Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Japan.
Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Ren Fail. 2020 Nov;42(1):646-655. doi: 10.1080/0886022X.2020.1788582.
There are few studies on the association between serum uric acid (UA) level and mortality in incident dialysis patients. We aimed to clarify whether the serum UA level at dialysis initiation is associated with mortality during maintenance dialysis.
We enrolled 1486 incident dialysis patients who participated in a previous multicenter prospective cohort study in Japan. We classified the patients into the following five groups according to their serum UA levels at dialysis initiation: G1 with a serum UA level <6 mg/dL; G2, 6.0-8.0 mg/dL; G3, 8.0-10.0 mg/dL; G4, 10.0-12.0 mg/dL; and G5, ≥12.0 mg/dL. We created three models (Model 1: adjusted for age and sex, Model 2: adjusted for Model 1 + 12 variables, and Model 3: stepwise regression adjusted for Model 2 + 13 variables) and performed a multivariate Cox proportional hazard regression analysis to examine the association between the serum UA level and outcomes, including infection-related mortality.
Hazard ratios (HRs) were calculated relative to the G2, because the all-cause mortality rate was the lowest in G2. For Models 1 and 2, the all-cause mortality rate was significantly higher in G5 than in G2 (HR: 1.63, 95% confidence interval [CI]: 1.14-2.33 and HR: 1.78, 95% CI: 1.19-2.68, respectively). For Models 1, 2, and 3, the infection-related mortality rate was significantly higher in G5 than in G2 (HR: 2.75, 95% CI: 1.37-5.54, HR: 3.09, 95% CI: 1.45-6.59, HR: 3.37, and 95% CI: 1.24-9.15, respectively).
Extreme hyperuricemia (serum UA level ≥12.0 mg/dL) at dialysis initiation is a risk factor for infection-related deaths.
血清尿酸（UA）水平与起始透析患者死亡率之间的相关性研究较少。我们旨在阐明起始透析时的血清 UA 水平是否与维持性透析期间的死亡率相关。
我们纳入了参加日本之前多中心前瞻性队列研究的 1486 名起始透析患者。我们根据起始透析时的血清 UA 水平将患者分为以下五组：G1 组，血清 UA 水平＜6mg/dL；G2 组，6.0-8.0mg/dL；G3 组，8.0-10.0mg/dL；G4 组，10.0-12.0mg/dL；G5 组，≥12.0mg/dL。我们创建了三个模型（模型 1：调整年龄和性别，模型 2：调整模型 1+12 个变量，模型 3：逐步回归调整模型 2+13 个变量），并进行了多变量 Cox 比例风险回归分析，以检查血清 UA 水平与结局之间的关联，包括感染相关死亡率。
相对于 G2 组，计算了 G1 组的危险比（HR），因为 G2 组的全因死亡率最低。对于模型 1 和模型 2，G5 组的全因死亡率明显高于 G2 组（HR：1.63，95%置信区间[CI]：1.14-2.33 和 HR：1.78，95%CI：1.19-2.68）。对于模型 1、2 和 3，G5 组的感染相关死亡率明显高于 G2 组（HR：2.75，95%CI：1.37-5.54，HR：3.09，95%CI：1.45-6.59，HR：3.37，95%CI：1.24-9.15）。
起始透析时的极度高尿酸血症（血清 UA 水平≥12.0mg/dL）是感染相关死亡的危险因素。
