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.
Highlights
Increased cardiovascular (CV) events have been extensively documented in patients with end-stage renal disease (ESRD) including peritoneal dialysis (PD) and hemodialysis(HD) population [1,2]
Previous studies have shown that Uric acid (UA) is closely associated with hypertension, coronary heart disease and chronic kidney disease (CKD) [10,11,12]
Each 1 mg/dL of increase in UA was associated with higher all-cause mortality with 1.05(1.00,1.10) of hazard ratio (HR)(P = 0.05) and higher CV mortality with 1.12 (1.05,1.20) of HR(P = 0.001) after adjusting for age, gender and center size (Tables 2 and 3)
Summary
Increased cardiovascular (CV) events have been extensively documented in patients with end-stage renal disease (ESRD) including peritoneal dialysis (PD) and hemodialysis(HD) population [1,2]. Exploring novel and potentially modifiable risk factors for CV and all-cause mortality is urgent. Uric acid (UA), as one of novel risk factors, has been paid more attention in recent years. High UA could independently predict CV events and mortality for ones with chronic diseases including CKD [13,14,15]. A few studies from HD population indicated inconsistent relationship between UA and outcomes, that is, UA is negatively or ‘J-shaped’ related to all-cause or CV mortality [16,17,18,19]. There is no specific data on UA and outcomes for PD population yet
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