The average follow-up duration ranged from 2.2 to 26.0 years. Most studies adjusted for a wide range of potential confounders for the association between serum uric acid levels and the risk of CKD, including age, sex, eGFR, BMI, and other components of metabolic syndrome. Nine studies presented results for adjustment to blood pressure, and five presented results for adjustment to hypertension Pranlukast hemihydrate status. Some studies also adjusted for proteinuria and lifestyle. Only two studies considered the effects of diuretic use, and two studies considered the effects of other drugs that influence serum uric acid, such as allopurinol. The characteristics of the selected studies are presented in Table 1. In the current meta-analysis of 15 cohort studies, we observed a significant positive association between serum uric acid levels and the incidence of CKD in middle-aged patients. For each 1 mg/dL increment in the serum uric acid level, a 22% increase in the risk of CKD was observed. This finding was consistent and did not differ appreciably according to the study location, follow-up length, mean serum uric acid level, source of subjects, and adjustment for metabolic syndrome components or proteinuria. Notably, the serum uric acid level was independently associated with CKD in middle-aged adults but not in elderly adults. A recent PTACH review by Sedaghat demonstrated a significant association between the serum uric acid level and CKD incidence. Our study has some important strengths compared with that review. We were able to enhance the precision of the risk estimates and perform subgroup and sensitivity analyses to explore the sources of heterogeneity, increasing the clinical relevance of our findings. More importantly, all of the included studies were longitudinal cohort studies, and the subjects with a baseline eGFR,60 mL/min/1.73 m2 were excluded. This approach greatly reduces the likelihood of selection bias and reverse causation. Additionally, the consistency in the positive association between serum uric acid levels and risk of CKD across multiple subgroups in our metaanalysis combined with the lack of publication bias suggest that the association is valid.