quartiles were defined as follows: <4.8, 4.8-<5.6, 5.6-<6.5, ≥6.5 mg/dL in males; and <3.8, 3.8-<4.3, 4.3-<5.1, ≥5.1 mg/dL in females. Metabolic syndrome was defined by the National Cholesterol Education Program Adult Treatment Panel III Criteria with adjusted waist circumference cutoffs (90 cm for males; 80 cm for females). The association between serum uric acid quartiles and metabolic syndrome was assessed using multivariate logistic regression.


The odds ratio for having metabolic syndrome in the highest versus lowest quartiles of serum uric acid levels was 2.67 (95% confidence interval [CI], 1.60 to 4.46) in males and 2.14 (95% CI, 1.50 to 3.05) in females after adjusting for age, smoking, alcohol intake, body mass index, total cholesterol, HbA1c, albumin, γ-glutamyltransferase, blood urea nitrogen, and log C-reactive protein. The number of metabolic abnormalities also increased gradually with increasing serum uric acid levels (adjusted p for trend < 0.001 in both sexes).


Higher serum uric acid levels are positively associated with the presence of metabolic syndrome in Korean males and females.



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    Algal Research.2022; 68: 102885.     CrossRef
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  • Uric Acid Levels Correlate with Sensory Nerve Function in Healthy Subjects
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    Dayan Zhang, Huazhong Liu, Ping Luo, Yanqun Li
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A Study on Polymorphism Affecting Excretion of Urinary Methylhippuric Acid due to Xylene Exposure.
Cheong Sik Kim, Sang Baek Koh, Hyeongsu Kim, Sue Kyung Park, Soung Hoon Chang
J Prev Med Public Health. 2004;37(4):321-328.   Published online November 30, 2004
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  • 49 Download
AbstractAbstract PDF
The purpose of this study was to investigate the effect of genetic polymorphism of cytochrome P450 2E1 (CYP2E1) and aldehyde dehydrogenase 2 (ALDH2) on the xylene metabolism. METHODS: Among 247 workers, 116 were occupationally exposed to xylene and 131 were not. Workers exposed to xylene had different work such as spray, touch-up, mix & assist, and pre-treat. Questionnaire variables were age, sex, use of personal protective equipment, smoking, previous night's drinking and work duration. The urinary methylhippuric acid was measured in the urine collected in the afternoon and corrected by urinary creatinine concentration. The genotypes of CYP2E1 and ALDH2 were investigated by using PCR-RFLP (polymerase chain reaction-restriction fragment length polymorphism) methods with DNA extracted from venous blood. RESULTS: 1. The urinary concentrations of o-, m-, and pmethylhippuric acid and total methylhippuric acid in the exposed group were significantly higher than those in the non-exposed group (p< 0.001). 2. In multiple regression analysis, the urinary methylhippuric acid concentration was significantly influenced by exposure grade (Job-exposure matrixes), smoking, drug use and kind of protective equipment (p< 0.1). 3. Genetic polymorphism of CYP2E1 and ALDH2 did not affect urinary methylhippuric acid level in the exposed group (p> 0.05). CONCLUSIONS: Exposure grade, smoking, drug use and kind of protective equipment affected urinary methylhippuric acid level, whereas genetic polymorphism of CYP2E1 and ALDH2 did not. However, further investigation for the effect of genetic polymorphism on the metabolism of xylene with a larger sample size is needed.
English Abstract
Effects of the Exposure to Polycyclic Aromatic Hydrocarbons or Toluene on Thiobarbituric Acid Reactive Substance Level in Elementary School Children and the Elderly in a Rural Area.
Dae Seon Kim, Chul Ho Lee, Sang Yong Eom, Tackshin Kang, Yong Dae Kim, Heon Kim
J Prev Med Public Health. 2008;41(1):61-67.
  • 4,191 View
  • 43 Download
  • 5 Crossref
AbstractAbstract PDF
Polycyclic aromatic hydrocarbons (PAH) and toluene have been reported to induce reactive oxygen species and oxidative stress. This study was performed to investigate the effects of low level exposure to PAHs or toluene on the lipid peroxidation level in elementary school children and the elderly in a rural area. METHODS: Forty seven elementary school children and 40 elderly people who were living in a rural area and not occupationally exposed to PAH or toluene were the subjects of this study. Information about active or passive smoking and diet was obtained using a self-administered questionnaire. The urinary 1-hydroxypyrene (1-OHP), 2-naphthol, hippuric acid and thiobarbituric acid reactive substance (TBARS) concentrations were measured, and these values were corrected with the urinary creatinine concentration. RESULTS: In school children, the geometric means of the urinary 1-OHP, 2-naphthol, hippuric acid and TBARS levels were 0.02 ymol/mol creatinine, 0.47 micron mol/mol creatinine, 0.14 g/g creatinine and 0.95 micron mol/g creatinine, respectively. Those values for the elderly were 0.07 micron mol/mol creatinine, 1.87 micron mol/mol creatinine, 0.11 g/g creatinine and 1.18 micron mol/g creatinine, respectively. The mean levels of urinary 1-OHP, 2-naphthol and TBARS were significantly higher in the elderly subjects than in the children. The urinary TBARS level was not correlated with the urinary 1-OHP, 2-naphthol and hippuric acid, but they were correlated with the age of the subjects. CONCLSIONS: These results suggest that low level inhalation exposure to PAH or toluene does not markedly increase lipid peroxidation, and age is a significant determinant of lipid peroxidation.


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Original Articles
Relationship of Serum Uric Acid to Cardiovascular Risk Factors in Korean Male Workers.
So Yeon Ryu, Jong Gab Oh, Chul Gab Lee, Ki Soon Kim
Korean J Prev Med. 2002;35(3):214-220.
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AbstractAbstract PDF
To investigate the relationship of serum uric acid to cardiovascular risk factors in Korean male workers. METHODS: We screened 522 male workers at an electrical manufacturing company by a periodic health examination and a questionnaire survey in 2000. We collected data relating to age, smoking status, alcohol drinking status, body mass index (BMI), blood pressure, serum lipid, fasting blood glucose and serum uric acid. The data were analyzed using a variety of methods, including ANOVA, Pearson's correlation, and multivariate regression analyses, to examine the association between uric acid and cardiovascular risk factors with a cross-sectional study design. RESULTS: The concentration of serum uric acid showed positive associations with BMI, total cholesterol, triglyceride, and LDL-cholesterol; it was also significantly correlated to systolic and diastolic blood pressures. Life-style characteristics, such as smoking and alcohol drinking showed no significant association. From the multivariate regression analyses, BMI, total cholesterol and fasting blood glucose levels were found to be independent positive predictors of uric acid; while age, blood pressure and smoking status give no independent contribution explaining the variability of serum uric acid levels. Conclusions : This study demonstrates that serum uric acid level have a significant association with cardiovascular risk factors, such as BMI, total cholesterol and blood glucose in some Korean male workers.
The Relationship Between Hippuric Acid in Blood Plasma and Toluene Concentration in the Air of Workplace.
Cheon Hyun Hwang, Won Jin Lee, Soung Hoon Chang, Hyoung Ah Kim
Korean J Prev Med. 2000;33(1):45-50.
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  • 76 Download
AbstractAbstract PDF
This study was undertaken to evaluate correlation between the levels of hippuric acid in blood plasma (HAP) and those of toluene concentration in the workplace air. METHODS: Study subjects were composed of two groups; 21 workers who were occupationally exposed to toluene and 25 rural-area residents who were not exposed to any known occupational toluene source, as an exposed group and a reference group, respectively. Mean age and work duration of the exposed was 42 years and five years, respectively. Mean age of the reference was 42 years. To determine toluene concentrations in the workplace air, air sampling has been conducted for more than six hours using a personal sampler, and analyzed by a gas chromatography-flame ionization detector. Concentrations of hippuric acid in biological samples were determined by a high performance liquid chromatography-ultraviolet detector. RESULTS: Geometric mean(geometric standard deviation) of HAP and hippuric acid in urine(HAU) for the exposed was 1.39(2.21) mg/L and 2.77(1.46) g/L, respectively, which were significantly different from those of the reference [HAP, 0.45(2.94); HAU, 0.37(0.45)]. Toluene concentration in the workplace air was 86.92(range: 45.18~151.23) ppm. The level of HAP or HAU was significantly correlated (r=0.70 and r=0.63, respectively) with that of toluene in the workplace air. The estimated regression equation was logHAP(mg/L)=-3.60+1.93 log(toluene, ppm) or logHAU(g/L)=-0.85+0.67 log(toluene, ppm). The magnitude of correlation was further enhanced when analyzing relationship between toluene concentrations lower than 100 ppm and its corresponding HAP levels. CONCLUSION: Overall, plasma hippuric acid levels were well correlated with toluene concentrations in the workplace air, and a statistically significant correlation was observed for the samples with toluene concentration lower than 100 ppm.
Psychiatric symptoms of workers exposed to organic solvents.
Seoung Hoon Lee, Nung Ki Yoon, Jong Young Lee, Suk Kwon Suh
Korean J Prev Med. 1992;25(1):1-12.
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AbstractAbstract PDF
To assess the pattern of psychiatric symptoms and to evaluate the relationship between exposure related variables(duration of work and urinary hippuric acid concenturation) and psychiatric symptoms in organic solvent exposed workers, case control study of forty-two solvent exposed workers and ninety-six non-exposed workers was conducted. The general health questionnaire 28(GHQ28) was administered to evaluate psychiatric symptoms and urinary hippuric acid concenturations was measured to estimate the present status of solvent exposure in exposed group and to estimate normal level in non-exposed group. The meand concenturation of urinary hippuric acid was significantly higher in exposed group (2.953g/creatinine g) than non-exposed group (0.395g/creatinine g) (P<0.01). The total positive rates of symptoms were significantly higher in exposed group(28.2%) than non-exposed group(17.5%) (P<0.05). The positive rates of symptoms for four sub-scales of GHQ 28 in exposed group were in the order of somatic symptoms, anxiety, social dysfunction, depression and in the order of social dysfunction, anxiety, depression, somatic symptoms in non-exposed group.The positive rates of symptoms for somatic symptoms and anxiety were significantly higher in exposed group than non-exposed group (P<0.05) and the proportion of workers with six or more positive symptoms(dysthymic states) in exposed group were significantly higher than non-exposed group (P<0.01). After the effect of age, sex, level of income, level of education, and duration of work were controlled, the total score of GHQ28 was still significantly different between exposed and non-exposed group(P<0.01). In multiple logistic regression analysis on the dysthymic state, the odds ratio of level of income was statistically significant in both group. The odds ratios of exposure related variables such as duration of work and hippuric acid concenturations were not statistically significant but there was a tendency that exposure related variables had an effect on dysthymic state in exposed group.In future, comtinuous evaluation of psychiatric symptoms on organic solvent exposed workers and studies to detect the factors that affect on psychiatric symptoms are required.
A Study on Relationship between Exposure to Toluene and Excretion of Hippuric Acid in Urine with Male Sovent Workers.
Sung Soo Lee, Kyu Dong Ahn, Byong Kook Lee, Taik Sung Nam
Korean J Prev Med. 1989;22(4):480-485.
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AbstractAbstract PDF
The objective of this study was to examine the correlation between personal exposure of toluene at workplace and the concentration of hippuric acid in urine of male solvent workers. The study groups are 60 toluene exposed workers who worked at video tape factory and printing factory. The results are as follows: 1. The coefficient of correlation between toluene concentration of personal exposure and concentration of urinary hippuric acid was 0.649 (regression equation Y=0.015X+0.936, Y=urinary hippuric acid concentration, X=Toluene concentration of personal exposure). 2. Urinary hippuric acid concentration of workers with TLV 100 ppm of toluene was calculated 2.44 g/L by the regression equation (Y=0.015X+0.936).
Urinary Hippuric Acid Excretion in Toluene Exposed Workers.
Chae Un Lee, Hai Rim Shin, Byung Mann Cho, Deog Hwan Moon, Hae Sook Shon, Kyu Il Cho, Sung Chun Kim, Yong Wan Kim
Korean J Prev Med. 1988;21(2):374-379.
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AbstractAbstract PDF
In order to prepare the fundamental data for preventing the hazardous effects at toluene exposure in many kinds of industry, the authors determined the level of urinary hippuric acid on 592 toluene exposed women(exposed group) and 102 unexposed women(control group) in Pusan area, from April 1 to October 31, 1986. Hippuric acid was measured by high performance liquid chromatography. The results were summarized as follows; 1. The mean value of urinary hippuric acid concentration of the control group was 0.44+/-0.21g/l(0.11-0.89g/l). The distribution of urinary hippuric acid concentration of the control group was not fit to the normal distribution. 2. The mean value of urinary hippuric acid concentration of the exposed group was 1.56+/-0.95g/l(0.44-4.57g/l). The distribution of urinary hippuric acid concentration of control group was not fit to the normal distribution. 3. The urinary hippuric acid concentration by age group was not statistically significant in the control group, but in the exposed the urinary hippuric acid concentration was highest in women between 20-29 years old(1.71+/-0.95g/l) and was statistically significant(p<0.01). 4. The urinary hippuric acid concentration by duration of working hours was not statistically significant(p>0.1).

JPMPH : Journal of Preventive Medicine and Public Health