Abstract
Purpose: To determine the relationship between uric acid (UA) and nutritional and antioxidant status in hemodialysis (HD) patients, given that hyperuricemia could be an indicator of good nutritional status possibly because of the antioxidant properties of UA. Methods: Cross-sectional study with 93 patients on HD. Hyperuricemia was considered as UA ≥6.0 mg/dL in females and ≥7.0 mg/dL in males. Nutritional variables were registered. Blood samples were taken before the dialysis session to determine oxidative damage as plasma malondialdehyde (MDA) content, and antioxidant capacity measuring 2,2-diphenyl-piclrylhidrazil radical (DPPH●) scavenging activity and oxygen radical absorbance capacity (ORAC) value. Results: Patients with hyperuricemia had higher creatinine (11.9 vs. 10.5 mg/dL; p = 0.004), potassium (5.5 vs. 5.0 mg/dL; p = 0.014) levels; phase angle (5.8 vs. 4.9; p = 0.005), protein consumption (normalized protein nitrogen appearance, nPNA, 1.03 vs. 0.83; p = 0.013) than normouricemic patients. DPPH● scavenging activity was higher in hyperuricemic subjects (1.139 vs. 1.049 mM Trolox equivalents; p = 0.007); likewise, hyperuricemic subjects had less oxidant damage measured by MDA (10.6 vs. 12.7 nmol/mL; p = 0.020). Subjects with normouricemia were at higher risk of having a reactance to height (Xc/H) ratio less than 35 (OR 2.79; 95% CI, 1.1–7.017, p = 0.028); nPNA < 1.0 (OR 3.78; 95% CI, 1.4–10.2, p = 0.007), diagnosis of cachexia (OR 2.95; 95% CI, 1156–7.518, p = 0.021), potassium levels <5 (OR 2.97; 95% CI, 1.136–7.772, p = 0.023) and PA < 5.5° (OR 3.38; 95% CI, 1.309–8.749, p = 0.012.) Conclusions: Patients with hyperuricemia had higher antioxidant capacity and better nutritional status. Purines and protein restrictions in HD patients with hyperuricemia need to be reviewed individually for each patient. More studies are needed to stablish a cut point of UA levels in renal population.
Highlights
The prevalence of hyperuricemia was 72% and that of protein energy wasting (PEW), according to MIS, was 35%
215.3 ± 17.3 min, and the dialysis vintage was 39 (21–79) months; the medium-flux filter (F80) was the most common filter used for the HD session (69%) and dialysis efficacy measured by Kt/V was 1.46 (1.25–1.77) and urea reduction rate (URR) was 71% (65–79)
We found a prevalence of PEW of 35%, a low prevalence compared to those usually found in HD patients worldwide, which ranges from 50% [49] according to MIS, to 52.5% [50] and
Summary
Chronic kidney disease (CKD) is a public health problem given its epidemic nature, the complications it causes and the lack of human and material resources available for its treatment [1,2,3].End stage renal disease (ESRD) patients are at high risk of protein energy wasting (PEW) syndromeNutrients 2020, 12, 2600; doi:10.3390/nu12092600 www.mdpi.com/journal/nutrients (a pathological entity characterized by low protein and energetic deposits and systemic inflammation), and their nutritional status should be thoroughly assessed to diagnose and treat PEW in time [4,5].The diet of renal patients on hemodialysis (HD) is restricted in different nutrients, such as potassium (K), phosphorus (P) and sodium (Na) [6,7], in addition to purines when hyperuricemia is detected [8,9].These dietary restrictions, together with other dietary factors and HD, may increase the risk and/or aggravate PEW [10]. End stage renal disease (ESRD) patients are at high risk of protein energy wasting (PEW) syndrome. The diet of renal patients on hemodialysis (HD) is restricted in different nutrients, such as potassium (K), phosphorus (P) and sodium (Na) [6,7], in addition to purines when hyperuricemia is detected [8,9]. These dietary restrictions, together with other dietary factors and HD, may increase the risk and/or aggravate PEW [10]. Hyperuricemia has been associated with the incidence of CKD in healthy subjects [14]; one of the reasons has been UA role as an oxidizing molecule [15]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
