血清尿酸与腹膜透析患者全因和心血管死亡率的关系。
Relationship between serum uric acid and all-cause and cardiovascular mortality in patients treated with peritoneal dialysis.
机构信息
Department of Nephrology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
Department of Nephrology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
出版信息
Am J Kidney Dis. 2014 Aug;64(2):257-64. doi: 10.1053/j.ajkd.2013.08.027. Epub 2013 Oct 28.
BACKGROUND
Although serum uric acid level appears to be associated with mortality in individuals treated with hemodialysis, the relationship between serum uric acid level and death is uncertain in patients treated with peritoneal dialysis (PD).
STUDY DESIGN
Cohort study.
SETTING & PARTICIPANTS: 985 patients from a single PD center in South China followed up for a median of 25.3 months.
PREDICTOR
Serum uric acid level.
OUTCOMES & MEASUREMENTS: The association of baseline sex-specific uric acid level with all-cause and cardiovascular mortality was evaluated. Models were adjusted for age, body mass index, comorbidity score, residual kidney function, total Kt/V, allopurinol and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker use, and laboratory test results, including hemoglobin, serum albumin, creatinine, calcium, phosphorus, triglycerides, low-density lipoprotein cholesterol, and high-sensitivity C-reactive protein.
RESULTS
Mean age was 48.3±15.4 (SD) years, and 23% had diabetes. Mean uric acid level was 7.0±1.3 (range, 3.8-19.8) mg/dL. During follow-up, 144 deaths were recorded, of which 64 were due to cardiovascular events. In multivariable models, the highest sex-specific tertile of uric acid level was associated with increased risk of all-cause mortality (HR, 1.93; 95% CI, 1.27-2.93; P=0.004) and cardiovascular mortality (HR, 3.31; 95% CI, 1.70-6.41; P<0.001) compared to the lowest tertile. Adjusted Cox regression models showed that the HRs per 1-mg/dL higher uric acid level for all-cause and cardiovascular mortality were 1.33 (95% CI, 1.14-1.56; P<0.001) and 1.44 (95% CI, 1.17-1.77; P=0.001) for men and 1.03 (95% CI, 0.86-1.24; P=0.8) and 1.16 (95% CI, 0.97-1.38; P=0.1) for women, respectively. A formal test for interaction indicated that the association of uric acid level with all-cause and cardiovascular mortality differed by sex (β = -0.06 [P=0.02] and β = -0.10 [P=0.02], respectively).
LIMITATIONS
Single measurement of uric acid at baseline. Cause of death determined by death certificates and expert consensus.
CONCLUSIONS
Elevated serum uric acid level is an independent risk factor for all-cause and cardiovascular mortality in men treated with PD.
背景
虽然血清尿酸水平似乎与接受血液透析治疗的个体的死亡率有关，但在接受腹膜透析 (PD) 治疗的患者中，血清尿酸水平与死亡之间的关系尚不确定。
研究设计
队列研究。
地点和参与者
来自中国南方一个单一 PD 中心的 985 例患者，中位随访时间为 25.3 个月。
预测指标
血清尿酸水平。
结局和测量
评估基线时性别特异性尿酸水平与全因和心血管死亡率的关系。模型调整了年龄、体重指数、合并症评分、残余肾功能、总 Kt/V、别嘌呤醇和血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂的使用以及血红蛋白、血清白蛋白、肌酐、钙、磷、甘油三酯、低密度脂蛋白胆固醇和高敏 C 反应蛋白等实验室检查结果。
结果
平均年龄为 48.3±15.4(SD) 岁，23%患有糖尿病。平均尿酸水平为 7.0±1.3(范围 3.8-19.8)mg/dL。随访期间，记录了 144 例死亡，其中 64 例死于心血管事件。多变量模型显示，尿酸水平最高的性别特异性三分位组与全因死亡率(HR,1.93;95%CI,1.27-2.93;P=0.004)和心血管死亡率(HR,3.31;95%CI,1.70-6.41;P<0.001)的风险增加相关，与最低三分位组相比。校正后的 Cox 回归模型显示，尿酸水平每升高 1mg/dL，全因死亡率和心血管死亡率的 HR 分别为 1.33(95%CI,1.14-1.56;P<0.001)和 1.44(95%CI,1.17-1.77;P=0.001)，男性和 1.03(95%CI,0.86-1.24;P=0.8)和 1.16(95%CI,0.97-1.38;P=0.1)，女性。正式的交互作用检验表明，尿酸水平与全因和心血管死亡率的相关性因性别而异(β=-0.06[P=0.02]和β=-0.10[P=0.02])。
局限性
基线时仅测量尿酸一次。死因由死亡证明和专家共识确定。
结论
在接受 PD 治疗的男性中，血清尿酸水平升高是全因和心血管死亡率的独立危险因素。
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