Xi Xia1, Feng He1, Xianfeng Wu1, Fenfen Peng1, Fengxian Huang2, Xueqing Yu3. 1. Department of Nephrology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China. 2. Department of Nephrology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China. Electronic address: hfxyl@163.net. 3. Department of Nephrology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China. Electronic address: yuxq@mail.sysu.edu.cn.
Abstract
BACKGROUND: Although serum uric acid level appears to be associated with mortality in individuals treated with hemodialysis, the relationship between serum uric acid level and death is uncertain in patients treated with peritoneal dialysis (PD). STUDY DESIGN: Cohort study. SETTING & PARTICIPANTS: 985 patients from a single PD center in South China followed up for a median of 25.3 months. PREDICTOR: Serum uric acid level. OUTCOMES & MEASUREMENTS: The association of baseline sex-specific uric acid level with all-cause and cardiovascular mortality was evaluated. Models were adjusted for age, body mass index, comorbidity score, residual kidney function, total Kt/V, allopurinol and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker use, and laboratory test results, including hemoglobin, serum albumin, creatinine, calcium, phosphorus, triglycerides, low-density lipoprotein cholesterol, and high-sensitivity C-reactive protein. RESULTS: Mean age was 48.3±15.4 (SD) years, and 23% had diabetes. Mean uric acid level was 7.0±1.3 (range, 3.8-19.8) mg/dL. During follow-up, 144 deaths were recorded, of which 64 were due to cardiovascular events. In multivariable models, the highest sex-specific tertile of uric acid level was associated with increased risk of all-cause mortality (HR, 1.93; 95% CI, 1.27-2.93; P=0.004) and cardiovascular mortality (HR, 3.31; 95% CI, 1.70-6.41; P<0.001) compared to the lowest tertile. Adjusted Cox regression models showed that the HRs per 1-mg/dL higher uric acid level for all-cause and cardiovascular mortality were 1.33 (95% CI, 1.14-1.56; P<0.001) and 1.44 (95% CI, 1.17-1.77; P=0.001) for men and 1.03 (95% CI, 0.86-1.24; P=0.8) and 1.16 (95% CI, 0.97-1.38; P=0.1) for women, respectively. A formal test for interaction indicated that the association of uric acid level with all-cause and cardiovascular mortality differed by sex (β = -0.06 [P=0.02] and β = -0.10 [P=0.02], respectively). LIMITATIONS: Single measurement of uric acid at baseline. Cause of death determined by death certificates and expert consensus. CONCLUSIONS: Elevated serum uric acid level is an independent risk factor for all-cause and cardiovascular mortality in men treated with PD. Crown
BACKGROUND: Although serum uric acid level appears to be associated with mortality in individuals treated with hemodialysis, the relationship between serum uric acid level and death is uncertain in patients treated with peritoneal dialysis (PD). STUDY DESIGN: Cohort study. SETTING & PARTICIPANTS: 985 patients from a single PD center in South China followed up for a median of 25.3 months. PREDICTOR: Serum uric acid level. OUTCOMES & MEASUREMENTS: The association of baseline sex-specific uric acid level with all-cause and cardiovascular mortality was evaluated. Models were adjusted for age, body mass index, comorbidity score, residual kidney function, total Kt/V, allopurinol and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker use, and laboratory test results, including hemoglobin, serum albumin, creatinine, calcium, phosphorus, triglycerides, low-density lipoprotein cholesterol, and high-sensitivity C-reactive protein. RESULTS: Mean age was 48.3±15.4 (SD) years, and 23% had diabetes. Mean uric acid level was 7.0±1.3 (range, 3.8-19.8) mg/dL. During follow-up, 144 deaths were recorded, of which 64 were due to cardiovascular events. In multivariable models, the highest sex-specific tertile of uric acid level was associated with increased risk of all-cause mortality (HR, 1.93; 95% CI, 1.27-2.93; P=0.004) and cardiovascular mortality (HR, 3.31; 95% CI, 1.70-6.41; P<0.001) compared to the lowest tertile. Adjusted Cox regression models showed that the HRs per 1-mg/dL higher uric acid level for all-cause and cardiovascular mortality were 1.33 (95% CI, 1.14-1.56; P<0.001) and 1.44 (95% CI, 1.17-1.77; P=0.001) for men and 1.03 (95% CI, 0.86-1.24; P=0.8) and 1.16 (95% CI, 0.97-1.38; P=0.1) for women, respectively. A formal test for interaction indicated that the association of uric acid level with all-cause and cardiovascular mortality differed by sex (β = -0.06 [P=0.02] and β = -0.10 [P=0.02], respectively). LIMITATIONS: Single measurement of uric acid at baseline. Cause of death determined by death certificates and expert consensus. CONCLUSIONS: Elevated serum uric acid level is an independent risk factor for all-cause and cardiovascular mortality in men treated with PD. Crown
Authors: Marta Gracia; Àngels Betriu; Montserrat Martínez-Alonso; David Arroyo; María Abajo; Elvira Fernández; José M Valdivielso Journal: Clin J Am Soc Nephrol Date: 2015-12-14 Impact factor: 8.237
Authors: Eunjin Bae; Hyun-Jeong Cho; Nara Shin; Sun Moon Kim; Seung Hee Yang; Dong Ki Kim; Yong-Lim Kim; Shin-Wook Kang; Chul Woo Yang; Nam Ho Kim; Yon Su Kim; Hajeong Lee Journal: Medicine (Baltimore) Date: 2016-06 Impact factor: 1.889