Department of Hematology, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
Department of Nephrology, General Hospital of Ningxia Medical University, Yinchuan, China.
Ren Fail. 2024 Dec;46(2):2407881. doi: 10.1080/0886022X.2024.2407881. Epub 2024 Oct 1.
Gastrointestinal bleeding is an important gastrointestinal complication among peritoneal dialysis patients and correlated with a higher risk of mortality. Increased uric acid levels are a significant complication for peritoneal dialysis patients and have been associated with an increased risk of hemorrhagic stroke. The objective of the present study was to investigate the relationship between serum uric acid levels and gastrointestinal bleeding in peritoneal dialysis patients.
A total of 2498 peritoneal dialysis patients were recruited. Based on the optimal uric acid cutoff value, two groups of patients were divided. We constructed a propensity-score-matched population of 1762 patients by matching sex, age, and body mass index. Survival outcomes between the two groups were compared using adjusted Kaplan-Meier curves. We constructed the restricted cubic splines regression to assess the correlation between levels of uric acid and gastrointestinal bleeding. A multivariate Cox proportional hazards regression was performed to test whether higher levels of uric acid are an independent risk factor for gastrointestinal bleeding. We performed a forest plot to show interaction effects in different subgroups.
According to restricted cubic splines regression, uric acid levels were positively correlated with the risk of gastrointestinal bleeding events. After adjusted different confounding factors, patients with high levels of uric acid were prone to experience gastrointestinal bleeding (HR 1.868, 95%CI 1.001-3.486). In subgroups, the interaction between higher levels of uric acid and utilizing proton pump inhibitors was significant (P for interaction = 0.034). Further research found that taking proton pump inhibitors could decrease the risk of gastrointestinal bleeding in peritoneal dialysis patients accompanied high levels of uric acid.
The baseline high levels of uric acid are an independent risk factor for gastrointestinal bleeding in patients undergoing peritoneal dialysis.
胃肠道出血是腹膜透析患者的一种重要胃肠道并发症，与更高的死亡率相关。尿酸水平升高是腹膜透析患者的一个重要并发症，与出血性中风风险增加相关。本研究的目的是探讨血清尿酸水平与腹膜透析患者胃肠道出血之间的关系。
共纳入 2498 名腹膜透析患者。根据最佳尿酸截断值，将两组患者分为两组。我们通过匹配性别、年龄和体重指数，构建了一个包含 1762 名患者的倾向评分匹配人群。使用调整后的 Kaplan-Meier 曲线比较两组之间的生存结局。我们构建了限制立方样条回归来评估尿酸水平与胃肠道出血之间的相关性。使用多变量 Cox 比例风险回归检验尿酸水平升高是否是胃肠道出血的独立危险因素。我们进行了森林图分析，以显示不同亚组中的交互作用效应。
根据限制立方样条回归，尿酸水平与胃肠道出血事件的风险呈正相关。在调整了不同混杂因素后，尿酸水平较高的患者更容易发生胃肠道出血（HR 1.868，95%CI 1.001-3.486）。在亚组中，尿酸水平较高与使用质子泵抑制剂之间的交互作用具有统计学意义（P 交互=0.034）。进一步研究发现，质子泵抑制剂的使用可以降低尿酸水平较高的腹膜透析患者胃肠道出血的风险。
基线尿酸水平升高是腹膜透析患者胃肠道出血的独立危险因素。
