Department of Nephrology, The First Affiliated Hospital of Nanchang University, 17# Yong wai street, Nanchang, 330006, China.
Int Urol Nephrol. 2021 Nov;53(11):2399-2408. doi: 10.1007/s11255-021-02902-x. Epub 2021 Jun 8.
The impact of serum uric acid (SUA) on development of cardiovascular disease (CVD) in patients undergoing peritoneal dialysis (PD) remains controversial, especially the impact of hypouricemia (HUA) on CVD. The aim of our study was to investigate the influence of low-level SUA on cardiovascular (CV) events in PD patients.
A retrospective cohort study was conducted.728 PD patients from February 1, 2010 to May 31, 2019 were enrolled. All demographic and laboratory data were collected at baseline and 6 months after PD treatment. The study cohort was divided into four groups according to SUA level (μmol/L) after 6 months of PD: Group1 (< 360), Group2 (360-420), Group3 (420-480), Group4 (≥ 480). The clinical characteristics of each group were analyzed. With Group2 as reference, logistic regression analysis was performed to investigate the correlation between SUA levels and risk of CV events in patients undergoing PD. Use Kaplan-Meier method to generate CV events risk graph.
728 patients were enrolled in this study, including 403 (55.4%) males and 325 (44.6%) females, with an average age of 48.66 ± 13.98 years; of which 158 (21.7%) patients developed CV events. Multivariate COX regression showed that after adjusting for multiple clinical factors, Group1 (HR = 1.92, 95% CI 1.17-3.15, P = 0.01), Group3 (HR = 1.89, 95% CI 1.13-3.15, P = 0.015), and Group4 (HR = 2.38, 95% CI 1.35-4.19, P = 0.003) are all independent risk factors for developing CV events. The Kaplan-Meier risk curve of CV events showed that the risk of CV events in the Group1, Group3 and Group4 were significantly higher (Log-Rank = 12.67; P = 0.005). Restricted cubic spline (RCS) showed that SUA level is non-linearly associated with the risk of CV events, showing an U-shaped curve ([Formula: see text]=13.3 P = 0.01).
Our study suggested that patients with SUA level less than 360 μmol/L also exhibited the higher risk for developing CV events, an U-shaped association between SUA level and risk of CV events in patients undergoing PD. Both SUA levels below 360 μmol/L and above 420 μmol/L were found to be significant risk factors for developing CV events in patients undergoing long-term PD.
血清尿酸（SUA）对腹膜透析（PD）患者心血管疾病（CVD）发展的影响仍存在争议，尤其是低尿酸血症（HUA）对 CVD 的影响。本研究旨在探讨低水平 SUA 对 PD 患者心血管（CV）事件的影响。
本研究为回顾性队列研究。纳入 2010 年 2 月 1 日至 2019 年 5 月 31 日期间的 728 例 PD 患者。所有人口统计学和实验室数据均在 PD 治疗后 6 个月时收集。根据 PD 治疗后 6 个月的 SUA 水平（μmol/L），将研究队列分为 4 组：组 1（<360）、组 2（360-420）、组 3（420-480）、组 4（≥480）。分析每组的临床特征。以组 2 为参照，进行逻辑回归分析，探讨 PD 患者 SUA 水平与 CV 事件风险的相关性。采用 Kaplan-Meier 法生成 CV 事件风险图。
本研究共纳入 728 例患者，其中男性 403 例（55.4%），女性 325 例（44.6%），平均年龄 48.66±13.98 岁；其中 158 例（21.7%）发生 CV 事件。多变量 COX 回归显示，在校正多个临床因素后，组 1（HR=1.92，95%CI 1.17-3.15，P=0.01）、组 3（HR=1.89，95%CI 1.13-3.15，P=0.015）和组 4（HR=2.38，95%CI 1.35-4.19，P=0.003）均为发生 CV 事件的独立危险因素。CV 事件的 Kaplan-Meier 风险曲线显示，组 1、组 3 和组 4 的 CV 事件风险明显较高（Log-Rank=12.67；P=0.005）。受限立方样条（RCS）显示，SUA 水平与 CV 事件风险呈非线性相关，呈 U 形曲线（[Formula: see text]=13.3，P=0.01）。
本研究表明，SUA 水平低于 360 μmol/L 的患者发生 CV 事件的风险也较高，PD 患者的 SUA 水平与 CV 事件风险之间呈 U 形关联。SUA 水平低于 360 μmol/L 和高于 420 μmol/L 均为 PD 患者发生 CV 事件的显著危险因素。
