Effect of hyperuricemia and treatment for hyperuricemia in Japanese hemodialysis patients: A cohort study.

Naoki Sugano,Iwao Ohno,Ikuto Masakane,Satoshi Kidoguchi,Atsushi Wada,Takashi Shigematsu,Yukio Maruyama,Takashi Yokoo,Tatsuo Shimosawa

doi:10.1371/journal.pone.0217859

Naoki Sugano, Iwao Ohno + Show 7 more

Open Access

https://doi.org/10.1371/journal.pone.0217859

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Abstract

Whether higher serum uric acid (UA) values comprise a risk factor for death and whether treatment for high UA is effective in patients undergoing hemodialysis (HD) are essentially unknown. To determine associations between UA and all-cause or cardiovascular (CV) mortality, interactions between UA or medication and effects on mortality, and significance of treatment for hyperuricemia in patients undergoing hemodialysis (HD). We collected the baseline data of 222,434 patients undergoing three HD sessions per week, extracted from a nationwide dialysis registry at the end of 2011 in Japan. Then we evaluated the interaction between serum uric acid level and all-cause and cardiovascular (CV) mortality by the end of 2012. Univariate and multivariate logistic regression and Cox regression analyses found higher all-cause and CV mortality rates among patients with lower, than higher UA values. Hazard ratios (HR) for all-cause and CV mortality were significantly lower in a group with, than without medication for hyperuricemia (HR, 0.837; 95% confidence interval (CI), 0.789–0.889 and HR, 0.830; 95%CI 0.758–0.909, respectively). Lower UA values remained associated with all-cause and CV mortality rates even when in patients taking medication for hyperuricemia. The chief interacting factors for higher mortality rates due to lower UA were higher BMI and diabetes mellitus. In conclusion, lower UA levels were independently associated with higher all-cause and CV mortality among Japanese patients undergoing HD. Intervention for hyperuricemia is considered to improve patient outcomes.

Highlights

High serum uric acid (UA) values confer risk for gout and kidney damage and comprise a risk factor for cardiovascular (CV) events [1,2,3,4,5,6] among patients with normal renal function
We considered interactions between clinical parameters and all-cause or CV mortality associated with UA or medication for high UA
We found that lower UA values conferred higher risk for all-cause and CV mortality among patients on HD

Summary

Introduction

High serum uric acid (UA) values confer risk for gout and kidney damage and comprise a risk factor for cardiovascular (CV) events [1,2,3,4,5,6] among patients with normal renal function. Uric acid in hemodialysis patients kidney disease (CKD) who do not undergo dialysis. Recent studies have associated lower UA values with higher all-cause and CV mortality among patients on hemodialysis (HD) [11,12,13]. Relationships between UA values and all-cause and CV mortality seem quite different depending on whether or not patients undergo dialysis. These investigations included relatively small numbers of patients. The relationship between UA values and all-cause or CV mortality remains uncertain for patients with CKD, especially those undergoing dialysis. The Dialysis Outcomes and Practice Patterns Study (DOPPS) associated higher all-cause or CV mortality with lower UA values, but these findings did not change in a model that included medication with allopurinol [13]

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