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Lower serum uric acid level predicts mortality in dialysis patients

View Article: PubMed Central - PubMed

ABSTRACT

We evaluated the impact of serum uric acid (SUA) on mortality in patients with chronic dialysis. A total of 4132 adult patients on dialysis were enrolled prospectively between August 2008 and September 2014. Among them, we included 1738 patients who maintained dialysis for at least 3 months and had available SUA in the database. We categorized the time averaged-SUA (TA-SUA) into 5 groups: <5.5, 5.5–6.4, 6.5–7.4, 7.5–8.4, and ≥8.5 mg/dL. Cox regression analysis was used to calculate the hazard ratio (HR) of all-cause mortality according to SUA group. The mean TA-SUA level was slightly higher in men than in women. Patients with lower TA-SUA level tended to have lower body mass index (BMI), phosphorus, serum albumin level, higher proportion of diabetes mellitus (DM), and higher proportion of malnourishment on the subjective global assessment (SGA). During a median follow-up of 43.9 months, 206 patients died. Patients with the highest SUA had a similar risk to the middle 3 TA-SUA groups, but the lowest TA-SUA group had a significantly elevated HR for mortality. The lowest TA-SUA group was significantly associated with increased all-cause mortality (adjusted HR, 1.720; 95% confidence interval, 1.007–2.937; P = 0.047) even after adjusting for demographic, comorbid, nutritional covariables, and medication use that could affect SUA levels. This association was prominent in patients with well nourishment on the SGA, a preserved serum albumin level, a higher BMI, and concomitant DM although these parameters had no significant interaction in the TA-SUA-mortality relationship except DM. In conclusion, a lower TA-SUA level <5.5 mg/dL predicted all-cause mortality in patients with chronic dialysis.

No MeSH data available.


Distribution of the time-averaged serum uric acid levels according to sex. Most of the time-averaged serum uric acid levels in men (white empty bar) overlap with those in women (gray-filled bar), although they are slightly deviated to the right side.
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Figure 2: Distribution of the time-averaged serum uric acid levels according to sex. Most of the time-averaged serum uric acid levels in men (white empty bar) overlap with those in women (gray-filled bar), although they are slightly deviated to the right side.

Mentions: Among a total of 4132 patients in the CRC-ESRD cohort, we excluded 1910 incident hemodialysis patients and 484 patients without available SUA levels. Therefore, 1738 patients were included in the final analysis (Fig. 1). Among them, 45.2% were women (n = 786) and 54.8% were men (n = 952). The mean age was 56 ± 13 years, with a median follow-up of 43.9 months. Fig. 2 shows the TA-SUA level distributions according to sex. The TA-SUA level distribution was not much different between men and women, although the TA-SUA level was slightly higher in men than in women (7.29 ± 2.70 mg/dL vs. 6.88 ± 1.66 mg/dL, P <0.001).


Lower serum uric acid level predicts mortality in dialysis patients
Distribution of the time-averaged serum uric acid levels according to sex. Most of the time-averaged serum uric acid levels in men (white empty bar) overlap with those in women (gray-filled bar), although they are slightly deviated to the right side.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4998435&req=5

Figure 2: Distribution of the time-averaged serum uric acid levels according to sex. Most of the time-averaged serum uric acid levels in men (white empty bar) overlap with those in women (gray-filled bar), although they are slightly deviated to the right side.
Mentions: Among a total of 4132 patients in the CRC-ESRD cohort, we excluded 1910 incident hemodialysis patients and 484 patients without available SUA levels. Therefore, 1738 patients were included in the final analysis (Fig. 1). Among them, 45.2% were women (n = 786) and 54.8% were men (n = 952). The mean age was 56 ± 13 years, with a median follow-up of 43.9 months. Fig. 2 shows the TA-SUA level distributions according to sex. The TA-SUA level distribution was not much different between men and women, although the TA-SUA level was slightly higher in men than in women (7.29 ± 2.70 mg/dL vs. 6.88 ± 1.66 mg/dL, P <0.001).

View Article: PubMed Central - PubMed

ABSTRACT

We evaluated the impact of serum uric acid (SUA) on mortality in patients with chronic dialysis. A total of 4132 adult patients on dialysis were enrolled prospectively between August 2008 and September 2014. Among them, we included 1738 patients who maintained dialysis for at least 3 months and had available SUA in the database. We categorized the time averaged-SUA (TA-SUA) into 5 groups:&#8202;&lt;5.5, 5.5&ndash;6.4, 6.5&ndash;7.4, 7.5&ndash;8.4, and &ge;8.5&#8202;mg/dL. Cox regression analysis was used to calculate the hazard ratio (HR) of all-cause mortality according to SUA group. The mean TA-SUA level was slightly higher in men than in women. Patients with lower TA-SUA level tended to have lower body mass index (BMI), phosphorus, serum albumin level, higher proportion of diabetes mellitus (DM), and higher proportion of malnourishment on the subjective global assessment (SGA). During a median follow-up of 43.9 months, 206 patients died. Patients with the highest SUA had a similar risk to the middle 3 TA-SUA groups, but the lowest TA-SUA group had a significantly elevated HR for mortality. The lowest TA-SUA group was significantly associated with increased all-cause mortality (adjusted HR, 1.720; 95% confidence interval, 1.007&ndash;2.937; P = 0.047) even after adjusting for demographic, comorbid, nutritional covariables, and medication use that could affect SUA levels. This association was prominent in patients with well nourishment on the SGA, a preserved serum albumin level, a higher BMI, and concomitant DM although these parameters had no significant interaction in the TA-SUA-mortality relationship except DM. In conclusion, a lower TA-SUA level&#8202;&lt;5.5&#8202;mg/dL predicted all-cause mortality in patients with chronic dialysis.

No MeSH data available.