Hsu Shih-Ping, Pai Mei-Fen, Peng Yu-Sen, Chiang Chin-Kang, Ho Tai-I, Hung Kuan-Yu
Department of Internal Medicine, Far Eastern Memorial Hospital and National Taiwan University Hospital, Taipei, Taiwan, Republic of China.
Nephrol Dial Transplant. 2004 Feb;19(2):457-62. doi: 10.1093/ndt/gfg563.
Although elevated serum levels of uric acid are common in patients with kidney disease or in those receiving maintenance dialysis therapy, the clinical impact of uric acid on mortality in haemodialysis (HD) patients remains unclear. This work was designed to explore the predictive value of serum uric acid levels on all-cause mortality of HD patients.
We retrospectively analysed mortality rates in 146 chronic HD patients that were treated with HD three times per week at our HD unit for a period of one full year. The analysed parameters included demographic characteristics, aetiology of end-stage renal disease, co-morbid conditions, duration (at least 1 year) and delivered dose of HD, normalized protein catabolic rate, serum albumin concentration, haematocrit, serum uric acid (UA) levels and other laboratory parameters. A multivariate Cox proportional hazards model, which included adjustment for the above factors, was applied to identify the predictive value of UA levels on patient mortality.
A Cox proportional hazards model revealed that decreased serum albumin, underlying diabetic nephropathy (DMN) and UA groups (< or =20th, 20-80th and > or =80th percentiles; P = 0.016) were all significant, independent predictors of all-cause mortality in HD patients. The hazard ratios of death were: serum albumin (per 0.5 g/dl decrease), 3.10 [95% confidence interval (95% CI), 1.80-5.34, P < 0.001]; DMN (vs non-DMN), 3.47 (95% CI, 1.25-9.59, P = 0.017); and UA groups (vs 20th to 80th percentile): < or =20th percentile, 2.98 (95% CI, 0.82-10.90, P = 0.099); > or = 80th percentile, 5.67 (95% CI, 1.71-18.78, P = 0.004).
These preliminary observations suggest that HD patients in the lowest and highest quintiles of UA levels would face higher risk of mortality. Further studies with larger sample sizes will be needed to confirm these findings.
尽管血清尿酸水平升高在肾病患者或接受维持性透析治疗的患者中很常见，但尿酸对血液透析（HD）患者死亡率的临床影响仍不清楚。这项研究旨在探讨血清尿酸水平对HD患者全因死亡率的预测价值。
我们回顾性分析了146例在我们血液透析中心每周接受3次血液透析治疗满一年的慢性HD患者的死亡率。分析参数包括人口统计学特征、终末期肾病的病因、合并症、血液透析的持续时间（至少1年）和透析剂量、标准化蛋白分解代谢率、血清白蛋白浓度、血细胞比容、血清尿酸（UA）水平及其他实验室参数。应用多变量Cox比例风险模型，对上述因素进行校正，以确定UA水平对患者死亡率的预测价值。
Cox比例风险模型显示，血清白蛋白降低、潜在的糖尿病肾病（DMN）和尿酸分组（<或=第20百分位数、第20至80百分位数和>或=第80百分位数；P=0.016）均是HD患者全因死亡率的显著独立预测因素。死亡风险比为：血清白蛋白（每降低0.5g/dl），3.10[95%置信区间（95%CI），1.80-5.34，P<0.001]；DMN（与非DMN相比），3.47（95%CI，1.25-9.59，P=0.017）；尿酸分组（与第20至80百分位数相比）：<或=第20百分位数，2.98（95%CI，0.82-10.90，P=0.099）；>或=第80百分位数，5.67（95%CI，1.71-18.78，P=0.004）。
这些初步观察结果表明，尿酸水平处于最低和最高五分位数的HD患者面临更高的死亡风险。需要进一步开展更大样本量的研究来证实这些发现。
