Lee S M Kurt, Lee Andrew L, Winters Thomas J, Tam Emily, Jaleel Mohammed, Stenvinkel Peter, Johnson Richard J
Biotronics Kidney Center, 2755 Liberty Avenue, Beaumont, TX 77702, USA.
Am J Nephrol. 2009;29(2):79-85. doi: 10.1159/000151292. Epub 2008 Aug 11.
A reverse epidemiology of classic cardiovascular risk factors was observed in hemodialysis patients with a high comorbidity burden. We hypothesized that uric acid, a novel cardiovascular risk factor, also has an altered association with survival in these patients.
A retrospective study was conducted on 168 consecutive outpatient hemodialysis patients over a 6-year period. Serum uric acid, albumin levels and relevant laboratory information were recorded monthly. The disease severity was assessed using Comorbidity Index (CoI) scores. Patients were stratified into 3 groups according to their serum uric acid concentrations: group I was the lowest quintile, group II was the middle 3 quintiles and group III was the highest quintile. The risks of death were calculated utilizing a Cox regression model.
Using group II as a reference group, the hazard ratio of group I was 2.23 [95% confidence interval (CI) 1.21-4.11, p = 0.01] and group III was 0.89 (95% CI 0.47-1.71, p = 0.74). The serum uric acid levels correlated inversely with CoI scores (r = -0.31, 95% CI -0.44 to -0.17, p < 0.0001) and positively with serum albumin levels (r = 0.35, 95% CI 0.21-0.48, p < 0.0001).
Low serum uric acid is a mortality risk factor in incident hemodialysis patients with a high comorbidity burden and hypoalbuminemia.
在合并症负担较高的血液透析患者中观察到经典心血管危险因素的反向流行病学现象。我们推测，尿酸作为一种新的心血管危险因素，在这些患者中与生存的关联也发生了改变。
对连续168例门诊血液透析患者进行了为期6年的回顾性研究。每月记录血清尿酸、白蛋白水平及相关实验室信息。使用合并症指数（CoI）评分评估疾病严重程度。根据血清尿酸浓度将患者分为3组：I组为最低五分位数，II组为中间3个五分位数，III组为最高五分位数。利用Cox回归模型计算死亡风险。
以II组作为参照组，I组的风险比为2.23[95%置信区间（CI）1.21 - 4.11，p = 0.01]，III组为0.89（95%CI 0.47 - 1.71，p = 0.74）。血清尿酸水平与CoI评分呈负相关（r = -0.31，95%CI -0.44至-0.17，p < 0.0001），与血清白蛋白水平呈正相关（r = 0.35，95%CI 0.21 - 0.48，p < 0.0001）。
低血清尿酸是合并症负担高且存在低白蛋白血症的初诊血液透析患者的死亡风险因素。
