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Hyperuricaemia: contributions of urate transporter ABCG2 and the fractional renal clearance of urate
  1. Diluk R W Kannangara1,2,
  2. Amanda J Phipps-Green3,
  3. Nicola Dalbeth4,
  4. Lisa K Stamp5,
  5. Kenneth M Williams1,2,
  6. Garry G Graham1,2,
  7. Richard O Day1,2,6,
  8. Tony R Merriman3
  1. 1School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
  2. 2Department of Clinical Pharmacology & Toxicology, St Vincent's Hospital, Sydney, New South Wales, Australia
  3. 3Department of Biochemistry, University of Otago, Dunedin, New Zealand
  4. 4Department of Medicine, University of Auckland, Auckland, New Zealand
  5. 5Department of Medicine, University of Otago, Christchurch, Canterbury, New Zealand
  6. 6St Vincent's Clinical School, University of New South Wales, Sydney, New South Wales, Australia
  1. Correspondence to Professor Richard O Day, Department of Clinical Pharmacology, St Vincent's Hospital, Darlinghurst, NSW 2010, Australia;{at}


Objective To investigate the contributions towards hyperuricaemia of known risk factors, focusing on fractional (renal) clearance of urate (FCU) and variation in the ATP-binding cassette transporter, sub-family G 2 (ABCG2) gene.

Methods The contributions of age, sex, ancestry, Q141K genotype for ABCG2, FCU, sugar-sweetened beverage and alcohol consumption, metabolic syndrome disorders and measures of renal function to the risk of hyperuricaemia were evaluated by comparing hyperuricaemic (serum urate≥0.42 mmol/L, n=448) with normouricaemic (serum urate<0.42 mmol/L, n=344) participants using stepwise logistic regression. Model performance was evaluated using the area under the receiver operator characteristic curve (AUROC).

Results ABCG2 genotype, FCU, male sex, body mass index, serum triglyceride concentrations, estimated glomerular filtration rate and consumption of alcohol were the best predictors of hyperuricaemia (AUROC 0.90, 81% accuracy). Homozygosity in the 141K variant for ABCG2 conferred an adjusted OR of 10.5 for hyperuricaemia (95% CI 2.4 to 46.2). For each 1% decrease of FCU, the adjusted OR increased by 51% (OR 1.51, 95% CI 1.37 to 1.66). There was no association between ABCG2 genotype and FCU (r=0.02, p=0.83).

Conclusions The ABCG2 141K variant and the FCU contribute strongly but independently to hyperuricaemia. These findings provide further evidence for a significant contribution of ABCG2 to extra-renal (gut) clearance of urate.

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