BACKGROUND: Calcium (CA) is crucial for a wide range of biological functions. However, the correlation between total calcium and hyperuricemia in US adults remains unclear. This study aimed to assess whether total calcium is associated with hyperuricemia. METHODS: Based on data from the NHANES (2011 - 2018), we conducted a cross-sectional study involving 20,028 US adults aged 18 or older. Logistic regression, fitting smooth curves, and interaction effects were utilized to support the research objectives. RESULTS: Regression analyses demonstrated a positive relation between total calcium and hyperuricemia (p <
0.001). Positive association between levels of total calcium and the risk of hyperuricemia was observed after full adjustment for all the confounding variables (odds ratio: 13.28, 95% confidence interval: 10.38 - 16.99, p <
0.001). The interaction of total calcium and hyperuricemia with age and gender was significant (p values for interaction <
0.05), while there was no interaction in other subgroups (p-values for interaction >
0.05). In addition, curve fitting after adjusting for all the confounding variables indicated a nonlinear positive correlation between total calcium and hyperuricemia (p for nonlinearity = 0.024). CONCLUSIONS: The present cross-sectional study revealed that a nonlinear positive association existed between total calcium and hyperuricemia in US adults. The results could be beneficial for the management and treatment of hyperuricemia.