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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.


Stratification analyses. A comparison of the adjusted hazard ratios for the subgroups is presented by forest plot. a Adjusted for age, sex, the dialysis type, body mass index, systolic blood pressure, calcium level, phosphorus level, albumin level, total cholesterol level, uric acid level, subjective global assessment, and DM for each subgroup (excluding its own group).
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Figure 5: Stratification analyses. A comparison of the adjusted hazard ratios for the subgroups is presented by forest plot. a Adjusted for age, sex, the dialysis type, body mass index, systolic blood pressure, calcium level, phosphorus level, albumin level, total cholesterol level, uric acid level, subjective global assessment, and DM for each subgroup (excluding its own group).

Mentions: Since the association between the SUA <5.5 mg/dL and mortality in patients on dialysis may be a feature of malnutrition, we dissected this relationship according to the SGA, albumin level, and BMI. We also performed subgroup analyses according to age, sex, and the dialysis type because these parameters were proven to affect the SUA level independently, as described in Table 2. Figure 5 summarizes the results. There were no significant interactions between the subgroups except DM. The harmful effect of the TA-SUA <5.5 mg/dL level on all-cause mortality was more prominent in age ≤65 years group (adjusted HR, 2.569; 95% CI, 1.152–5.731; P = 0.021; P for interaction = 0.365), patients with HD treatment (adjusted HR, 2.797; 95% CI, 1.335–5.861; P = 0.006; P for interaction = 0.746), overweight (BMI >23 kg/m2) (adjusted HR 2.116, 95% CI, 0.849–5.275; P = 0.108; P for interaction = 0.384), normoalbuminemic (adjusted HR 3.003, 95% CI, 1.572–5.737; P = 0.001; P for interaction = 0.978), well-nourished (adjusted HR 2.665; 95% CI, 1.397–5.086; P = 0.002; P for interaction = 0.313), and patients with DM (adjusted HR 2.158; 95% CI, 1.138–4.095; P = 0.024; P for interaction = 0.019). The harmful effect of the TA-SUA was similar between women (adjusted HR, 1.797; 95% CI, 0.767–4.208; P = 0.177) and men (adjusted HR, 1.846; 95% CI, 0.846–4.025; P = 0.123; P for interaction = 0.463).


Lower serum uric acid level predicts mortality in dialysis patients
Stratification analyses. A comparison of the adjusted hazard ratios for the subgroups is presented by forest plot. a Adjusted for age, sex, the dialysis type, body mass index, systolic blood pressure, calcium level, phosphorus level, albumin level, total cholesterol level, uric acid level, subjective global assessment, and DM for each subgroup (excluding its own group).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 5: Stratification analyses. A comparison of the adjusted hazard ratios for the subgroups is presented by forest plot. a Adjusted for age, sex, the dialysis type, body mass index, systolic blood pressure, calcium level, phosphorus level, albumin level, total cholesterol level, uric acid level, subjective global assessment, and DM for each subgroup (excluding its own group).
Mentions: Since the association between the SUA <5.5 mg/dL and mortality in patients on dialysis may be a feature of malnutrition, we dissected this relationship according to the SGA, albumin level, and BMI. We also performed subgroup analyses according to age, sex, and the dialysis type because these parameters were proven to affect the SUA level independently, as described in Table 2. Figure 5 summarizes the results. There were no significant interactions between the subgroups except DM. The harmful effect of the TA-SUA <5.5 mg/dL level on all-cause mortality was more prominent in age ≤65 years group (adjusted HR, 2.569; 95% CI, 1.152–5.731; P = 0.021; P for interaction = 0.365), patients with HD treatment (adjusted HR, 2.797; 95% CI, 1.335–5.861; P = 0.006; P for interaction = 0.746), overweight (BMI >23 kg/m2) (adjusted HR 2.116, 95% CI, 0.849–5.275; P = 0.108; P for interaction = 0.384), normoalbuminemic (adjusted HR 3.003, 95% CI, 1.572–5.737; P = 0.001; P for interaction = 0.978), well-nourished (adjusted HR 2.665; 95% CI, 1.397–5.086; P = 0.002; P for interaction = 0.313), and patients with DM (adjusted HR 2.158; 95% CI, 1.138–4.095; P = 0.024; P for interaction = 0.019). The harmful effect of the TA-SUA was similar between women (adjusted HR, 1.797; 95% CI, 0.767–4.208; P = 0.177) and men (adjusted HR, 1.846; 95% CI, 0.846–4.025; P = 0.123; P for interaction = 0.463).

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.