Nephrology Division, Department of Medicine, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China.
Nephrology Division, Department of Medicine, Guangdong Province Traditional Chinese Medical Hospital, Guangzhou, Guangdong, China.
Ren Fail. 2020 Nov;42(1):447-454. doi: 10.1080/0886022X.2020.1761387.
Hyperuricemia occurs frequently in patients with continuous ambulatory peritoneal dialysis (CAPD). This study aimed to evaluate the impact of serum uric acid (UA) over time on residual renal function (RRF) loss in a cohort of patients with CAPD. A total of 201 patients who started CAPD therapy between January 1, 2008 and April 30, 2016 were included in this single-center, retrospective cohort study. All patients were followed up until December 31, 2016. The median follow-up time was 23.43 ± 16.60 months. RRF loss was represented as the time to anuria. Eighty-six patients developed anuria within 5 years. Multivariate Cox regression analysis showed that time-averaged serum UA and peritonitis were independent risk factors for RRF loss, while weekly Kt/V urea was a protective factor. Cox proportional hazard regression models showed that both patients with time-averaged uric acid (TA-UA) < 6.77 mg/dL [hazard ratio (HR) = 1.165, 95% confidence interval (CI) 1.054-1.387; < 0.05] and those with TA-UA≥ 7.64 mg/dL (HR = 1.184, 95% CI 1.045-2.114; < 0.05) had a higher risk of RRF than those with TA-UA in the range of 6.77-7.64 mg/dL. Penalized spline smoothing also showed a U-shaped relationship between continuous UA and RRF loss. The present study demonstrated that both high and low serum UA over time were associated with RRF loss in patients with CAPD.
高尿酸血症在持续性不卧床腹膜透析（CAPD）患者中很常见。本研究旨在评估血清尿酸（UA）随时间变化对 CAPD 患者残余肾功能（RRF）丧失的影响。这项单中心回顾性队列研究纳入了 201 例 2008 年 1 月 1 日至 2016 年 4 月 30 日期间开始 CAPD 治疗的患者。所有患者均随访至 2016 年 12 月 31 日。中位随访时间为 23.43±16.60 个月。RRF 丧失表示为无尿的时间。86 例患者在 5 年内发生无尿。多变量 Cox 回归分析显示，时间平均血清 UA 和腹膜炎是 RRF 丧失的独立危险因素，而每周 Kt/V 尿素是保护因素。Cox 比例风险回归模型显示，时间平均尿酸（TA-UA）<6.77mg/dL 的患者（HR=1.165，95%CI 1.054-1.387； < 0.05）和 TA-UA≥7.64mg/dL 的患者（HR=1.184，95%CI 1.045-2.114； < 0.05）与 TA-UA 范围在 6.77-7.64mg/dL 的患者相比，RRF 丧失的风险更高。惩罚样条平滑也显示连续 UA 与 RRF 丧失之间存在 U 形关系。本研究表明，CAPD 患者血清 UA 持续升高和降低均与 RRF 丧失有关。
