Objective To investigate the association pathway between hyperuricemia (HUA) and blood pressure, renal function in middle-aged and young men, and provide a theoretical basis for the prevention and treatment of HUA and the protection of renal function.

Methods A cross-sectional study was adopted and a total of 37 175 middle-aged and young male health check-ups in Xuzhou Central hospital in 2021 were selected. HUA was defined as those with fasting serum uric acid (SUA) ＞420 μmol/L. Univariate analysis and logistic regression analysis were used to screen related factors of HUA. The aggregation relationship between SUA and associated diseases was demonstrated using comprehensive attribution risk analysis, frequency analysis and correspondence analyses. The association pathways between HUA and blood pressure and renal function were verified using the mediation effects analysis.

Results The prevalence of HUA in middle-aged and young male was 10.37% (95%CI 10.06%–10.69%). The results of univariant analysis showed that the age, occupation, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), blood urea nitrogen (BUN), creatinine (Cr), estimated glomerular filtration rate (eGFR), total cholesterol (TC), triacylglycerol (TG), high density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), plasma viscosity (PV) were significantly related to HUA (P＜0.001). Logistic regression analysis showed that age, BMI, high level of TC, TG, blood pressure and low level of eGFR were independent related factors of HUA (P＜0.001). Frequency analysis showed that the frequency of comorbidity was higher than that of shared single nucleotide polymorphism (SNP). Correspondence analysis showed that with the gradual increase of SUA, high TC, hypertension, low eGFR and high TG gradually emerged. The mediating effect analysis showed that 10.73% of the decline in renal function may be mediated by elevated blood pressure, and 6.67% of the increase in SUA may be mediated by the decline in eGFR.

Conclusions The prevalence of HUA in middle-aged and young male is high. High level of SUA is positively correlated with TC, TG, blood pressure, and BMI, and negatively correlated with age and eGFR. The metabolism-blood pressure-renal function pathway may mediate 10.73% of renal function decline. Controlling dyslipidemias and hypertension in early stage can protect renal function. When choosing antihypertensive, lipid-lowering, and uric acid lowering drugs, attention should be paid to synergy with other factors and protection of renal function.