Beth Israel Medical Center, Albert Einstein College of Medicine, New York, New York, USA.
Clin J Am Soc Nephrol. 2011 Oct;6(10):2470-7. doi: 10.2215/CJN.00670111. Epub 2011 Aug 25.
Hyperuricemia is associated with hypertension, coronary artery disease, and chronic kidney disease. However, there are no specific data on the relationship of uric acid to cardiovascular disease in the chronic hemodialysis setting.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Data from 5827 patients on chronic hemodialysis from six countries affiliated with the Dialysis Outcomes and Practice Patterns Study (DOPPS) were analyzed. All laboratory data were based upon the initial cross-section of patients in DOPPS I and II. Cox regression was used to calculate the hazard ratio (HR) of all-cause and cardiovascular (CV) mortality with adjustments for case-mix including 14 classes of comorbidity.
There were no clinically significant differences in baseline characteristics between those who had measured uric acid (n = 4637) and those who did not (n = 1190). Uric acid level was associated with lower all-cause mortality (HR: 0.95, 95% confidence interval [CI]: 0.90 to 1.00 per 1 mg/dl higher uric acid level) and CV mortality (HR: 0.92, 95% CI: 0.86 to 0.99). When analyzed as a dichotomous variable, the adjusted HR at uric acid ≤8.2 mg/dl compared with >8.2 mg/dl was 1.24 (95% CI: 1.03 to 1.49) for all-cause mortality and 1.54 (95% CI: 1.15 to 2.07) for CV mortality.
Higher uric acid levels were associated with lower risk of all-cause and CV mortality in the hemodialysis population. These results are in contrast to the association of hyperuricemia with higher cardiovascular risk in the general population and should be the subject of further research.
高尿酸血症与高血压、冠状动脉疾病和慢性肾脏病有关。然而，在慢性血液透析环境中，尿酸与心血管疾病的关系尚无具体数据。
设计、地点、参与者和测量：对来自六个国家的 5827 名接受慢性血液透析的患者的数据进行了分析，这些患者来自 Dialysis Outcomes and Practice Patterns Study（DOPPS）的第一期和第二期。所有实验室数据均基于 DOPPS I 和 II 中患者的初始横断面。Cox 回归用于计算全因和心血管（CV）死亡率的风险比（HR），调整了包括 14 类合并症在内的病例组合。
在基线特征方面，有尿酸测量值的患者（n=4637）和没有尿酸测量值的患者（n=1190）之间没有显著差异。尿酸水平与较低的全因死亡率（HR：0.95，95%置信区间[CI]：每升高 1mg/dl 尿酸水平 0.90 至 1.00）和 CV 死亡率（HR：0.92，95%CI：0.86 至 0.99）相关。当作为二分类变量进行分析时，尿酸水平≤8.2mg/dl 与>8.2mg/dl 相比，全因死亡率的调整 HR 为 1.24（95%CI：1.03 至 1.49），CV 死亡率的调整 HR 为 1.54（95%CI：1.15 至 2.07）。
在血液透析人群中，较高的尿酸水平与全因和 CV 死亡率的风险降低相关。这些结果与高尿酸血症与一般人群中更高的心血管风险相关的关联相反，应进一步研究。
