Abstract
The association between serum uric acid (SUA) and all-cause and cardiovascular disease (CVD) mortality in peritoneal dialysis (PD) patients is controversial. Therefore, we aimed to determine the relationship between SUA and all-cause and CVD mortality in PD patients. Web of Science, EMBASE, PubMed and the Cochrane Library databases were searched from their inception to 7 April 2021. Effect estimates were presented as hazard ratios (HRs) with 95% confidence intervals (95% CIs) and pooled using random effects model. Thirteen cohort studies with 22418 patients were included in this systematic review, of which 9 were included in the meta-analysis. Before switching the reference group, pooled result for the highest SUA category was significantly greater than the median for all-cause mortality (HR = 2.41, 95% CI: 1.37-4.26). After switching the reference group, the highest SUA category did not demonstrate an increased all-cause (HR = 1.40, 95% CI: 0.95-2.05) or CVD (HR = 1.30, 95% CI: 0.72-2.34) mortality compared with the lowest SUA category. Dose-response analysis suggested a nonlinear association between SUA and all-cause mortality risk (Pnonlinearity = 0.002). This meta-analysis didn't find the relationship between SUA levels and all-cause and CVD mortality risk in PD patients. More rigorously designed studies are warranted in the future.
Highlights
Chronic kidney disease (CKD) is a worldwide public health problem with high incidence rate [1, 2] and high mortality [3], which have aggravated the burden of medical care
Nineteen articles were conducted full text assessment, and 6 studies were excluded, including 3 studies [28–30] excluded for the reasons of part of participants treated with hemodialysis and 3 studies [31–33] excluded for exploring the cause of mortality in patients treated with peritoneal dialysis (PD)
A study [21] was excluded in the meta-analysis because they focused on whether the longitudinal change in serum uric acid (SUA) affected all- cause mortality (SUA decliner vs SUA non-decliner) and another literature [37] explored the relationship between SUA and PD treatment failure
Summary
Chronic kidney disease (CKD) is a worldwide public health problem with high incidence rate [1, 2] and high mortality [3], which have aggravated the burden of medical care. In the treatment of chronic kidney disease, dialysis is a conventional treatment method, including peritoneal dialysis (PD) and hemodialysis (HD). Due to the limited health-care resources, combined with the advantages of PD treatment and the support of government policies, PD has been widely used worldwide, including in China, Thailand and the United States [3, 6]. The association between serum uric acid (SUA) and all-cause and cardiovascular disease (CVD) mortality in peritoneal dialysis (PD) patients is controversial. We aimed to determine the relationship between SUA and all-cause and CVD mortality in PD patients
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