Uric Acid Levels and All-Cause and Cardiovascular Mortality in the Hemodialysis Population

Abstract

SummaryBackground and objectives Hyperuricemia is associated with hypertension, coronary artery disease, and chronic kidney disease. However, there are no specific data on the relationship of uric acid to cardiovascular disease in the chronic hemodialysis setting.Design, setting, participants, & measurements Data from 5827 patients on chronic hemodialysis from six countries affiliated with the Dialysis Outcomes and Practice Patterns Study (DOPPS) were analyzed. All laboratory data were based upon the initial cross-section of patients in DOPPS I and II. Cox regression was used to calculate the hazard ratio (HR) of all-cause and cardiovascular (CV) mortality with adjustments for case-mix including 14 classes of comorbidity.Results There were no clinically significant differences in baseline characteristics between those who had measured uric acid (n ϭ 4637) and those who did not (n ϭ 1190). Uric acid level was associated with lower all-cause mortality (HR: 0.95, 95% confidence interval [CI]: 0.90 to 1.00 per 1 mg/dl higher uric acid level) and CV mortality (HR: 0.92, 95% CI: 0.86 to 0.99). When analyzed as a dichotomous variable, the adjusted HR at uric acid Յ8.2 mg/dl compared with Ͼ8.2 mg/dl was 1.24 (95% CI: 1.03 to 1.49) for all-cause mortality and 1.54 (95% CI: 1.15 to 2.07) for CV mortality. ConclusionsHigher uric acid levels were associated with lower risk of all-cause and CV mortality in the hemodialysis population. These results are in contrast to the association of hyperuricemia with higher cardiovascular risk in the general population and should be the subject of further research.

Hyperuricemia and chronic kidney disease: an enigma yet to be solved

“…128 Another large retrospective study involving 5827 HD patients reported that higher serum UA levels were correlated with lower risk of allcause and CVD mortality. 13 These results might be explained by the reverse epidemiology. Interestingly, from ancient times, it was well known that gout was a disease of the Emperors of the Byzantium suggesting their better socialeconomic status compared with malnourished people.…”

“…The impact of UA in all-cause and CV mortality of dialysis patients' remains controversial. 12,13 Controversial also remains the role of UA in renal transplantation. 7 Relationship of HUA -chronic kidney disease incidence and progression Several studies with conflicting results in some instance have investigated the relationship between HUA and CKD.…”

Longitudinal Study of Serum Uric Acid, Nutritional Status, and Mortality in Maintenance Hemodialysis Patients

“…In the general population, hyperuricemia has been shown to be associated with an increased risk of hypertension (8,9), prehypertension (10), peripheral arterial disease (11), diabetes mellitus (12), CKD (13), and cardiovascular disease (CVD) (8,10,14). Conversely, in the HD population, hyperuricemia has been shown as a good nutritional marker (15) that can also predict lower rates of upcoming hospitalizations (15) as well as lower all-cause and cardiovascular death risks (15,16). Although the data about the mortality predictive role of higher SUA levels in the HD population are somewhat controversial (3,4,(15)(16)(17)(18), most of the studies conducted on this topic presented low SUA as a mortality risk factor in patients on MHD (3,4,15,16,18).…”

Hyperuricemia and Urologic Disease

“…A similar mechanism might explain the apparent protective effect of hyperuricemia on patients with end-stage renal disease, who are on hemodialysis. Higher SUA has been shown previously to be associated with lower risk of all-cause mortalities and CV deaths [7].…”