Serum uric acid level and all-cause and cardiovascular mortality in peritoneal dialysis patients: A systematic review and dose-response meta-analysis of cohort studies

Abstract

Background The association between serum uric acid (SUA) and all-cause and cardiovascular disease (CVD) mortality in peritoneal dialysis (PD) patients is controversial. Therefore, we aimed to determine the relationship between SUA and all-cause and CVD mortality in PD patients. Method Web of Science, EMBASE, PubMed and the Cochrane Library databases were searched from their inception to 7 April 2021. Effect estimates were presented as hazard ratios (HRs) with 95% confidence intervals (95% CIs) and pooled using random effects model. Result Thirteen cohort studies with 22418 patients were included in this systematic review, of which 9 were included in the meta-analysis. Before switching the reference group, pooled result for the highest SUA category was significantly greater than the median for all-cause mortality (HR = 2.41, 95% CI: 1.37–4.26). After switching the reference group, the highest SUA category did not demonstrate an increased all-cause (HR = 1.40, 95% CI: 0.95–2.05) or CVD (HR = 1.30, 95% CI: 0.72–2.34) mortality compared with the lowest SUA category. Dose-response analysis suggested a nonlinear association between SUA and all-cause mortality risk (Pnonlinearity = 0.002). Conclusion This meta-analysis didn’t find the relationship between SUA levels and all-cause and CVD mortality risk in PD patients. More rigorously designed studies are warranted in the future.

Elevated Uric Acid Mediates the Effect of Obesity on Hypertension Development: A Causal Mediation Analysis in a Prospective Longitudinal Study

“…[3][4][5] As the final enzyme product of purine metabolism, uric acid (UA) levels in serum have been associated with many diseases, 6 including metabolic syndrome, 7 diabetes mellitus, 8 dyslipidemia, 9 chronic kidney disease, 10 and liver dysfunctions. 11 Recent studies have demonstrated that serum UA levels are also associated with obesity 6,12 and are considered a predictor of cardiovascular disorders 13 including hypertension. 14,15 However, the causal linkages between the three metabolic conditions are not very clear.…”

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“… 13 For example, although febuxostat and allopurinol drugs can reduce uric acid levels, they increase the risk of cardiovascular disease. 14 In order to provide more diversified treatment options for patients, we have studied the role of Chinese medicine in the treatment of gout. Tongbixiao pills were developed by the Gout TCM Research Cooperation Group of Jingzhou Hospital of Traditional Chinese Medicine.…”

Association between systemic immune inflammation Index and all-cause mortality in incident peritoneal dialysis-treated CKD patients: a multi-center retrospective cohort study

“…Some traditional CVD risk factors [ 3 ] including smoking, physical activity, hypertension, diabetes, and hyperlipidemia, may contribute to poor survival outcomes among PD patients [ 4 ]. Other studies have shown that inflammatory status [ 5 , 6 ], malnutrition [ 6 – 9 ], electrolyte disturbance [ 10 – 12 ], metabolic disorder [ 13 – 15 ], lower plant-based protein intake [ 16 ], alkaline phosphatases [ 17 ], and older age [ 18 ] were risk factors for all-cause mortality in patients undergoing PD. These factors above, particularly inflammation, are well-known nontraditional CVD risk factors [ 3 ] and may further increase the risk of death in such populations [ 19 ].…”