The association between the serum uric acid to creatinine ratio and all-cause mortality in elderly hemodialysis patients

Abstract

Background Elderly hemodialysis patients have a higher rate of mortality than nonelderly hemodialysis patients. Recent studies shown that the serum uric acid to creatinine ratio (SUA/Scr) was associated with all-cause mortality in general adults. The purpose of the present study was to investigate the association between the SUA/Scr and all-cause and cardiovascular disease mortality among elderly hemodialysis patients. Methods A total of 222 patients (≥ 60 years) who received hemodialysis more than 8 h per week at Taizhou Second People’s Hospital for at least 3 months were enrolled in the present study from January 2015 to December 2019. Clinical characteristics including age, sex and height et. al, were obtained from the hemodialysis database. The laboratory data, including albumin (ALB), total cholesterol (TC), serum uric acid (SUA), serum creatinine (Scr) and so on, were collected before hemodialysis and analyzed by automatic biochemical analyzer. Survival information was recorded during the follow-up period. Multiple Cox regression was carried out to analyze the association between SUA/Scr and all-cause mortality. The survival rate of each group was calculated by the Kaplan–Meier method, and the ratio of survival curves was analyzed by the log-rank test. The contribution of SUA/Scr for predicting all-cause mortality risk was evaluated by net reclassification improvement (NRI). Results During the 19-month observation period, 78 patients died. Individuals in the nonsurviving group had significantly older ages (P < 0.001), body mass index (BMI) (P = 0.004), serum creatinine (P = 0.005) and prealbumin (P = 0.006) than surviving patients. After adjusting for age, sex, BMI, prealbumin, dialysis vintage, dialysis frequency, single-pool Kt/V (spKt/V), DM, hypertension and comorbidities, a higher ratio of SUA/Scr was independently associated with a higher risk of all-cause mortality (HR: 1.292; 95% CI: 1.013–1.648; P = 0.039). The predict value on all-cause mortality of SUA/Scr was superior to SUA (additive NRI = 0.214, P = 0.015) and Scr (additive NRI = 0.476, P < 0.001) among elderly hemodialysis patients. Conclusion The serum uric acid to creatinine ratio is strongly associated with all-cause mortality in elderly hemodialysis patients which is more predictive than SUA or Scr alone.

Serum uric acid / serum creatinine ratio as a predictor of cardiovascular events. Detection of prognostic cardiovascular cut-off values

“…In addition to being generally accepted as another independent CV risk indicator [9], serum creatinine (sCr) is also an index of renal function, and can represent an easily available and inexpensive parameter for indexing SUA to renal function. As a matter of fact, the ratio between SUA mg/dl and sCr mg/dl is strictly associated to metabolic syndrome [10] and has sometimes been proposed as a metabolic mediator [11] and as a new variable able to explore CV risk [12] mainly in some categories of selected people such as patients with diabetes, nephropathy or chronic pulmonary disease [13][14][15][16] or in menopausal women [17].…”

Serum uric acid to creatinine ratio is a useful predictor of all-cause mortality among hypertensive patients

“…SUA/Cr has been estimated using SUA and Cr, as well as SUA normalized by renal function, which has emerged as a new biomarker. SUA/Cr has been found to be superior to SUA or Cr in predicting all-cause mortality for elderly patients on hemodialysis [ 29 ]. Research examining the relationship between SUA/Cr and disease status and severity in patients with Parkinson’s disease has reported interferential effects of SUA on sex and renal function [ 30 ].…”

Subjectivity study on health conservation of elderly hemodialysis patients

“…They also have social problems due to economic burden and absence of a spouse [ 4 ]. A nursing approach to the health management of elderly hemodialysis patients is required due to the necessity of health management for disease-related complications, regular dialysis and medication, diet control, arteriovenous fistula, exercise and rest, blood pressure, and weight [ 2 , 5 , 6 ].…”

“…There have been no studies on people’s various attitudes, values, beliefs, and subjectivity toward health conservation. Many other health conservation studies investigated the relationship between variables and health conservation targeting the elderly and middle-aged women [ 3 – 6 , 9 , 10 ].…”

“…Health conservation enables the elderly to maintain a positive state of well-being while undergoing treatment and maintenance of disease [ 6 , 10 ]. In the case of the elderly with chronic diseases, it is important to preserve their functions so that they can perform daily activities independently rather than simply extending their lifespan or taking a treatment-oriented approach [ 9 ].…”