Abstract
BackgroundThe results remain controversial with regards to the impact of serum uric acid on clinical outcomes from peritoneal dialysis population. The aim of our study was to investigate the influence of serum uric acid levels on mortality in peritoneal dialysis patients.MethodsData on 9405 peritoneal dialysis patients from the Zhejiang Renal Data system were retrospectively analyzed. All demographic and laboratory data were recorded at baseline. The study cohort was divided into quintiles according to baseline uric acid level (mg/dL): Q1 (< 6.06), Q2 (6.06–6.67), Q3 (6.68–7.27) (reference), Q4 (7.28–8.03), and Q5 (≥8.04). Hazards ratio (HR) of all-cause and cardiovascular mortality was calculated.ResultsMean serum uric acid was 7.07 ± 1.25 mg/dL. During a median follow-up of 29.4 (range, 3.0 to 115.4) months, 1226 (13.0%) patients died, of which 515 (5.5%) died of cardiovascular events. The Kaplan-Meier survival curves showed that patients in the middle uric acid quintile (Q3: 6.68–7.27) exhibited the highest patient and cardiovascular survival rates (log-rank test P < 0.05). Multivariate Cox regression analysis showed that, using Q3 as the reference, in the fully adjusted model, a higher uric acid level (Q4: 7.28–8.03, and Q5: ≥8.04) was significantly associated with higher all-cause mortality (Model 3; Q4: HR, 1.335, 95% CI, 1.073 to 1.662, P = 0.009; Q5: HR, 1.482, 95% CI, 1.187 to 1.849, P = 0.001), but not with cardiovascular mortality. The adverse effect of higher uric acid level (≥7.28 mg/dL) on all-cause mortality was more prominent in groups such as male, hypoalbuminemia, normal weight, non-diabetes mellitus at baseline rather than in their counterparts respectively.ConclusionsA higher uric acid level was an independent risk factor for all-cause mortality in peritoneal dialysis patients.
Highlights
The results remain controversial with regards to the impact of serum uric acid on clinical outcomes from peritoneal dialysis population
We found that men, a higher Body mass index (BMI), higher albumin levels, higher serum phosphorus and potassium levels, lower calcium and fasting plasma glucose levels were significantly associated with higher serum Uric acid (UA) levels
Note: Values are presented as mean ± standard deviation or number (%) Abbreviations: BMI body mass index, parathyroid hormone (PTH) Parathyroid hormone, RRF Residual renal function, AKP alkaline phosphatase, FPG fasting plasma glucose, DM diabetes mellitus, CVD cardiovascular disease adjusting for various covariates, a higher UA level (Q4: 7.28–8.03, and Q5: ≥8.04) was significantly associated with higher all-cause mortality (Model 3; Q4: Hazards ratio (HR), 1.335, 95% CI, 1.073 to 1.662, P = 0.009; Q5: HR, 1.482, 95% CI, 1.187 to 1.849, P = 0.001), but not the lower UA level groups (Model 3; Q1: HR, 1.162, 95% CI, 0.945 to 1.427, P = 0.154; Q2: HR, 1.160, 95% CI, 0.938 to 1.434, P = 0.172)
Summary
The results remain controversial with regards to the impact of serum uric acid on clinical outcomes from peritoneal dialysis population. The aim of our study was to investigate the influence of serum uric acid levels on mortality in peritoneal dialysis patients. Epidemiological studies have identified the cardiovascular events and mortality predictive role of higher serum UA levels in CKD patients [10,11,12]. For dialysis population, it has been equivocal regarding the impact of UA on the outcomes of dialysis patients from current evidence. Studies have revealed a positive, negative, or “J-shaped” relationship between UA and all-cause
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