Selim Gjulsen, Stojceva-Taneva Olivera, Tozija Liljana, Zafirova-Ivanovska Beti, Spasovski Goce, Gerasimovska Vesna, Petronijevic Zvezdana, Trajceska Lada, Dzekova-Vidimliski Pavlina, Gjorgjievski Nikola, Pavleska-Kuzmanovska Svetlana, Kabova Angela, Georgievska-Ismail Ljubica
University Clinic of Nephrology, Ss. Cyril and Methodius University Skopje, Republic of North Macedonia.
Institute of Epidemiology and Biostatistics, Ss. Cyril and Methodius University Skopje, Republic of North Macedonia.
Clin Kidney J. 2019 Dec 22;14(2):578-585. doi: 10.1093/ckj/sfz172. eCollection 2021 Feb.
The impact of serum uric acid (UA) on morbidity and mortality in hemodialysis (HD) patients is quite controversial in relation to the general population. The aim of this study was to evaluate the association of serum UA with both mortality and left ventricular hypertrophy (LVH) in HD patients.
This longitudinal study enrolled 225 prevalent HD patients who were classified into three groups according to their follow-up-averaged UA (FA-UA) levels: low FA-UA (FA-UA <400 µmol/L), intermediate/reference FA-UA (FA-UA between 400 and 450 µmol/L) and high FA-UA (FA-UA >450 µmol/L). Echocardiography was performed on a nondialysis day and the presence of LVH was defined based on a left ventricular mass index (LVMI) >131 and >100 g/m for men and women, respectively. The patients were followed during a 60-month period.
The mean FA-UA level was 425 ± 59 µmol/L (range 294-620). There was a consistent association of higher FA-UA with better nutritional status (higher body mass index, normalized protein catabolic rate, creatinine, albumin and phosphorus), higher hemoglobin, but lower C-reactive protein and LVMI. During the 5-year follow-up, 81 patients died (36%) and the main causes of death were cardiovascular (CV) related (70%). When compared with the reference group, the hazard ratio for all-cause mortality was 1.75 [95% confidence interval (CI) 1.02-2.98; P = 0.041] in the low FA-UA group, but there was no significant association with the high FA-UA group. In contrast, FA-UA did not show an association with CV mortality neither with the lower nor with the high FA-UA group. The unadjusted odds ratio (OR) of LVH risk in the low FA-UA compared with the reference FA-UA group was 3.11 (95% CI 1.38-7.05; P = 0.006), and after adjustment for age, gender, diabetes and CV disease, ORs for LVH persisted significantly only in the low FA-UA group [OR 2.82 (95% CI 1.16-6.88,); P = 0.002].
Low serum UA is a mortality risk factor and is associated with LVH in HD patients. These results are in contrast with the association of UA in the general population and should be the subject of further research.
与普通人群相比，血清尿酸（UA）对血液透析（HD）患者发病率和死亡率的影响颇具争议。本研究旨在评估HD患者血清UA与死亡率及左心室肥厚（LVH）之间的关联。
这项纵向研究纳入了225例HD患者，根据其随访平均UA（FA-UA）水平分为三组：低FA-UA组（FA-UA<400µmol/L）、中/参考FA-UA组（FA-UA在400至450µmol/L之间）和高FA-UA组（FA-UA>450µmol/L）。在非透析日进行超声心动图检查，LVH的存在根据男性和女性的左心室质量指数（LVMI）分别>131和>100g/m²来定义。对患者进行为期60个月的随访。
平均FA-UA水平为425±59µmol/L（范围294 - 620）。较高的FA-UA与更好的营养状况（更高的体重指数、标准化蛋白分解代谢率、肌酐、白蛋白和磷）、更高的血红蛋白相关，但与较低的C反应蛋白和LVMI相关。在5年的随访期间，81例患者死亡（36%），主要死亡原因与心血管（CV）相关（70%）。与参考组相比，低FA-UA组全因死亡率的风险比为1.75[95%置信区间（CI）1.02 - 2.98；P = 0.041]，但高FA-UA组无显著关联。相比之下，FA-UA与低FA-UA组和高FA-UA组的CV死亡率均无关联。与参考FA-UA组相比，低FA-UA组LVH风险的未调整优势比（OR）为3.11（95%CI 1.38 - 7.05；P = 0.006），在调整年龄、性别、糖尿病和CV疾病后，LVH的OR仅在低FA-UA组中仍显著存在[OR 2.82（95%CI 1.16 - 6.88）；P = 0.002]。
低血清UA是HD患者的死亡风险因素，且与LVH相关。这些结果与普通人群中UA的关联相反，应成为进一步研究的主题。
