Serum Uric Acid and Cardiovascular or All-Cause Mortality in Peritoneal Dialysis Patients: A Systematic Review and Meta-Analysis

Abstract

Background: Studies have shown inconsistent associations between serum uric acid (SUA) levels and mortality in peritoneal dialysis (PD) patients. We conducted this meta-analysis to determine whether SUA levels were associated with cardiovascular or all-cause mortality in PD patients.Methods: PubMed, Embase, Web of Science, the Cochrane Library, CNKI, VIP, Wanfang Database, and trial registry databases were systematically searched up to April 11, 2021. Cohort studies of SUA levels and cardiovascular or all-cause mortality in PD patients were obtained. Random effect models were used to calculate the pooled adjusted hazard ratio (HR) and corresponding 95% confidence interval (CI). Sensitivity analyses were conducted to assess the robustness of the pooled results. Subgroup analyses and meta-regression analyses were performed to explore the sources of heterogeneity. Funnel plots, Begg's tests, and Egger's tests were conducted to evaluate potential publication bias. The GRADE approach was used to rate the certainty of evidence. This study was registered with PROSPERO, CRD42021268739.Results: Seven studies covering 18,113 PD patients were included. Compared with the middle SUA levels, high SUA levels increased the risk of all-cause mortality (HR = 1.74, 95%CI: 1.26–2.40, I2 = 34.8%, τ2 = 0.03), low SUA levels were not statistically significant with the risk of all-cause or cardiovascular mortality (HR = 1.04, 95%CI: 0.84–1.29, I2 = 43.8%, τ2 = 0.03; HR = 0.89, 95%CI: 0.65–1.23, I2 = 36.3%, τ2 = 0.04; respectively). Compared with the low SUA levels, high SUA levels were not statistically associated with an increased risk of all-cause or cardiovascular mortality (HR = 1.19, 95%CI: 0.59–2.40, I2 = 88.2%, τ2 = 0.44; HR = 1.22, 95%CI: 0.39–3.85, I2 = 89.3%, τ2 = 0.92; respectively).Conclusion: Compared with middle SUA levels, high SUA levels are associated with an increased risk of all-cause mortality in PD patients. SUA levels may not be associated with cardiovascular mortality. More high-level studies, especially randomized controlled trials, are needed to determine the association between SUA levels and cardiovascular or all-cause mortality in PD patients.Systematic Review Registration:https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021268739, identifier: CRD42021268739.

Serum uric acid level and all-cause and cardiovascular mortality in peritoneal dialysis patients: A systematic review and dose-response meta-analysis of cohort studies

“…However, they did not research the impact of intermediate levels of SUA on mortality compared with the highest and lowest levels. Another meta-analysis by Liu et al [ 43 ] found that high SUA levels were associated with an increased risk of all-cause mortality in PD patients compared with middle SUA levels, but SUA levels may not be associated with CVD mortality, which is consistent with our results before recalculating HRs and 95% CIs. What is more, it may be a pity that both them did not recalculate the original data using the lowest dose group as the reference and perform the dose-response analysis.…”

Construction and validation of a predictive model for the risk of peritoneal dialysis-associated peritonitis after peritoneal dialysis catheterization

“…In patients receiving PD, a positive relationship was shown between UA levels and mortality ( 48 , 49 ). High UA levels were associated with an increased risk of all-cause mortality in patients with PD compared to moderate UA levels ( 50 ). UA may induce oxidative stress by activating NADPH oxidase, stimulating the renin-angiotensin system, and interfering with mitochondrial function ( 51 ).…”