National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China.
The First People's Hospital of Foshan, Foshan, China.
Am J Nephrol. 2020;51(10):823-832. doi: 10.1159/000509258. Epub 2020 Oct 16.
Several studies have reported that low serum uric acid (SUA) levels are related to increased risk of mortality in maintenance hemodialysis (MHD) patients. However, the possible detrimental effects of high SUA on the mortality risk have not been well examined. Moreover, the possible effect modifiers for the SUA-mortality association have not been fully investigated. To address the aforementioned gap, we aimed to explore the nonlinear relationship between SUA levels and all-cause and cardiovascular disease (CVD) mortality risk, and to examine any possible effect modifiers in MHD patients.
We conducted a multicenter, prospective cohort study among 1,018 MHD patients from 8 hemodialysis centers. The primary outcome was all-cause mortality, and the secondary outcomes were CVD mortality and non-CVD mortality.
The mean value for SUA in the total population was 8.5 ± 1.9 mg/dL. The lowest and highest quintiles of SUA were <7.0 and >10.1 mg/dL, respectively. Over a median follow-up of 45.6 months, 343 deaths were recorded, of which 202 (58.9%) were due to CVD. When SUA was assessed as quintiles, a significantly higher risk of all-cause mortality was found in patients in quintile 1 (<7.0 mg/dL; hazard ratio [HR], 1.33; 95% confidence interval [CI]: 1.02-1.73) or quintile 5 (≥10.1 mg/dL; HR, 1.47; 95% CI: 1.09-2.00), compared to those in quintiles 2-4 (7-10.1 mg/dL). Moreover, the U-shaped SUA-mortality association was mainly found in those with lower C-reactive protein levels (<3 compared with ≥3 mg/L; p for interaction = 0.018). Similar trends were found for CVD mortality and non-CVD mortality.
There was a U-shaped relationship between SUA levels and the risk of all-cause mortality, CVD mortality, and non-CVD mortality in MHD patients.
多项研究报告称，血清尿酸（SUA）水平较低与维持性血液透析（MHD）患者的死亡率增加有关。然而，高 SUA 对死亡率的潜在不利影响尚未得到充分研究。此外，SUA 与死亡率之间关联的可能的效应修饰因子也尚未得到充分研究。为了解决上述差距，我们旨在探讨 SUA 水平与全因和心血管疾病（CVD）死亡率风险之间的非线性关系，并研究 MHD 患者中可能存在的任何效应修饰因子。
我们对来自 8 个血液透析中心的 1018 名 MHD 患者进行了一项多中心、前瞻性队列研究。主要结局是全因死亡率，次要结局是 CVD 死亡率和非 CVD 死亡率。
总人群中 SUA 的平均值为 8.5±1.9mg/dL。SUA 的最低和最高五分位数分别为<7.0 和>10.1mg/dL。在中位随访 45.6 个月期间，记录了 343 例死亡，其中 202 例（58.9%）归因于 CVD。当 SUA 被评估为五分位时，发现第一分位（<7.0mg/dL；危险比[HR]，1.33；95%置信区间[CI]：1.02-1.73）或第五分位（≥10.1mg/dL；HR，1.47；95%CI：1.09-2.00）的患者全因死亡率风险显著更高，与第二至第四分位（7-10.1mg/dL）相比。此外，SUA 与死亡率之间的 U 型关联主要见于较低的 C 反应蛋白水平（<3 与≥3mg/L；交互作用的 p 值=0.018）的患者中。CVD 死亡率和非 CVD 死亡率也呈现出类似的趋势。
在 MHD 患者中，SUA 水平与全因死亡率、CVD 死亡率和非 CVD 死亡率之间存在 U 型关系。
