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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.


Related in: MedlinePlus

Mortality rates and hazard ratios according to the time-averaged serum uric acid level. This graph shows the crude mortality rate according to the TA-SUA groups. The lowest TA-SUA group has a significantly increased mortality rate compared with the other 4 TA-SUA groups. The log hazard ratios for mortality in relation to the TA-SUA level are presented. A U-shape relationship is plotted between mortality and the TA-SUA level in patients with end-stage renal disease.
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Figure 3: Mortality rates and hazard ratios according to the time-averaged serum uric acid level. This graph shows the crude mortality rate according to the TA-SUA groups. The lowest TA-SUA group has a significantly increased mortality rate compared with the other 4 TA-SUA groups. The log hazard ratios for mortality in relation to the TA-SUA level are presented. A U-shape relationship is plotted between mortality and the TA-SUA level in patients with end-stage renal disease.

Mentions: During the follow-up periods, 206 of 1738 (11.9%) patients died. The all-cause mortality rate was higher in patients on PD than in those on HD (16.3% [106/651] vs. 9.2% [100/1087], P <0.001). Figure 3A illustrates the categorical mortality rate. The highest TA-SUA group had a similar mortality rate to the middle 3 TA-SUA groups. However, the lowest TA-SUA group had a steeply elevated mortality rate compared with the other 4 TA-SUA groups. Figure 3B shows nonlinear mortality risk according to the TA-SUA level after adjusting for clinical covariates such as age, sex, the dialysis type, SBP, BMI, diabetes, albumin level, and SGA. In terms of the nonlinear spline curve, there was an overall U-shape association between the TA-SUA level and adjusted log HR. Different from a wide range of CIs of the mortality risk for higher TA-SUA levels, an increase in the mortality risk was more prominent in the lower TA-SUA levels with a narrow CI range. Moreover, this association was obvious for the TA-SUA level <5.5 mg/dL in terms of both the HR and CI. Subsequently, we performed survival analyses by stratifying the TA-SUA into 2 groups: TA-SUA <5.5 mg/dL and TA-SUA ≥5.5 mg/dL.


Lower serum uric acid level predicts mortality in dialysis patients
Mortality rates and hazard ratios according to the time-averaged serum uric acid level. This graph shows the crude mortality rate according to the TA-SUA groups. The lowest TA-SUA group has a significantly increased mortality rate compared with the other 4 TA-SUA groups. The log hazard ratios for mortality in relation to the TA-SUA level are presented. A U-shape relationship is plotted between mortality and the TA-SUA level in patients with end-stage renal disease.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Mortality rates and hazard ratios according to the time-averaged serum uric acid level. This graph shows the crude mortality rate according to the TA-SUA groups. The lowest TA-SUA group has a significantly increased mortality rate compared with the other 4 TA-SUA groups. The log hazard ratios for mortality in relation to the TA-SUA level are presented. A U-shape relationship is plotted between mortality and the TA-SUA level in patients with end-stage renal disease.
Mentions: During the follow-up periods, 206 of 1738 (11.9%) patients died. The all-cause mortality rate was higher in patients on PD than in those on HD (16.3% [106/651] vs. 9.2% [100/1087], P <0.001). Figure 3A illustrates the categorical mortality rate. The highest TA-SUA group had a similar mortality rate to the middle 3 TA-SUA groups. However, the lowest TA-SUA group had a steeply elevated mortality rate compared with the other 4 TA-SUA groups. Figure 3B shows nonlinear mortality risk according to the TA-SUA level after adjusting for clinical covariates such as age, sex, the dialysis type, SBP, BMI, diabetes, albumin level, and SGA. In terms of the nonlinear spline curve, there was an overall U-shape association between the TA-SUA level and adjusted log HR. Different from a wide range of CIs of the mortality risk for higher TA-SUA levels, an increase in the mortality risk was more prominent in the lower TA-SUA levels with a narrow CI range. Moreover, this association was obvious for the TA-SUA level <5.5 mg/dL in terms of both the HR and CI. Subsequently, we performed survival analyses by stratifying the TA-SUA into 2 groups: TA-SUA <5.5 mg/dL and TA-SUA ≥5.5 mg/dL.

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.


Related in: MedlinePlus