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

Abstract

<title>Abstract</title> <bold>BACKGROUND:</bold> 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 <italic><bold>METHODOLOGY:</bold></italic> 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 <italic><bold>RESULTS:</bold></italic> 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.<italic><bold> </bold></italic>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. <italic><bold>CONCLUSION:</bold></italic> 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.