Studies have shown inconsistent results about the association between serum uric acid levels and mortality in patients with chronic kidney disease (CKD).

A systematic literature search in MEDLINE, Web of Science and bibliographies of retrieved articles was performed to identify studies investigating the association between serum uric acid and mortality in patients with CKD. Pooled hazard ratios (HR) and corresponding 95% confidence intervals (CIs) were calculated using random-effects models.

A total of 24 studies with 25,453 patients with CKD were included. By meta-analysis, patients with the highest serum uric acid level were associated with a significantly higher risk for mortality (14 studies; HR, 1.52; 95% CI, 1.33–1.73) compared with patients with the lowest serum uric acid level. For dose–response analysis, a linear relationship (8 studies; P_{for non-linearity} = 0.14) between serum uric acid levels and risk of mortality was found. Overall, an increase of 1 mg/dl in serum uric acid level was associated with an 8% increased risk of mortality (21 studies; HR, 1.08; 95% CI, 1.04–1.11).

Elevated serum uric acid levels are significantly associated with risk of mortality in patients with CKD. Further randomized controlled trials should attempt to determine whether it improves survival to target serum uric acid in patients with CKD.