The Association of Longitudinal Serum Uric Acid and All-Cause Mortality in Incident Peritoneal Dialysis Patients

Chang, Wenxiu; Zhang, Wenyu; Wang, Xichao; Liu, Ying; Han, Yingying; Tu, Yangke; Uchida, Shunya

doi:10.1159/000494987

Cited by 12 publications

(22 citation statements)

References 28 publications

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“…Similar findings were reported by Chang et al. [ 5 ]. Time-averaged (TA) UA value was used for the first time to investigate the longitudinal association with all-cause mortality.…”

supporting

confidence: 92%

“…In the adjusted model, both lower(<5mg/ dL) and higher (8 mg/dL)) UA levels were independently associated with higher adjusted HR (1.8, 95% CI 1.13-2.86;1.88, 95%CI 1.06-3.35, all p < .05) of all-cause mortality compared to the reference group (7.0-7.5 mg/ dL). Similar findings were reported by Chang et al [5]. Time-averaged (TA) UA value was used for the first time to investigate the longitudinal association with all-cause mortality.…”

Section: Letter To the Editorsupporting

confidence: 68%

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Relationship between serum uric acid and all-cause mortality in dialysis patients: like being in wonderland, disoriented

et al. 2020

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“…Similar findings were reported by Chang et al. [ 5 ]. Time-averaged (TA) UA value was used for the first time to investigate the longitudinal association with all-cause mortality.…”

supporting

confidence: 92%

Section: Letter To the Editorsupporting

confidence: 68%

Relationship between serum uric acid and all-cause mortality in dialysis patients: like being in wonderland, disoriented

et al. 2020

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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: 98%

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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The Association of Longitudinal Serum Uric Acid and All-Cause Mortality in Incident Peritoneal Dialysis Patients

Cited by 12 publications

References 28 publications

Relationship between serum uric acid and all-cause mortality in dialysis patients: like being in wonderland, disoriented

Relationship between serum uric acid and all-cause mortality in dialysis patients: like being in wonderland, disoriented

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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