The significance of serum uric acid in maintenance hemodialysis patients
Objective To analyze the correlation of serum uric acid (SUA) with all-cause mortality and cardiovascular (CV) death in maintenance hemodialysis (MHD) patients,and explore the significance of SUA in MHD patients. Methods The basic data of 284 MHD patients were collected,and SUA was the pre-dialysis SUA level after 3 months of stable dialysis. According to SUA level,they were divided into Group 1 (57 cases),<379.6 μmol/L,i.e.,<20 percentiles;Group 2 (170 cases),379.6-560.2 μmol/L,i.e.,20-80 percentiles;Group 3 (57 cases),>560.2 μmol/L,i.e.>80 percentiles. The basic data,clinical and experimental indicators,and mortality rates (all-cause mortality and cardiovascular mortality) of the three groups were compared,and the multi-factor death events of MHD patients were analyzed. Results There were no significant differences in age,body mass index (BMI),years of dialysis,percentage of female,hypertension and smoking among the three groups (P>0.05). Comparison of percentage of diabetes mellitus and use of febuxostat among the three groups was statistically significant (P<0.05). Compared with group 1,patients in Group 2 and Group 3 had higher hemoglobin,albumin,creatinine,urea nitrogen,blood phosphorus,SUA,triglycerides,C-reactive protein,and ferritin,and there were statistical significance (P<0.05). There was no significant difference in the comparison of white blood cells,blood potassium,blood calcium,low-density lipoprotein cholesterol,urea clearance index (Kt/V),and ejection fraction (EF) among the three groups (P>0.05). Group 1 had all-cause mortality in 16 cases (28.1％) and cardiovascular deaths in 5 cases (8.8％);Group 2 had all-cause mortality in 54 cases (31.8％) and cardiovascular deaths in 22 cases (12.9％);Group 3 had all-cause mortality in 21 cases (36.8％) and cardiovascular deaths in 11 cases (19.3％);comparison of all-cause mortality and cardiovascular mortality among patients in the three groups showed no significant difference (P>0.05). Cox proportional risk model was used to analyze the relationship between every 100 μmol/L increase in SUA and all-cause mortality and cardiovascular mortality,and it was found that each 100 μmol/L increase in SUA was associated with an increased risk of all-cause mortality,with a mortality risk ratio of 1.246[95％CI=(1.028,1.511);P=0.025<0.05]after correcting for age,sex,ethnicity,BMI,years of dialysis,uric acid-lowering medications,tumors,hypertension and diabetes mellitus,and EF values;however,SUA was nonlinearly related to all-cause mortality,and all-cause mortality was low when SUA fluctuated at about 470-650 μmol/L. The risk of cardiovascular mortality increased with every 100 μmol/L increase in SUA,and the mortality risk ratio was 1.509[95％CI=(1.077,2.113);P=0.017<0.05];however,there was also a nonlinear relationship between SUA and cardiovascular mortality,and cardiovascular mortality was low when SUA fluctuated at about 470-650 μmol/L. Conclusion SUA has a nonlinear relationship with all-cause mortality and CV mortality in MHD patients. MHD patients with higher SUA seemed to have lower mortality.
Serum uric acidMaintenance hemodialysisAll-cause mortalityCardiovascular death
万方数据
维普
