Jin Seok Jeon1, Sung Hee Chung2, Dong Cheol Han1, Hyunjin Noh1, Soon Hyo Kwon1, Bengt Lindholm3, Hi Bahl Lee4. 1. Hyonam Kidney Laboratory, Soon Chun Hyang University, Seoul, Korea. 2. Baxter Novum and Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden. 3. Baxter Novum and Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden. Electronic address: Bengt.Lindholm@ki.se. 4. Hyonam Kidney Laboratory, Soon Chun Hyang University, Seoul, Korea; Kim's Clinic and Dialysis Unit, Miryang, Korea.
Abstract
OBJECTIVES: It is controversial to what extent serum uric acid (SUA) is associated with mortality in patients with chronic kidney disease undergoing hemodialysis (HD). We analyzed the predictive role of SUA in the mortality of diabetic and nondiabetic chronic kidney disease patients starting on maintenance HD therapy. DESIGN AND SUBJECTS: SUA was measured at the initiation of HD therapy in 319 patients (137 females and 193 diabetic patients) with mean age of 60 ± 14 years and mean estimated glomerular filtration rate of 7.5 ± 3.8 mL/min/1.73 m(2). The patients were divided into 2 groups, hyperuricemia (HUA; n = 165) and non-HUA (n = 154) groups based on laboratory limit for normal SUA. Mortality was recorded during 31.5 ± 24.8 months. RESULTS: Among the 193 diabetic patients, but not among the whole group of 319 patients, survival was significantly lower in HUA than in non-HUA patients. Among diabetic patients 2-year patient survival was worse in patients with HUA and cardiovascular disease (CVD; 52.3%; n = 30) than in non-HUA patients with CVD (81.1%; n = 36), HUA without CVD (88.6%; n = 62), and non-HUA without CVD (93.9%; n = 65). Cox analysis in all 319 patients showed that, old age, CVD, other comorbidity, and low serum albumin but not high SUA predicted mortality. Among diabetic patients, predictors of increased mortality risk were old age, CVD, other comorbidity but also high SUA with adjusted hazard ratio of 1.12 (95% confidence interval 1.02-1.22) per 1 mg/dL increase in SUA. In diabetic patients with HUA and CVD, adjusted hazard ratio for mortality was 5.98 times that of diabetic non-HUA patients without CVD. CONCLUSIONS: High SUA is associated with poor survival in diabetic patients undergoing HD but not in nondiabetic patients undergoing HD. High SUA was found to be a risk marker especially in diabetic HD patients with concurrent CVD.
OBJECTIVES: It is controversial to what extent serum uric acid (SUA) is associated with mortality in patients with chronic kidney disease undergoing hemodialysis (HD). We analyzed the predictive role of SUA in the mortality of diabetic and nondiabetic chronic kidney diseasepatients starting on maintenance HD therapy. DESIGN AND SUBJECTS:SUA was measured at the initiation of HD therapy in 319 patients (137 females and 193 diabeticpatients) with mean age of 60 ± 14 years and mean estimated glomerular filtration rate of 7.5 ± 3.8 mL/min/1.73 m(2). The patients were divided into 2 groups, hyperuricemia (HUA; n = 165) and non-HUA (n = 154) groups based on laboratory limit for normal SUA. Mortality was recorded during 31.5 ± 24.8 months. RESULTS: Among the 193 diabeticpatients, but not among the whole group of 319 patients, survival was significantly lower in HUA than in non-HUA patients. Among diabeticpatients 2-year patient survival was worse in patients with HUA and cardiovascular disease (CVD; 52.3%; n = 30) than in non-HUA patients with CVD (81.1%; n = 36), HUA without CVD (88.6%; n = 62), and non-HUA without CVD (93.9%; n = 65). Cox analysis in all 319 patients showed that, old age, CVD, other comorbidity, and low serum albumin but not high SUA predicted mortality. Among diabeticpatients, predictors of increased mortality risk were old age, CVD, other comorbidity but also high SUA with adjusted hazard ratio of 1.12 (95% confidence interval 1.02-1.22) per 1 mg/dL increase in SUA. In diabeticpatients with HUA and CVD, adjusted hazard ratio for mortality was 5.98 times that of diabetic non-HUA patients without CVD. CONCLUSIONS: High SUA is associated with poor survival in diabeticpatients undergoing HD but not in nondiabeticpatients undergoing HD. High SUA was found to be a risk marker especially in diabetic HDpatients with concurrent CVD.
Authors: Adam M Zawada; Juan Jesus Carrero; Melanie Wolf; Astrid Feuersenger; Stefano Stuard; Adelheid Gauly; Anke C Winter; Rosa Ramos; Denis Fouque; Bernard Canaud Journal: Kidney Int Rep Date: 2020-06-02