Low Serum Uric Acid Level Is a Risk Factor for Death in Incident Hemodialysis Patients

Lee, S.M. Kurt; Lee, Andrew L.; Winters, Thomas; Tam, Emily K.; Jaleel, M. A.; Stenvinkel, Peter; Johnson, Richard J.

doi:10.1159/000151292

Cited by 81 publications

(77 citation statements)

References 24 publications

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“…We did not find use of a longitudinal design in the few studies that we did find providing data about the association of SUA and clinical outcome in patients on MHD (3,4,(15)(16)(17)(18). Instead, a relatively large number of studies has used longitudinal data to analyze the association of changes in albumin (38), BMI (39), and TSF (28) over time with prognosis.…”

Section: Discussionmentioning

confidence: 98%

“…Conversely, in the HD population, hyperuricemia has been shown as a good nutritional marker (15) that can also predict lower rates of upcoming hospitalizations (15) as well as lower all-cause and cardiovascular death risks (15,16). Although the data about the mortality predictive role of higher SUA levels in the HD population are somewhat controversial (3,4,(15)(16)(17)(18), most of the studies conducted on this topic presented low SUA as a mortality risk factor in patients on MHD (3,4,15,16,18).…”

Section: Introductionmentioning

confidence: 99%

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Longitudinal Study of Serum Uric Acid, Nutritional Status, and Mortality in Maintenance Hemodialysis Patients

Beberashvili

Erlich²,

Azar

et al. 2016

CJASN

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Background and objectives We hypothesized that longitudinal changes in uric acid (UA) may have independent associations with changes in nutritional parameters over time and consequently, long-term survival of patients on maintenance hemodialysis.Design, setting, participants, & measurements We conducted a retrospective, longitudinal cohort study of a clinical database containing the medical records of patients on maintenance hemodialysis receiving dialysis between June of 1999 and December of 2012 in a single center; 200 patients (130 men and 70 women) with a median age of 69.0 (interquartile range, 59.3-77.0) years old were included in the study. Dietary intake, biochemical markers of nutrition, anthropometric measurements, and UA levels were recorded at 0, 6, 12, 18, 24, 30, and 36 months followed by 15 additional months of clinical observations. The patients were followed until January 31, 2015 (median follow-up was 38.0 [interquartile range, 30.0-46.8] months).Results In a linear mixed effects model adjusted for baseline demographics and clinical parameters, each 1.0-mg/dl longitudinal increase in UA was associated with a 13.4% slower rate of decline in geriatric nutritional risk index (GNRI) levels over 3 years of observation (95% confidence interval [95% CI], 0.11 to 0.39; P,0.001 for UA 3 time interaction). UA remained associated with the rate of change in GNRI, even after controlling for C-reactive protein. During the follow-up, 87 (43.5%) all-cause and 38 (19.0%) cardiovascular deaths were reported. For each 1.0-mg/dl increase in serum UA over time, the multivariate adjusted all-cause mortality hazard ratio using Cox models with the effect of time-varying risk was 0.83 (95% CI, 0.74 to 0.95; P,0.01), which continued to be significant, even after including the baseline GNRI levels in this model: 0.89 (95% CI, 0.79 to 0.98; P=0.02).Conclusions Longitudinal changes in serum UA seem to track with changes in nutritional status over time, and these changes are associated with survival of patients on maintenance hemodialysis. An increase in serum UA levels over time is accompanied by improvement of nutritional status and lower mortality rate.

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Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Longitudinal Study of Serum Uric Acid, Nutritional Status, and Mortality in Maintenance Hemodialysis Patients

Beberashvili

Erlich²,

Azar

et al. 2016

CJASN

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“…In Group I, there was a significant decrease in uric acid levels in comparison to Groups II and III; however, the levels were within the normal range. In iron deficiency anemia there is increased DNA damage (19) and, therefore, a con comitant increase in uric acid levels may be expected together with co-morbid conditions like diabetes (20). However, since xanthine oxidase is a non-heme iron protein, iron deficiency will lower the uric acid levels.…”

Section: Discussionmentioning

confidence: 99%

Oxidative Stress in Type 2 Diabetes with Iron Deficiency in Asian Indians

Ganesh¹,

Dharmalingam²,

Marcus³

2012

Journal of Medical Biochemistry

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Kratak sadr`aj: Metabolizam gvo`|a, dijabetes i oksidativni stres blisko su povezani. Dijabetes i redoks-aktivno gvo`|e zasebno poja~avaju oksidativni stres. Me|utim, jo{ nije ustanovljena uloga nedostatka gvo`|a i oksidativnog stresa u dijabetesu; stoga su upore|eni nivoi oksidativnog stresa u dijabetesu tipa 2 sa i bez nedostatka gvo`|a. Izabrane su dve grupe od po 30 pacijenata sa dijabetesom (jedna grupa sa nedostatkom gvo`|a a druga sa nor malnim nivoima gvo`|a) i upore|ene sa 30 zdravih kontrolnih subjekata. Izmereni su antropometrijski parametri, {e}er u krvi na prazan stomak, profil gvo`|a i parametri oksi dativnog stresa (nivoi malondialdehida (indeks lipidne per oksidacije) i nivoi mokra}ne kiseline u serumu (antioksidant)). Dok su u grupi dijabeti~ara nivoi feritina (reaktant akutne faze i antioksidant) u serumu bili zna~ajno povi{eni u pore|enju sa zdravim kontrolnim subjektima (P = 0,040), u grupi dijabeti~ara s nedostatkom gvo`|a bili su sni`eni nivoi gvo`|a (P = 0,000), feritina (P = 0,000) i mokra}ne kiseline (P = 0,000) u serumu u pore|enju s dijabe ti~arima bez nedostatka gvo`|a. Ova studija pokazuje da bi porast oksidativnog stresa u grupi dijabeti~ara s nedostatkom gvo`|a uz redukciju nivoa antioksidanata mogao dodatno pove}ati nivoe prooksidanata i poja~ati inflamaciju, {to bi za po sledicu imalo razvoj komplikacija u ovoj visokorizi~noj indijskoj po pu laciji.

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“…127 On the contrary, data from a retrospective study reported that low serum UA concentration in HD patients with hypoalbuminemia is a mortality risk factor. 128 Another large retrospective study involving 5827 HD patients reported that higher serum UA levels were correlated with lower risk of allcause and CVD mortality. 13 These results might be explained by the reverse epidemiology.…”

Section: Hua and CV Mortalitymentioning

confidence: 99%

Hyperuricemia and chronic kidney disease: an enigma yet to be solved

et al. 2014

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The role of uric acid (UA) on the pathogenesis and progression of chronic kidney disease (CKD) remains controversial. Experimental and clinical studies indicate that UA is associated with several risk factors of CKD including diabetes, hypertension, oxidative stress, and inflammation and hyperuricemia could be considered as a common dominator linking CKD and cardiovascular disease. Notably, the impact of serum UA levels on the survival of CKD, dialysis patients, and renal transplant recipients is also a matter of debate, as there are conflicting results from clinical studies. At present, there is no definite data whether UA is causal, compensatory, coincidental or it is only an epiphenomenon in these patients. In this article, we attempt to review and elucidate the dark side of this old molecule in CKD and renal transplantation.

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Low Serum Uric Acid Level Is a Risk Factor for Death in Incident Hemodialysis Patients

Cited by 81 publications

References 24 publications

Longitudinal Study of Serum Uric Acid, Nutritional Status, and Mortality in Maintenance Hemodialysis Patients

Longitudinal Study of Serum Uric Acid, Nutritional Status, and Mortality in Maintenance Hemodialysis Patients

Oxidative Stress in Type 2 Diabetes with Iron Deficiency in Asian Indians

Hyperuricemia and chronic kidney disease: an enigma yet to be solved

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