The Associations of Uric Acid, Cardiovascular and All-Cause Mortality in Peritoneal Dialysis Patients

Abstract

AimsTo investigate whether uric acid (UA) is an independent predictor of cardiovascular (CV) and all-cause mortality in peritoneal dialysis (PD) patients after controlling for recognized CV risk factors.MethodsA total of 2264 patients on chronic PD were collected from seven centers affiliated with the Socioeconomic Status on the Outcome of Peritoneal Dialysis (SSOP) Study. All demographic and laboratory data were recorded at baseline. Multivariate Cox regression was used to calculate the hazard ratio (HR) of CV and all-cause mortality with adjustments for recognized traditional and uremia-related CV factors.ResultsThere were no significant differences in baseline characteristics between patients with (n = 2193) and without (n = 71) UA measured. Each 1 mg/dL of increase in UA was associated with higher all-cause mortality with 1.05(1.00∼1.10) of HR and higher CV mortality with 1.12 (1.05∼1.20) of HR after adjusting for age, gender and center size. The highest gender-specific tertile of UA predicted higher all-cause mortality with 1.23(1.00∼1.52) of HR and higher CV mortality with 1.69 (1.21∼2.38) of HR after adjusting for age, gender and center size. The predictive value of UA was stronger in patients younger than 65 years without CV disease or diabetes at baseline. The prognostic value of UA as both continuous and categorical variable weakened or disappeared after further adjusted for uremia-related and traditional CV risk factors.ConclusionsThe prognostic value of UA in CV and all-cause mortality was weak in PD patients generally, which was confounded by uremia-related and traditional CV risk factors.

Lower serum uric acid level predicts mortality in dialysis patients

“…An advanced age and menopausal status, [35,36] impaired renal uric acid excretion state, and sex hormonal dysfunction in the uremic status [37] may affect the SUA metabolism, although further studies are warranted to clarify this smaller sex difference of the SUA level and its mechanism. The relationship between the SUA level and mortality in those with ESRD has been explored in 5 HD cohorts [16,[19][20][21]38] and 3 PD cohorts, [25,26,39] and the results were diverse. Several studies showed that a low SUA level may be harmful against mortality, [16,[19][20][21]26] whereas others insisted that hyperuricemia increased mortality.…”

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

“…130,131 However, in a recent observational study including 2264 PD patients, only a weak correlation of HUA with all-cause mortality could be detected. 132 The lack of large prospective studies in this field does not lead to reliable conclusions.…”

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

“…And this kind of relationship only exists in male patients with diabetes [15][16][17]. Another study showed a weak prognostic value of UA in cardiovascular and all-cause mortality in PD patients generally [18]. The studies on the associations between UA and residual renal function (RRF) decline in PD patients showed a positive or "U-shaped" relationship [19,20].…”