Dong Jie, Han Qing-Feng, Zhu Tong-Ying, Ren Ye-Ping, Chen Jiang-Hua, Zhao Hui-Ping, Chen Meng-Hua, Xu Rong, Wang Yue, Hao Chuan-Ming, Zhang Rui, Zhang Xiao-Hui, Wang Mei, Tian Na, Wang Hai-Yan
Renal Division, Department of Medicine, Peking University First Hospital; Institute of Nephrology, Peking University; Key Laboratory of Renal Disease, Ministry of Health; Key Laboratory of Renal Disease, Ministry of Education; Beijing, China.
Department of Nephrology, Peking University Third Hospital, Beijing, China.
PLoS One. 2014 Jan 8;9(1):e82342. doi: 10.1371/journal.pone.0082342. eCollection 2014.
To investigate whether uric acid (UA) is an independent predictor of cardiovascular (CV) and all-cause mortality in peritoneal dialysis (PD) patients after controlling for recognized CV risk factors.
A total of 2264 patients on chronic PD were collected from seven centers affiliated with the Socioeconomic Status on the Outcome of Peritoneal Dialysis (SSOP) Study. All demographic and laboratory data were recorded at baseline. Multivariate Cox regression was used to calculate the hazard ratio (HR) of CV and all-cause mortality with adjustments for recognized traditional and uremia-related CV factors.
There were no significant differences in baseline characteristics between patients with (n = 2193) and without (n = 71) UA measured. Each 1 mg/dL of increase in UA was associated with higher all-cause mortality with 1.05(1.00∼1.10) of HR and higher CV mortality with 1.12 (1.05∼1.20) of HR after adjusting for age, gender and center size. The highest gender-specific tertile of UA predicted higher all-cause mortality with 1.23(1.00∼1.52) of HR and higher CV mortality with 1.69 (1.21∼2.38) of HR after adjusting for age, gender and center size. The predictive value of UA was stronger in patients younger than 65 years without CV disease or diabetes at baseline. The prognostic value of UA as both continuous and categorical variable weakened or disappeared after further adjusted for uremia-related and traditional CV risk factors.
The prognostic value of UA in CV and all-cause mortality was weak in PD patients generally, which was confounded by uremia-related and traditional CV risk factors.
在控制公认的心血管风险因素后，研究尿酸（UA）是否为腹膜透析（PD）患者心血管（CV）和全因死亡率的独立预测因素。
从腹膜透析结局社会经济地位（SSOP）研究的7个中心收集了总共2264例慢性PD患者。在基线时记录所有人口统计学和实验室数据。使用多变量Cox回归计算CV和全因死亡率的风险比（HR），并对公认的传统和尿毒症相关CV因素进行调整。
测量了UA的患者（n = 2193）和未测量UA的患者（n = 71）之间的基线特征无显著差异。在校正年龄、性别和中心规模后，UA每增加1mg/dL与全因死亡率较高相关，HR为1.05（1.00～1.10），与CV死亡率较高相关，HR为1.12（1.05～1.20）。在校正年龄、性别和中心规模后，UA最高的特定性别三分位数预测全因死亡率较高，HR为1.23（1.00～1.52），CV死亡率较高，HR为1.69（1.21～2.38）。在基线时年龄小于65岁、无CV疾病或糖尿病的患者中，UA的预测价值更强。在进一步校正尿毒症相关和传统CV风险因素后，UA作为连续和分类变量的预后价值减弱或消失。
一般而言，UA在PD患者的CV和全因死亡率中的预后价值较弱，这受到尿毒症相关和传统CV风险因素的混淆。
