Pre- and Postdialysis Uric Acid Difference and Risk of Long-Term All-Cause and Cardiovascular Mortalities in Japanese Hemodialysis Patients; Miyazaki Dialysis Cohort Study

Abstract

Background/Aims: Uric acid (UA) levels are affected by changes in dialysis; however, the relationship between the pre- and postdialysis UA difference (UAD) and mortality remains unclear. Methods: A total of 1,073 patients receiving maintenance hemodialysis (HD) were enrolled in this cohort study and followed up for 5 years. Patients were divided into quartile categories according to baseline UAD. Cox’s regression analyses were used to investigate the relationship between UAD categories and all-cause and cardiovascular (CV) mortalities while adjusting for potential confounders. Results: A total of 280 patients died of all causes, including 121 CV deaths, during the follow-up. In the analysis for all-cause mortality, hazard ratios were significantly higher in the lowest UAD group (< 4.7 mg/dL) than in the highest UAD group (> 6.2 mg/dL). A correlation was not observed with CV mortality. Conclusion: UAD correlated with all-cause mortality. UAD may be the most appropriate reference for controlling UA in HD patients.

Literature Review: Hubungan Kadar Asam Urat terhadap Risiko Kematian Pasien Gagal Ginjal Kronik (GGK) yang Menjalani Hemodialisa

“…16 Kadar asam urat yang lebih rendah dapat meningkatkan risiko kematian non-kardiovaskular yang lebih tinggi pada pasien hemodialisa, sedangkan asam urat yang tinggi dapat menurunkan risiko kematian non-kardiovaskular pada pasien penyakit ginjal stadium akhir yang menjalani hemodialisa di Korea. 18,19 Kadar asam urat mungkin menjadi referensi yang paling tepat untuk mengendalikan pasien yang menjalani hemodialisa. 19 Peningkatan kadar asam urat juga meningkatkan produksi sitokin sistemik, yaitu tumor necrosis factor-α (TNF-α), dan ekspresi lokal kemokin, monocyte chemotactic protein 1 (MCP-1) di ginjal dan cyclooxygenase 2 (COX-2) di pembuluh darah sehingga mempunyai peran penting dalam sistem imun tubuh.…”

“…Meskipun asam urat dianggap sebagai antioksidan, asam urat juga pro-oksidatif dalam kondisi tertentu, terutama ketika SOD rendah. 18 Studi literatur yang telah dilakukan, semua literatur menunjukkan hubungan antara kadar asam urat terhadap risiko kematian pasien gagal ginjal kronik yang menjalani hemodialisa. Empat dari tujuh literatur jurnal mengatakan bahwa rendahnya kadar asam urat dapat meningkatkan risiko kematian akibat kardiovaskular maupun non-kardiovaskular.…”

High uric acid or low uric acid which is better for hemodialysis patients?

“…Finally, Tatsunori et al [5]. conducted a prospective observational study with 1073 HD patients from 27dialysis centers and followed up for 5 years to reveal UA difference (UAD), which may be the most appropriate reference for controlling UA levels, correlated with all-cause mortality in HD patients.…”

The relationship between uric acid concentration and cardiovascular risk: Retrospective analysis of patients on hemodialysis

“…U fiziološkim koncentracijama MK je prisutna u osnovnom molekulskom obliku, a kada je njena koncentracija u krvi povećana, spontano formira kristale mononatrijumurata. Uzimajuću u obzir da se oko 70% ukupne količine MK izlučuje bubregom, kod 50% bolesnika sa smanjenom funkcijom bubrega, zbog smanjenog klirensa, nagomilavaju se značajne količine MK (2). Dosadašnji literaturni podaci ukazuju na kontroverznu ulogu MK (3)(4)(5).…”