High serum uric acid level is a mortality risk factor in peritoneal dialysis patients: a retrospective cohort study

Xiang, Shilong; Zhang, Xiaohui; Xie, Xueping; Zhou, Qin; Chen, Zhimin; Wang, Yaomin; Liu, Guangjun; Han, Fei; Chen, Jianghua

doi:10.1186/s12986-019-0379-y

Cited by 25 publications

(32 citation statements)

References 46 publications

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“…Among them, in a retrospective study including 156 PD patients, Feng et al [44] reported that higher SUA levels were associated with increased all-cause mortality. Xia et al [12] reported that elevated SUA level was an independent risk factor for all-cause and CVD mortality in male PD patients [45] and CVD mortality in diabetic male PD patients [46] in a retrospective cohort study of 985 PD patients and 328 PD patients with diabetes, respectively. And, a study from Xiang et al [12] showed that high SUA level was associated with higher all-cause but not CVD mortality, and the prognostic effects were more prominent in male, hypoalbuminemia, lower BMI, and nondiabetes patients subgroup [12].…”

Section: Discussionmentioning

confidence: 99%

“…As a common feature of protein-energy wasting [9], lower appendicular skeletal muscle mass (ASM) was shown to independently predict mortality in PD patients [10,11]. The gender and diabetics status were revealed to modify the prognostic effect, and the study by Xiang et al [12] suggested that the adverse effect of higher SUA level on all-cause mortality was also more prominent in hypoalbuminemia and normal-weight groups of PD patients. However, the relationship between SUA and ASM was unknown in PD population and the effect of the ASM level on the association between SUA and all-cause or CVD mortality in PD patients remains to be explored.…”

Section: Introductionmentioning

confidence: 99%

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The Association between Serum Uric Acid and Appendicular Skeletal Muscle Mass and the Effect of Their Interaction on Mortality in Patients on Peritoneal Dialysis

Xiao

Chen

Peng

et al. 2020

Kidney Blood Press Res

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Background: Serum uric acid (SUA) has been revealed to be positively associated with the body composition parameters in hemodialysis patients, but few studies have investigated that in patients on peritoneal dialysis (PD). The aim of this study was to identify the relationship between SUA and appendicular skeletal muscle mass (ASM) and the effect of their interaction on mortality in PD patients. Methods: This was a single-center retrospective cohort study. Patients who underwent multifrequency bioelectrical impedance analysis between January 1, 2013, and December 31, 2016, and had data on SUA values were enrolled. All patients were followed up until December 31, 2019. Results: In total, 802 prevalent PD patients (57.9% male), with mean age of 46.2 ± 14.2 years were enrolled. The average SUA and ASM were 6.8 ± 1.3 mg/dL and 21.2 ± 4.9 kg. According to multiple linear regression models, SUA was positively associated with relative ASM in middle-aged and older PD patients (standardized coefficients [β] 0.117; 95% confidence interval [CI] 0.027, 0.200; p = 0.010). Further sex-stratified analysis showed that the association existed only in males (β 0.161; 95% CI 0.017, 0.227; p = 0.023). Moreover, the presence of hyperuricemia was found to predict lower risk of all-cause mortality (hazard ratio [HR] 0.514, 95% CI 0.272, 0.970; p = 0.040) only in patients with lower relative ASM. And, the adjusted HR of every 1 mg/dL elevated SUA level was 0.770 (95% CI 0.609, 0.972; p = 0.028) for all-cause mortality in the lower relative ASM subgroup. Conclusions: There exists a positive association between the SUA and ASM, and the ASM significantly affected the association between SUA and all-cause PD mortality.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Association between Serum Uric Acid and Appendicular Skeletal Muscle Mass and the Effect of Their Interaction on Mortality in Patients on Peritoneal Dialysis

Xiao

Chen

Peng

et al. 2020

Kidney Blood Press Res

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“…Among patients receiving peritoneal dialysis (PD), the relationship between serum UA level and mortality appears variable. Although many reports have demonstrated a positive relationship, 18 –21 some reports have described an inverse, 22 a U-shaped, 23 or no relationship 24 between UA levels and all-cause or CV mortality rate. Potential reasons for these discrepancies were diversities in methods of analysis, patient characteristics, dialysis prescription, and confounding factors.…”

Section: Introductionmentioning

confidence: 99%

Effect of uric acid levels on mortality in Japanese peritoneal dialysis patients

et al. 2020

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Background: Unlike the situation in the general population, most studies of patients receiving hemodialysis have reported lower uric acid (UA) as associated with higher mortality. However, the relationship between UA level and mortality remains unclear among patients receiving peritoneal dialysis (PD). Methods: We collected baseline data for 4742 prevalent PD patients (age, 63 ± 14 years; male, 61.5%; diabetes, 29.1%; median dialysis duration, 28 months) from a nationwide dialysis registry in Japan at the end of 2012. One-year all-cause and cardiovascular (CV) mortality and mortality caused by infectious disease were assessed using Cox regression analysis and competing-risks regression analysis, respectively. We used multiple imputation to deal with missing covariate data. Results: Within 1 year, 379 patients (8.0%) died, including 129 patients (2.7%) from CV causes and 95 patients (2.0%) from infectious disease. In multivariate analysis, serum UA, treated as a continuous variable, was not associated with any outcome. Conversely, both lower (<297 µmol/L) and higher (≥476 µmol/L) UA levels were independently associated with higher all-cause mortality compared to the reference group (416 to <446 µmol/L) in analyses where serum UA was treated as a categorical variable. Body mass index (BMI) affected the association between serum UA and all-cause mortality (interaction p = 0.049). Conclusions: A U-shaped relationship appears to exist between UA levels and all-cause mortality among Japanese PD patients. Additionally, lower BMI significantly enhanced the effect of UA levels on mortality.

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“…In the general population, some studies [7-9], but not all [10-12], have indicated that an elevated SUA level is a risk factor for the CVD and all-cause mortality. In the peritoneal dialysis (PD) patients, studies have shown positive [13-15], negative [16] or U-shaped [17] associations between SUA and mortality. To date, only a handful of studies have detected the association between SUA levels and the risk of mortality in maintenance hemodialysis (MHD) patients and reached inconsistent conclusions.…”

Section: Introductionmentioning

confidence: 99%

Relationship between Serum Uric Acid and Mortality Risk in Hemodialysis Patients: A Multicenter Prospective Cohort Study

Yang¹,

Li²,

Yang³

et al. 2020

Am J Nephrol

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Background: Several studies have reported that low serum uric acid (SUA) levels are related to increased risk of mortality in maintenance hemodialysis (MHD) patients. However, the possible detrimental effects of high SUA on the mortality risk have not been well examined. Moreover, the possible effect modifiers for the SUA-mortality association have not been fully investigated. To address the aforementioned gap, we aimed to explore the nonlinear relationship between SUA levels and all-cause and cardiovascular disease (CVD) mortality risk, and to examine any possible effect modifiers in MHD patients. Methods: We conducted a multicenter, prospective cohort study among 1,018 MHD patients from 8 hemodialysis centers. The primary outcome was all-cause mortality, and the secondary outcomes were CVD mortality and non-CVD mortality. Results: The mean value for SUA in the total population was 8.5 ± 1.9 mg/dL. The lowest and highest quintiles of SUA were <7.0 and >10.1 mg/dL, respectively. Over a median follow-up of 45.6 months, 343 deaths were recorded, of which 202 (58.9%) were due to CVD. When SUA was assessed as quintiles, a significantly higher risk of all-cause mortality was found in patients in quintile 1 (<7.0 mg/dL; hazard ratio [HR], 1.33; 95% confidence interval [CI]: 1.02–1.73) or quintile 5 (≥10.1 mg/dL; HR, 1.47; 95% CI: 1.09–2.00), compared to those in quintiles 2–4 (7–10.1 mg/dL). Moreover, the U-shaped SUA-mortality association was mainly found in those with lower C-reactive protein levels (<3 compared with ≥3 mg/L; p for interaction = 0.018). Similar trends were found for CVD mortality and non-CVD mortality. Conclusion: There was a U-shaped relationship between SUA levels and the risk of all-cause mortality, CVD mortality, and non-CVD mortality in MHD patients.

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High serum uric acid level is a mortality risk factor in peritoneal dialysis patients: a retrospective cohort study

Cited by 25 publications

References 46 publications

The Association between Serum Uric Acid and Appendicular Skeletal Muscle Mass and the Effect of Their Interaction on Mortality in Patients on Peritoneal Dialysis

The Association between Serum Uric Acid and Appendicular Skeletal Muscle Mass and the Effect of Their Interaction on Mortality in Patients on Peritoneal Dialysis

Effect of uric acid levels on mortality in Japanese peritoneal dialysis patients

Relationship between Serum Uric Acid and Mortality Risk in Hemodialysis Patients: A Multicenter Prospective Cohort Study

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