Creatinine Predicts Hyperuricemia in Patients With Breast Cancer

Creatinine was found to be the most important factor of hyperuricemia in patients with breast cancer and was independently associated with hyperuricemia and performed well in predicting it.1

“At present, there was no study reporting the risk factors associated with the hyperuricemia in breast cancer. Therefore, this study aimed to explore the potential risk factors and determine the core indicator associated with the hyperuricemia risk in breast cancer, using the public National Health and Nutrition Examination Survey (NHANES) data. By identifying the risk factors of hyperuricemia in breast cancer, early screening can be carried out for high-risk patients before the occurrence of the disease,” lead investigator Ting-ting Meng Department of Thyroid and Breast Surgery, Qilu Hospital of Shandong University Dezhou Hospital, Dezhou, China, and colleagues wrote.1 “In addition, certain chemotherapy drugs may increase the risk of hyperuricemia through nephrotoxicity or metabolic disorders.2 After identifying these risk factors, safer chemotherapy drugs can be selected or the dosage can be adjusted.”

Meng and colleagues screened influencing factors of hyperuricemia using univariate and multivariate generalized linear regression and ranked the importance of influence by Logistic and XGBoost algorithms. They assessed predictive performance and clinical benefit with Receiver Operating Characteristic (ROC) curves and Decision Curve Analysis (DCA) curves and further explored relationships with hyperuricemia with trend analysis, Restricted cubic spline (RCS) analysis, and generalized additive models.

The analysis included 359 patients with breast cancer, 99 of which had hyperuricemia. Meng and colleagues found that BMI, total calcium, creatinine, hypertension, and gout were all independent factors of hyperuricemia (all P <.05). Among these factors, creatinine was found to have the strongest influence on hyperuricemia.

Specifically, BMI had an ROC area under the curve (AUC) of 0.626 (95% CI, 0.574-0.685) and creatinine had an AUC of 0.77 (95% CI, 0.674-0.685). The prediction performance difference between them was insignificant (P for Delong test = 0.051). On DCA, creatinine achieved better clinical net benefit than BMI. Meng and colleagues also found that creatinine had a detailed positive association with hyperuricemia (P for trend<.001), with a linear relationship (P for non-linear = 0.428).

“Among all related factors analyzed, the importance of creatinine on hyperuricemia ranked first. In addition, creatinine had more favorable prediction performance on hyperuricemia and can achieve better clinical net benefit than others. Creatinine can be regarded as the most important factor of hyperuricemia in breast cancer patients, and their linear positive association was also clarified. Our findings were conducive to the early screening of renal function impairment, provide reference value for the treatment decision-making (especially in the dosage adjustment of chemotherapy drug), as well as distant metastasis assessment,” Meng and colleagues concluded.

The investigators noted limitations of their study, including that there was one record for uric acid data in the NHANES, while 2 measurement times are recommended so the uric acid levels may have large fluctuations; there may be confounding factors influencing hyperuricemia not included in the study, such as GLUT-9 and ABCG2; and the study’s cross-sectional nature only clarifies the association but no causality between creatinine and hyperuricemia.

Meng and colleagues suggested future research, including in-depth studies on the molecular mechanisms underlying the co-occurrence of elevated creatinine levels and hyperuricemia, the interactions between breast cancer cells and kidney cells, and large-scale, multicenter, prospective cohort studies to clarify the relationship between creatinine and hyperuricemia and assess the accuracy of the combined indicators of both in predicting the prognosis of patients with breast cancer.

REFERENCES

1. Meng TT, Wang W, Zheng YQ, Liu GD. Key factors determination of hyperuricemia and association analysis among patients with breast cancer: results from NHANES data. Front. Nutr. 2025; 12. doi: 10.3389/fnut.2025.1535879

2. Santos MLC, de Brito BB, da Silva FAF, Botelho ACDS, de Melo FF. Nephrotoxicity in cancer treatment: An overview. World J Clin Oncol. 2020;11(4):190-204. doi:10.5306/wjco.v11.i4.190