Huang Wanqing, Ding Ning, Zhang Yanping, Qiu Dongxia, Wei Lin, Zhao Chen, Ren Zhuo, Wang Qian, Ren Kaiming, Bai Jiuxu, Cao Ning
Department of Blood Purification, General Hospital of Northern Theater Command, Shenyang, China.
Ren Fail. 2025 Dec;47(1):2509787. doi: 10.1080/0886022X.2025.2509787. Epub 2025 May 25.
Uric acid is a risk factor for death in hemodialysis patients, but its exact role is still unclear. The serum uric acid-to-serum creatinine (SUA/SCr) ratio is a new indicator. This study aimed to clarify the relationship between this indicator and cardiovascular death in maintenance hemodialysis patients.
Kaplan-Meier analysis was used to compare all-cause and cardiovascular mortality. Restricted cubic splines were used to plot the relationships between SUA/SCr and all-cause and cardiovascular mortality. Multivariable Cox regression was used to analyze the relationships between SUA/SCr and the risk of all-cause death or cardiovascular death. The C statistic was calculated to test the model discrimination performance. The net reclassification index was calculated to demonstrate the prediction accuracy of SUA and SUA/SCr.
Kaplan-Meier analysis showed that all-cause and cardiovascular mortality were significantly higher in the highest SUA/SCr quartile ( < 0.001, for both). Restricted cubic splines indicate a nonlinear relationship between SUA/SCr and cardiovascular mortality. Multivariable Cox regression analysis showed that there was no significant difference in all-cause mortality, but patients with the highest SUA/SCr quartile had a higher risk of cardiovascular death (HR = 4.023, 95% CI, 1.979-8.179; < 0.001; HR = 4.339, 95% CI, 2.091-9.002; < 0.001; HR = 2.747, 95% CI, 1.170-6.450; = 0.020). The C-statistic of the SUA/SCr model was greater than those of the SUA and SCr models alone. The NRI demonstrated that the SUA/SCr ratio was superior to SUA alone in the prediction of cardiovascular death.
In maintenance hemodialysis patients patients, higher levels of SUA/SCr are associated with a greater risk of cardiovascular mortality.
尿酸是血液透析患者死亡的一个危险因素，但其确切作用仍不清楚。血清尿酸与血清肌酐（SUA/SCr）比值是一个新指标。本研究旨在阐明该指标与维持性血液透析患者心血管死亡之间的关系。
采用Kaplan-Meier分析比较全因死亡率和心血管死亡率。使用限制立方样条来描绘SUA/SCr与全因死亡率和心血管死亡率之间的关系。采用多变量Cox回归分析SUA/SCr与全因死亡或心血管死亡风险之间的关系。计算C统计量以检验模型的判别性能。计算净重新分类指数以证明SUA和SUA/SCr的预测准确性。
Kaplan-Meier分析显示，在最高SUA/SCr四分位数组中，全因死亡率和心血管死亡率均显著更高（两者均P<0.001）。限制立方样条表明SUA/SCr与心血管死亡率之间存在非线性关系。多变量Cox回归分析显示，全因死亡率无显著差异，但SUA/SCr四分位数最高的患者心血管死亡风险更高（HR = 4.023，95%CI，1.979 - 8.179；P<0.001；HR = 4.339，95%CI，2.091 - 9.002；P<0.001；HR = 2.747，95%CI，1.170 - 6.450；P = 0.020）。SUA/SCr模型的C统计量大于单独的SUA和SCr模型。NRI表明，SUA/SCr比值在预测心血管死亡方面优于单独的SUA。
在维持性血液透析患者中，较高水平的SUA/SCr与更大的心血管死亡风险相关。
