Key result
Higher serum uric acid linked to ~70% lower all-cause mortality in maintenance hemodialysis patients.
Why the study?
There is no consensus on the role of abnormal uric acid levels in the prognosis of patients undergoing maintenance hemodialysis.
Is higher serum uric acid concentration associated with reduced all-cause and cardiac death in patients undergoing maintenance hemodialysis?
Cohort (n=325)
Yes
Is higher serum uric acid concentration associated with reduced all-cause and cardiac death in patients undergoing maintenance hemodialysis?
Odds Ratio: 0.3 (95% CI 0.1–0.7)
Absolute Event Rate: 23.2% vs 55.6%
p-value: p=0.001
Low serum uric acid levels are associated with increased all-cause mortality in patients undergoing maintenance hemodialysis, highlighting a paradoxical relationship in this population.
Low UA levels were associated with higher all-cause mortality in MHD patients; leaves open whether targeting UA improves survival.
Objective. There is no consensus on the role of abnormal uric acid (UA) levels in the prognosis of patients undergoing hemodialysis. We therefore aimed to investigate the effects of changes in UA concentration on the risk of all-cause death and cardiac death in such patients. Method. In this retrospective cohort study, patients admitted to two hemodialysis centers performing maintenance hemodialysis (MHD) in Wuhan First Hospital and Fourth Hospital Hemodialysis Center from January 1, 2007, to October 31, 2017, were included. Results. In all, 325 patients undergoing MHD aged 59.7±14.7 years, including 195 men (60%), were enrolled, with a median follow-up of 37 months. Serum UA ( p<0.001 ) was significantly higher in the surviving group than in the death group. No significant difference was found in UA variability ( p=0.193 ) between the two groups. Patients were assigned Quartile 1-Quartile 4 (from lowest to highest) based on serum UA levels. A total of 45 of 81 (55.6%) patients in Quartile 1 experienced all-cause death; 19 of 82 (23.2%) in Quartile 4 had all-cause mortality (OR, 0.2; 95% confidence interval, 0.1 to 0.5; p for trend<0.001 ). 25 of 81 (30.9%) in Quartile 1 had cardiac death; and 11 of 82 (13.4%) in Quartile 4 had cardiac death (OR, 0.3; 95% confidence interval, 0.2 to 0.8; p for trend=0.003 ). After adjusting for age, primary renal disease, vascular access, serum albumin, and UA variability, the OR values and 95% CI for all-cause death and cardiac death were 0.3 and 0.1-0.7 ( p=0.001 ) and 0.6 and 0.2-1.4 ( p=0.101 ), respectively. Additionally, the receiver operating characteristic curve showed that UA concentration and its changes combined with age had a good predictive value for all-cause mortality in patients undergoing MHD ( AUC=0.7517 , 95% CI: 0.6677-0.811, p=0.0245 ). However, the predictive value of cardiac death was not improved ( AUC=0.7394 , 95% CI: 0.6677-0.811, p=0.2194 ). Conclusion. Low UA levels were closely related to all-cause mortality in patients undergoing MHD. Although UA levels had no significant effect on cardiac death, they had a good predictive value for long-term prognosis in patients on MHD.
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Dong et al. (2020) conducted a cohort in Maintenance hemodialysis (n=325). High serum uric acid concentration (Quartile 4) vs. Low serum uric acid concentration (Quartile 1) was evaluated on All-cause mortality (OR 0.3, 95% CI 0.1-0.7, p=0.001). Higher serum uric acid levels were associated with a lower risk of all-cause mortality in patients on maintenance hemodialysis (adjusted OR 0.3; 95% CI 0.1-0.7; p=0.001).
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