We reported a hyperuricemia prevalence of 39% in the Pakistani population with a mean uric acid (MUA) level of 6.11 ± 1.7 mg/dl among all subjects while 7.67±1.26 mg/dl MUA level among hyperuricemic subjects. HU was found to be more prevalent in women than in men (49.3% vs. 27.9%). The proportion of clinically asymptomatic HU was 9.2%. Most of our HU sample had one or more comorbidities and was symptomatic. Most common comorbidity in our patients with HU was Diabetes Mellitus. Although Ischemic Heart Disease was the least common comorbidity, all patients of IHD were symptomatic. Except for chronic kidney disease and IHD, all other comorbidities were significantly related to SUA levels in our study.

This is the first report of hyperuricemia prevalence from Pakistan and helps determine the burden of this condition in the population. These latest prevalence estimates help determine the burden of the condition on the Pakistani healthcare system. As per our knowledge, no other study has been conducted on such a large sample including population from various cities of Pakistan. However, we have not utilized laboratory methods to measure uric acids levels which would have been more accurate but also expensive, and only utilized portable MultiSure kit (a validated test).[12]

Attempts have been made to assess the global burden of hyperuricemia and findings suggested widest range of prevalence in East Asia with Chinese prevalence of 6-25%, Taiwanese 10-52% and Indonesian prevalence of 18%. [1] Even in an Indian obese population, HU prevalence is 44.6%, however they report more hyperuricemic males. [13] Furthermore, as per The National Health and Nutrition Examination Survey 2007–2008, the prevalence of HU in the United States general population is 21.4%. [14] In a local study involving a relatively smaller sample, the frequency of elevated SUA levels was 47%. [15]

Consistent with our findings, prevalence of metabolic syndrome and its components increased significantly according to SUA concentration in both sexes in a Korean study. [16] Hyperuricemia has been studied to be somehow responsible for the proinflammatory endocrine imbalance in the adipose tissue, which is an underlying mechanism of inflammation and consequent insulin resistance. [17] UA levels have also been regarded as a metabolic biomarker in older adults for early detection and prevention of Metabolic Syndrome. [18]

A meta-analysis of 13 studies showed 1.3% incidence of ischemic heart disease in individuals with HU and an overall risk of IHD death increased by 12% for each increase of 1 mg/dl of serum uric acid level. [19] Another five year long Japanese cohort concluded asymptomatic HU to possess a significant risk for developing hypertension, dyslipidemia, obesity and chronic renal disease. [20]

As far as the studies on recent trend of chronic kidney diseases are concerned, it has been seen that both elevated SUA levels and metabolic syndrome are associated with increase in the prevalence of CKD. [21, 22] In a longitudinal cohort, the incidence of CKD was influenced by the presence of hyperuricemia, but not by that of metabolic syndrome. However, if complicated by metabolic syndrome, HU had an even detrimental effect. [23]

In view of the crucial role of HU and its incapacitating impacts on essential bodily systems and functions, it becomes vital to first assess its burden, recognize the targeted population and then make endeavours in bringing about relevant management strategies to detect hyperuricemia at an early stage and prevent its consequent complications. This study has taken the first step in this region. With such a high prevalence of hyperuricemia in Pakistan, this study leads other researchers to investigate more of this alarming issue.