{"id":"https://openalex.org/W7224130608","doi":"https://doi.org/10.37349/emd.2026.1007141","title":"Low serum urate levels are not associated with increased mortality risk during urate-lowering treatment in patients with gout","display_name":"Low serum urate levels are not associated with increased mortality risk during urate-lowering treatment in patients with gout","publication_year":2026,"publication_date":"2026-10-28","ids":{"openalex":"https://openalex.org/W7224130608","doi":"https://doi.org/10.37349/emd.2026.1007141"},"language":"en","primary_location":{"id":"doi:10.37349/emd.2026.1007141","doi":"https://doi.org/10.37349/emd.2026.1007141","is_oa":true,"landing_page_url":"https://doi.org/10.37349/emd.2026.1007141","pdf_url":"https://www.explorationpub.com//uploads/Article/A1007141/1007141.pdf","source":{"id":"https://openalex.org/S4387280006","display_name":"Exploration of Musculoskeletal Diseases","issn_l":"2836-6468","issn":["2836-6468"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["cwts-core","doaj"],"host_organization":null,"host_organization_name":null,"host_organization_lineage":[],"host_organization_lineage_names":[],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Exploration of Musculoskeletal Diseases","raw_type":"journal-article"},"volume":null,"type":"article","indexed_in":["crossref","doaj"],"open_access":{"is_oa":true,"oa_status":"diamond","oa_url":"https://www.explorationpub.com//uploads/Article/A1007141/1007141.pdf","any_repository_has_fulltext":false},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5033544814","display_name":"Fernando P\u00e9rez-Ruiz","orcid":"https://orcid.org/0000-0002-5268-1894","observed_orcids":["https://orcid.org/0000-0002-5268-1894"]},"institutions":[{"id":"https://openalex.org/I169108374","display_name":"University of the Basque Country","ror":"https://ror.org/000xsnr85","country_code":"ES","type":"education","lineage":["https://openalex.org/I169108374"]},{"id":"https://openalex.org/I4210125364","display_name":"Osakidetza","ror":"https://ror.org/02g7qcb42","country_code":"ES","type":"healthcare","lineage":["https://openalex.org/I4210125364"]},{"id":"https://openalex.org/I4210137412","display_name":"Hospital de Cruces","ror":"https://ror.org/03nzegx43","country_code":"ES","type":"healthcare","lineage":["https://openalex.org/I4210125364","https://openalex.org/I4210137412"]}],"countries":["ES"],"is_corresponding":true,"raw_author_name":"Fernando Perez-Ruiz","raw_affiliation_strings":["Osakidetza, OSI EEC, Cruces University Hospital, Rheumatology Division, 48903 Barakaldo, Spain; Medicine and Nursery School, Department of Medicine, University of the Basque Country, Cruces University Hospital, 48903 Barakaldo, Spain"],"raw_orcid":"https://orcid.org/0000-0002-5268-1894","affiliations":[{"raw_affiliation_string":"Osakidetza, OSI EEC, Cruces University Hospital, Rheumatology Division, 48903 Barakaldo, Spain; Medicine and Nursery School, Department of Medicine, University of the Basque Country, Cruces University Hospital, 48903 Barakaldo, Spain","institution_ids":["https://openalex.org/I169108374","https://openalex.org/I4210125364","https://openalex.org/I4210137412"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5092951031","display_name":"Nerea Perez-Herrero","orcid":"https://orcid.org/0009-0009-8687-7527","observed_orcids":["https://orcid.org/0009-0009-8687-7527"]},"institutions":[{"id":"https://openalex.org/I136040515","display_name":"Universidad de Deusto","ror":"https://ror.org/00ne6sr39","country_code":"ES","type":"education","lineage":["https://openalex.org/I136040515"]}],"countries":["ES"],"is_corresponding":false,"raw_author_name":"Nerea Perez-Herrero","raw_affiliation_strings":["Medicine School, University of Deusto, 48007 Bilbao, Spain"],"raw_orcid":"https://orcid.org/0009-0009-8687-7527","affiliations":[{"raw_affiliation_string":"Medicine School, University of Deusto, 48007 Bilbao, Spain","institution_ids":["https://openalex.org/I136040515"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":4,"corresponding_author_ids":["https://openalex.org/A5033544814"],"corresponding_institution_ids":["https://openalex.org/I169108374","https://openalex.org/I4210125364","https://openalex.org/I4210137412"],"apc_list":null,"apc_paid":null,"fwci":0.0,"has_fulltext":true,"cited_by_count":0,"citation_normalized_percentile":{"value":0.84864759,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":null,"biblio":{"volume":"4","issue":null,"first_page":null,"last_page":null},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T11139","display_name":"Gout, Hyperuricemia, Uric Acid","score":1.0,"subfield":{"id":"https://openalex.org/subfields/2727","display_name":"Nephrology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T11139","display_name":"Gout, Hyperuricemia, Uric Acid","score":1.0,"subfield":{"id":"https://openalex.org/subfields/2727","display_name":"Nephrology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T11117","display_name":"Drug-Induced Adverse Reactions","score":0.0,"subfield":{"id":"https://openalex.org/subfields/2736","display_name":"Pharmacology (medical)"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T12827","display_name":"Biochemical and Molecular Research","score":0.0,"subfield":{"id":"https://openalex.org/subfields/1312","display_name":"Molecular Biology"},"field":{"id":"https://openalex.org/fields/13","display_name":"Biochemistry, Genetics and Molecular Biology"},"domain":{"id":"https://openalex.org/domains/1","display_name":"Life Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/gout","display_name":"gout","score":0.9670000076293945},{"id":"https://openalex.org/keywords/serum-uric-acid","display_name":"serum uric acid","score":0.8659999966621399},{"id":"https://openalex.org/keywords/urate-lowering-therapy","display_name":"urate-lowering therapy","score":0.9900000095367432},{"id":"https://openalex.org/keywords/mortality-risk","display_name":"mortality risk","score":0.7129999995231628},{"id":"https://openalex.org/keywords/tophaceous-gout","display_name":"tophaceous gout","score":0.8019999861717224},{"id":"https://openalex.org/keywords/polyarticular-gout","display_name":"polyarticular gout","score":0.9480000138282776},{"id":"https://openalex.org/keywords/tophi","display_name":"tophi","score":0.6019999980926514},{"id":"https://openalex.org/keywords/comorbidity","display_name":"comorbidities","score":0.7039999961853027},{"id":"https://openalex.org/keywords/chronic-kidney-disease","display_name":"chronic kidney disease","score":0.5659999847412109},{"id":"https://openalex.org/keywords/cardiovascular-events","display_name":"cardiovascular events","score":0.34200000762939453}],"concepts":[{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.9506999850273132},{"id":"https://openalex.org/C126322002","wikidata":"https://www.wikidata.org/wiki/Q11180","display_name":"Internal medicine","level":1,"score":0.771399974822998},{"id":"https://openalex.org/C2780402116","wikidata":"https://www.wikidata.org/wiki/Q133087","display_name":"Gout","level":2,"score":0.7480000257492065},{"id":"https://openalex.org/C2779159551","wikidata":"https://www.wikidata.org/wiki/Q1414874","display_name":"Comorbidity","level":2,"score":0.6430000066757202},{"id":"https://openalex.org/C38180746","wikidata":"https://www.wikidata.org/wiki/Q1952580","display_name":"Multivariate analysis","level":2,"score":0.5843999981880188},{"id":"https://openalex.org/C2779721657","wikidata":"https://www.wikidata.org/wiki/Q49970","display_name":"Hyperuricemia","level":3,"score":0.5674999952316284},{"id":"https://openalex.org/C50440223","wikidata":"https://www.wikidata.org/wiki/Q1475848","display_name":"Risk factor","level":2,"score":0.4763999879360199},{"id":"https://openalex.org/C2779134260","wikidata":"https://www.wikidata.org/wiki/Q12136","display_name":"Disease","level":2,"score":0.46389999985694885},{"id":"https://openalex.org/C179755657","wikidata":"https://www.wikidata.org/wiki/Q58702","display_name":"Mortality rate","level":2,"score":0.4099000096321106},{"id":"https://openalex.org/C141071460","wikidata":"https://www.wikidata.org/wiki/Q40821","display_name":"Surgery","level":1,"score":0.40689998865127563},{"id":"https://openalex.org/C2779881121","wikidata":"https://www.wikidata.org/wiki/Q105522","display_name":"Uric acid","level":2,"score":0.4036000072956085},{"id":"https://openalex.org/C144301174","wikidata":"https://www.wikidata.org/wiki/Q7893852","display_name":"Univariate analysis","level":3,"score":0.40209999680519104},{"id":"https://openalex.org/C201903717","wikidata":"https://www.wikidata.org/wiki/Q1778788","display_name":"Cohort study","level":2,"score":0.38769999146461487},{"id":"https://openalex.org/C72563966","wikidata":"https://www.wikidata.org/wiki/Q1303415","display_name":"Cohort","level":2,"score":0.38580000400543213},{"id":"https://openalex.org/C167135981","wikidata":"https://www.wikidata.org/wiki/Q2146302","display_name":"Retrospective cohort study","level":2,"score":0.37139999866485596},{"id":"https://openalex.org/C90924648","wikidata":"https://www.wikidata.org/wiki/Q120569","display_name":"Gastroenterology","level":1,"score":0.3531999886035919},{"id":"https://openalex.org/C2777984932","wikidata":"https://www.wikidata.org/wiki/Q7336293","display_name":"Risk of mortality","level":2,"score":0.34869998693466187},{"id":"https://openalex.org/C2777466421","wikidata":"https://www.wikidata.org/wiki/Q1266890","display_name":"Vascular disease","level":2,"score":0.3314000070095062},{"id":"https://openalex.org/C2778653478","wikidata":"https://www.wikidata.org/wiki/Q1054718","display_name":"Kidney disease","level":2,"score":0.3034999966621399},{"id":"https://openalex.org/C156957248","wikidata":"https://www.wikidata.org/wiki/Q1862216","display_name":"Odds ratio","level":2,"score":0.2930000126361847},{"id":"https://openalex.org/C146357865","wikidata":"https://www.wikidata.org/wiki/Q1123245","display_name":"Stage (stratigraphy)","level":2,"score":0.2883000075817108},{"id":"https://openalex.org/C500440147","wikidata":"https://www.wikidata.org/wiki/Q701216","display_name":"Pharmacotherapy","level":2,"score":0.2849000096321106},{"id":"https://openalex.org/C10515644","wikidata":"https://www.wikidata.org/wiki/Q543310","display_name":"Survival analysis","level":2,"score":0.27950000762939453},{"id":"https://openalex.org/C50382708","wikidata":"https://www.wikidata.org/wiki/Q223218","display_name":"Proportional hazards model","level":2,"score":0.2732999920845032},{"id":"https://openalex.org/C44249647","wikidata":"https://www.wikidata.org/wiki/Q208498","display_name":"Confidence interval","level":2,"score":0.2687999904155731},{"id":"https://openalex.org/C2779384505","wikidata":"https://www.wikidata.org/wiki/Q17007513","display_name":"Concomitant","level":2,"score":0.2687000036239624},{"id":"https://openalex.org/C30036603","wikidata":"https://www.wikidata.org/wiki/Q17125150","display_name":"Severity of illness","level":2,"score":0.25760000944137573},{"id":"https://openalex.org/C3018683220","wikidata":"https://www.wikidata.org/wiki/Q736715","display_name":"Chronic renal disease","level":3,"score":0.2574000060558319},{"id":"https://openalex.org/C2779668873","wikidata":"https://www.wikidata.org/wiki/Q6693756","display_name":"Lower risk","level":3,"score":0.25600001215934753},{"id":"https://openalex.org/C2776283816","wikidata":"https://www.wikidata.org/wiki/Q332823","display_name":"Survival rate","level":2,"score":0.2538999915122986},{"id":"https://openalex.org/C2779918671","wikidata":"https://www.wikidata.org/wiki/Q200656","display_name":"Diuretic","level":2,"score":0.2531000077724457},{"id":"https://openalex.org/C61511704","wikidata":"https://www.wikidata.org/wiki/Q1671857","display_name":"Incidence (geometry)","level":2,"score":0.2522999942302704},{"id":"https://openalex.org/C3019063607","wikidata":"https://www.wikidata.org/wiki/Q1414874","display_name":"Charlson comorbidity index","level":3,"score":0.25040000677108765}],"mesh":[],"locations_count":1,"locations":[{"id":"doi:10.37349/emd.2026.1007141","doi":"https://doi.org/10.37349/emd.2026.1007141","is_oa":true,"landing_page_url":"https://doi.org/10.37349/emd.2026.1007141","pdf_url":"https://www.explorationpub.com//uploads/Article/A1007141/1007141.pdf","source":{"id":"https://openalex.org/S4387280006","display_name":"Exploration of Musculoskeletal Diseases","issn_l":"2836-6468","issn":["2836-6468"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["cwts-core","doaj"],"host_organization":null,"host_organization_name":null,"host_organization_lineage":[],"host_organization_lineage_names":[],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Exploration of Musculoskeletal Diseases","raw_type":"journal-article"}],"best_oa_location":{"id":"doi:10.37349/emd.2026.1007141","doi":"https://doi.org/10.37349/emd.2026.1007141","is_oa":true,"landing_page_url":"https://doi.org/10.37349/emd.2026.1007141","pdf_url":"https://www.explorationpub.com//uploads/Article/A1007141/1007141.pdf","source":{"id":"https://openalex.org/S4387280006","display_name":"Exploration of Musculoskeletal Diseases","issn_l":"2836-6468","issn":["2836-6468"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["cwts-core","doaj"],"host_organization":null,"host_organization_name":null,"host_organization_lineage":[],"host_organization_lineage_names":[],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Exploration of Musculoskeletal Diseases","raw_type":"journal-article"},"sustainable_development_goals":[{"score":1.0,"display_name":"Good health and well-being","id":"https://metadata.un.org/sdg/3"}],"study_designs":[{"display_name":"Observational Study","id":"https://openalex.org/study-designs/observational-study"}],"awards":[],"funders":[],"has_content":{"grobid_xml":true,"pdf":true},"content_urls":{"pdf":"https://content.openalex.org/works/W7224130608.pdf","grobid_xml":"https://content.openalex.org/works/W7224130608.grobid-xml"},"referenced_works_count":32,"referenced_works":["https://openalex.org/W2052661775","https://openalex.org/W2097767113","https://openalex.org/W2099748786","https://openalex.org/W2145066076","https://openalex.org/W2162235829","https://openalex.org/W2168761711","https://openalex.org/W2170246607","https://openalex.org/W2170639775","https://openalex.org/W2171243007","https://openalex.org/W2296621975","https://openalex.org/W2335302945","https://openalex.org/W2741094455","https://openalex.org/W2755440358","https://openalex.org/W2774860054","https://openalex.org/W2980131823","https://openalex.org/W2981212322","https://openalex.org/W3092590405","https://openalex.org/W3094441593","https://openalex.org/W4213167423","https://openalex.org/W4229537562","https://openalex.org/W4233562854","https://openalex.org/W4234393699","https://openalex.org/W4238251256","https://openalex.org/W4239705542","https://openalex.org/W4249825849","https://openalex.org/W4293576329","https://openalex.org/W4385722952","https://openalex.org/W4401793873","https://openalex.org/W4404039123","https://openalex.org/W4404373780","https://openalex.org/W4405903089","https://openalex.org/W4410607679"],"related_works":["https://openalex.org/W4379517974","https://openalex.org/W1934958750","https://openalex.org/W2949760676","https://openalex.org/W4405071470","https://openalex.org/W2908125758","https://openalex.org/W6991114920","https://openalex.org/W3049094204","https://openalex.org/W4405621002","https://openalex.org/W2982535404","https://openalex.org/W2205862613"],"abstract_inverted_index":{"Aim:":[0],"To":[1],"study":[2,22],"whether":[3],"very":[4],"low":[5,84,242],"serum":[6],"urate":[7],"(sUA)":[8],"levels":[9,54,108,185,244],"are":[10,259,281],"associated":[11,151,160,195,261,282],"with":[12,75,96,116,152,161,196,207,262,267,283],"increased":[13,153,197,225,263,284],"mortality":[14,162,226,264],"rate":[15],"during":[16,58,92,109,135,191,245,255],"urate-lowering":[17,256],"therapy":[18,110],"(ULT).":[19],"Methods:":[20],"This":[21],"analyzed":[23],"data":[24],"from":[25,39,113],"a":[26,76,117,250],"bidirectional":[27],"cohort":[28],"of":[29,42,45,121,155,181,199,230,253],"gout":[30],"patients.":[31],"General":[32],"variables":[33,37],"(age,":[34],"gender),":[35],"disease":[36,149],"(time":[38],"onset,":[40],"number":[41,44],"flares,":[43],"joints":[46],"involved,":[47],"tophi,":[48,183],"previous":[49,71,142],"and":[50,57,60,103,147,188,274],"prescribed":[51],"ULT,":[52,246],"sUA":[53,85,107,134,157,184,189,208,243,271],"at":[55,186,247],"baseline":[56,132],"follow-up),":[59],"comorbid":[61],"conditions":[62],"such":[63],"as":[64],"hypertension,":[65,140],"hyperlipidemia,":[66],"diabetes,":[67,141],"chronic":[68],"renal":[69],"disease,":[70],"vascular":[72,143],"event,":[73,144],"along":[74],"comorbidity":[77],"index":[78],"were":[79,111,150,159,193],"available":[80,112],"for":[81,94,235,249],"analysis.":[82],"Very":[83,241],"(<":[86,219],"3":[87,212],"mg/dL)":[88,273,280],"was":[89,202,224],"specifically":[90],"pursued":[91],"ULT":[93,192],"patients":[95,115,206,228,266],"the":[97,165,169,216,231,276],"most":[98],"severe":[99],"gout,":[100,268],"i.e.,":[101],"polyarticular":[102,137],"tophaceous":[104,148],"gout.":[105],"Results:":[106],"1,618":[114],"mean":[118],"follow-up":[119],"period":[120,252],"43.6":[122],"months.":[123],"Univariate":[124],"survival":[125,173],"analysis":[126,174],"showed":[127,175],"that":[128,176],"female":[129],"gender,":[130,178],"age,":[131,177],"sUA,":[133],"follow-up,":[136],"joint":[138],"involvement,":[139],"CKD,":[145],"comorbidity,":[146,179],"risk":[154,198],"mortality.":[156,200,285],"strata":[158,190],"only":[163],"in":[164,227,265],"higher":[166],"range,":[167,233],"outside":[168],"therapeutic":[170,217,232],"target.":[171],"Multivariate":[172],"presence":[180],"subcutaneous":[182],"baseline,":[187],"independently":[194],"There":[201],"no":[203],"difference":[204],"between":[205],"under":[209],"or":[210],"over":[211,237],"mg/dL":[213],"but":[214,222],"within":[215],"range":[218],"6":[220],"mg/dL),":[221],"there":[223],"out":[229],"especially":[234,275],"those":[236],"9":[238,279],"mg/dL.":[239],"Conclusions:":[240],"least":[248],"limited":[251],"time":[254],"debulking":[257],"therapy,":[258],"not":[260],"while":[269],"high":[270],"(6\u20138.9":[272],"highest":[277],"(\u2265":[278]},"counts_by_year":[],"updated_date":"2026-11-04T10:54:05.112534","created_date":"2026-10-29T00:00:00"}