Gan Wenyuan, Zhu Fan, Fang Xun, Wang Wenzhe, Shao Danni, Mao Huihui, Xiao Wei, Chen Wenli, Xu Fang, Zeng Xingruo
Department of Nephrology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Front Nutr. 2024 Dec 2;11:1499438. doi: 10.3389/fnut.2024.1499438. eCollection 2024.
The association between serum uric acid (UA) and all-cause and cardiovascular-related mortality in hemodialysis (HD) patients is conflicting. We investigated this association and explored the effect modification of underlying nutritional status, as reflected in the lean tissue index (LTI) and the Geriatric Nutritional Risk Index (GNRI), which serve as markers of muscle mass and nutritional risk in HD patients.
A retrospective cohort study was conducted from January 2019 to December 2023. We investigated the association between serum UA and the outcomes using the Cox proportional hazards regression and restricted cubic splines. Subgroup analyses based on the LTI and GNRI were conducted to explore possible effect modification.
During a mean follow-up of 32.9 months, 876 patients who underwent HD were included in the analysis. The association between serum UA and all-cause mortality showed a non-linear U-shaped pattern ( = 0.007), with a survival benefit observed for the patients with serum UA levels between 3.4 and 6.8 mg/dL. In the multivariable-adjusted model, the low and high UA groups were associated with a greater risk of all-cause mortality compared to the reference UA group (hazard ratio (HR) =1.24, confidence interval (CI) 1.03-2.12, = 0.027; HR = 1.09; CI 1.05-2.08. = 0.012). In the low UA group, a greater risk of mortality was observed in patients with low LTI (<12.3; HR 1.56, 95% CI 1.22-1.82) and GNRI values (<102.1; HR 1.43, 95% CI 1.12-1.76), but not in those with high LTI and GNRI values. There was no significant association between serum UA and cardiovascular disease-related mortality.
Our study showed that lower and higher serum UA levels increase the risk of all-cause mortality in HD patients. Among the patients with lower UA levels, low LTI and GNRI values showed a greater risk of mortality. This finding suggested that better nutritional status, rather than elevated UA levels, is likely to improve long-term survival in HD patients.
血液透析（HD）患者血清尿酸（UA）与全因死亡率及心血管相关死亡率之间的关联存在争议。我们研究了这种关联，并探讨了以瘦组织指数（LTI）和老年营养风险指数（GNRI）反映的潜在营养状况的效应修正作用，这两个指标可作为HD患者肌肉量和营养风险的标志物。
进行了一项回顾性队列研究，时间跨度为2019年1月至2023年12月。我们使用Cox比例风险回归和限制性立方样条来研究血清UA与结局之间的关联。基于LTI和GNRI进行亚组分析，以探讨可能的效应修正作用。
在平均32.9个月的随访期间，纳入分析的HD患者有876例。血清UA与全因死亡率之间的关联呈非线性U形模式（P = 0.007），血清UA水平在3.4至6.8mg/dL之间的患者观察到生存获益。在多变量调整模型中，与参考UA组相比，低UA组和高UA组全因死亡率风险更高（风险比（HR）= 1.24，置信区间（CI）1.03 - 2.12，P = 0.027；HR = 1.09；CI 1.05 - 2.08，P = 0.012）。在低UA组中，LTI低（<12.3；HR 1.56，95% CI 1.22 - 1.82）和GNRI值低（<102.1；HR 1.43，95% CI 1.12 - 1.76）的患者死亡率风险更高，但LTI和GNRI值高的患者并非如此。血清UA与心血管疾病相关死亡率之间无显著关联。
我们的研究表明，较低和较高的血清UA水平会增加HD患者全因死亡率风险。在UA水平较低的患者中，低LTI和GNRI值显示出更高的死亡风险。这一发现表明，更好的营养状况而非升高的UA水平可能会改善HD患者的长期生存。
