Serum Uric Acid Level and Cardiovascular Risks in Hemodialysis Patients: An Algerian Cohort Study

Gouri, Adel; Dekaken, Aoulia; Bentorki, Ahmed Aimen; Touaref, Amel; Yakhlef, Amina; Kouicem, Nabila

doi:10.7754/clin.lab.2013.130310

Cited by 12 publications

(12 citation statements)

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“…In fact, serum uric acid level is significantly associated with handgrip strength, geriatric nutritional risk index, and malnutrition-inflammatory score, which are useful tools for monitoring nutritional status in hemodialysis patients [ 19 ]. In line with previous studies [ 18 , 19 , 21 – 23 ], we also found that high uric acid level was positively correlated with nutritional status indicators of body mass index, nPCR, and serum level of albumin, phosphorus, and creatinine. Level of nPCR is often used as a measure of daily protein intake among dialysis patients.…”

Section: Discussionsupporting

confidence: 92%

“…Several studies have shown that elevated serum uric acid level increases the mortality risk among diabetic patients undergoing hemodialysis or peritoneal dialysis [ 14 – 17 ]. On the other hand, lower uric acid level has been associated with a higher risk of all-cause or cardiovascular mortality among hemodialysis patients [ 18 – 23 ]. Moreover, a recent study showed that a longitudinal increase in serum uric acid level over time is associated with lower all-cause or cardiovascular mortality in this clinical population [ 24 ].…”

Section: Introductionmentioning

confidence: 99%

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Relationship between serum uric acid and mortality among hemodialysis patients: Retrospective analysis of Korean end-stage renal disease registry data

Kim

Jin

Yun

et al. 2017

Kidney Res Clin Pract.

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BackgroundIt is thought that hyperuricemia might lower the risk of mortality among hemodialysis patients, unlike in the general population, but the evidence is controversial. The aim of the current study was to evaluate the impact of serum uric acid level on the long-term clinical outcomes of hemodialysis patients in Korea.MethodsRetrospective analysis was performed on data from the End-Stage Renal Disease Registry of the Korean Society of Nephrology. This included data for 7,333 patients (mean age, 61 ± 14 years; 61% male) who received hemodialysis from January 2001 through April 2015. Initial laboratory data were used in the analysis.ResultsThe mean serum uric acid level in this study was 7.1 ± 1.7 mg/dL. Body mass index, normalized protein catabolic rate, albumin, and cholesterol were positively correlated with serum uric acid level after controlling for age and sex. After controlling for demographic data, comorbidities, and residual renal function, a higher uric acid level was independently associated with a significantly lower all-cause mortality (hazard ratio [HR], 0.90 per 1 mg/dL increase in uric acid level; 95% confidence interval [CI], 0.83–0.97; P = 0.008), but not cardiovascular mortality (HR, 0.90; 95% CI, 0.80–1.01; P = 0.078). Comparing uric acid levels in the highest and lowest quintiles, the HR for all-cause mortality was 0.65 (95% CI, 0.42–0.99; P = 0.046).ConclusionHyperuricemia was strongly associated with a lower risk of all-cause mortality, but there seems to be no significant association between serum uric acid level and cardiovascular mortality among Korean hemodialysis patients with end-stage renal disease.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Relationship between serum uric acid and mortality among hemodialysis patients: Retrospective analysis of Korean end-stage renal disease registry data

Kim

Jin

Yun

et al. 2017

Kidney Res Clin Pract.

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“…In fact, a recent double-blind, multicenter, randomized controlled trial of patients with heart failure and moderate CKD found that xanthine oxidase inhibitor did not improve clinical status, quality of life, or left ventricular ejection fraction [ 24 ]. Serum UA in the HD population has different prognostic impact from that in general population [ 10 , 25 ]. In HD-dependent patients, some investigators found a J-curve relationship between UA and mortality, while others disclosed an association between high serum UA and lower mortality.…”

Section: Discussionmentioning

confidence: 99%

High Uric Acid Ameliorates Indoxyl Sulfate-Induced Endothelial Dysfunction and Is Associated with Lower Mortality among Hemodialysis Patients

Hsu

Liu

et al. 2017

Toxins

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High uric acid (UA) can act as a pro-oxidant in normal physiological conditions; however, emerging evidence is still debatable with regard to the association between high UA and poor outcomes among chronic hemodialysis (HD) patients. In the present study, 27,229 stable prevalent HD patients were enrolled and divided into four groups according to the quartiles of baseline UA concentration, and 5737 died during a median follow-up of 38 months. Multivariate Cox regression analysis showed that a UA level of <6.1 mg/dL was associated with a higher risk of all-cause mortality compared with a UA level of >8.1 mg/dL [HR, 1.20, 95% CI (1.10–1.31)] adjusting for baseline demographic and biochemical parameters. Moreover, a UA level of <6.1 mg/dL was associated with greater risks of cardiovascular mortality [HR, 1.26, 95% CI (1.13–1.41)] and stroke-related mortality [HR, 1.59, 95% CI (1.12–2.25)], respectively. In vitro experiments further showed an increase in oxidative stress and an inhibition nitric oxide synthesis by indoxyl sulfate (IS) in human aortic endothelial cells, which were significantly attenuated by UA in a dose-dependent manner. We concluded that higher UA in serum was associated with lower risk of all-cause and cardiovascular mortality among HD patients probably through its antioxidant property in ameliorating the IS-related vascular toxicity.

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“…There have been several reports on the influence of hyperuricemia on cardiovascular events or all‐cause mortality in HD patients. Many of them have demonstrated so‐called J‐curve phenomena where hypouricemia as well as hyperuricemia is the risk for cardiovascular events . The following mechanisms have been proposed for the increase in the risk by hypouricemia: 1)Hypouricemic patients are in poor nutritional condition because uric acid is an indicator of nutritional status; and 2)Hypouricemic patients do not have the benefit of vascular protection mediated by antioxidant action of uric acid …”

Section: Discussionmentioning

confidence: 99%

The effect of small dose of topiroxostat on serum uric acid in patients receiving hemodialysis

Nagaoka

Tanaka

Yoshimoto

et al. 2017

Hemodialysis International

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Serum Uric Acid Level and Cardiovascular Risks in Hemodialysis Patients: An Algerian Cohort Study

Cited by 12 publications

References 0 publications

Relationship between serum uric acid and mortality among hemodialysis patients: Retrospective analysis of Korean end-stage renal disease registry data

Relationship between serum uric acid and mortality among hemodialysis patients: Retrospective analysis of Korean end-stage renal disease registry data

High Uric Acid Ameliorates Indoxyl Sulfate-Induced Endothelial Dysfunction and Is Associated with Lower Mortality among Hemodialysis Patients

The effect of small dose of topiroxostat on serum uric acid in patients receiving hemodialysis

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