Serum Uric Acid and Mortality Risk Among Hemodialysis Patients
Although high serum uric acid (SUA) has been consistently associated with an increased risk of death in the general population and in persons with nondialysis chronic kidney disease (CKD), studies in patients undergoing dialysis are conflicting. It has been postulated that low SUA simply reflects po...
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| Published in: | Kidney international reports Vol. 5; no. 8; pp. 1196 - 1206 |
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| Abstract | Although high serum uric acid (SUA) has been consistently associated with an increased risk of death in the general population and in persons with nondialysis chronic kidney disease (CKD), studies in patients undergoing dialysis are conflicting. It has been postulated that low SUA simply reflects poor nutritional status in dialysis patients. We here characterize the association between SUA and the risk of death in a large dialysis cohort and explore effect modification by underlying nutritional status as reflected by body composition.
In this retrospective cohort study, we included 16,057 hemodialysis (HD) patients treated during 2007 to 2016 in NephroCare centers as recorded in the European Clinical Database (EuCliD). The association between SUA, all-cause, and cardiovascular (CV)−related mortality was evaluated with competing risk models and characterized with splines. Effect modification was explored by lean tissue index (LTI) and fat tissue index (FTI).
During a mean of 1.8 years of follow-up, 2791 patients (17.4%) died. We found a multivariable-adjusted U-shaped pattern between SUA and all-cause mortality. Patients with SUA levels of 6.5 mg/dl (387 μmol/l) were at the lowest risk of death (subdistribution hazard ratio = 0.94 [confidence interval {CI} 0.91; 0.96]). The form of association was not meaningfully affected by underlying LTI and FTI.
We found a U-shaped pattern between SUA levels and all-cause mortality among HD patients, which was independent of the patients’ body composition.
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| AbstractList | INTRODUCTION: Although high serum uric acid (SUA) has been consistently associated with an increased risk of death in the general population and in persons with nondialysis chronic kidney disease (CKD), studies in patients undergoing dialysis are conflicting. It has been postulated that low SUA simply reflects poor nutritional status in dialysis patients. We here characterize the association between SUA and the risk of death in a large dialysis cohort and explore effect modification by underlying nutritional status as reflected by body composition. METHODS: In this retrospective cohort study, we included 16,057 hemodialysis (HD) patients treated during 2007 to 2016 in NephroCare centers as recorded in the European Clinical Database (EuCliD). The association between SUA, all-cause, and cardiovascular (CV)-related mortality was evaluated with competing risk models and characterized with splines. Effect modification was explored by lean tissue index (LTI) and fat tissue index (FTI). RESULTS: During a mean of 1.8 years of follow-up, 2791 patients (17.4%) died. We found a multivariable-adjusted U-shaped pattern between SUA and all-cause mortality. Patients with SUA levels of 6.5 mg/dl (387 μmol/l) were at the lowest risk of death (subdistribution hazard ratio = 0.94 [confidence interval \CI\ 0.91; 0.96]). The form of association was not meaningfully affected by underlying LTI and FTI. CONCLUSION: We found a U-shaped pattern between SUA levels and all-cause mortality among HD patients, which was independent of the patients' body composition. Although high serum uric acid (SUA) has been consistently associated with an increased risk of death in the general population and in persons with nondialysis chronic kidney disease (CKD), studies in patients undergoing dialysis are conflicting. It has been postulated that low SUA simply reflects poor nutritional status in dialysis patients. We here characterize the association between SUA and the risk of death in a large dialysis cohort and explore effect modification by underlying nutritional status as reflected by body composition. In this retrospective cohort study, we included 16,057 hemodialysis (HD) patients treated during 2007 to 2016 in NephroCare centers as recorded in the European Clinical Database (EuCliD). The association between SUA, all-cause, and cardiovascular (CV)-related mortality was evaluated with competing risk models and characterized with splines. Effect modification was explored by lean tissue index (LTI) and fat tissue index (FTI). During a mean of 1.8 years of follow-up, 2791 patients (17.4%) died. We found a multivariable-adjusted U-shaped pattern between SUA and all-cause mortality. Patients with SUA levels of 6.5 mg/dl (387 μmol/l) were at the lowest risk of death (subdistribution hazard ratio = 0.94 [confidence interval {CI} 0.91; 0.96]). The form of association was not meaningfully affected by underlying LTI and FTI. We found a U-shaped pattern between SUA levels and all-cause mortality among HD patients, which was independent of the patients' body composition. INTRODUCTIONAlthough high serum uric acid (SUA) has been consistently associated with an increased risk of death in the general population and in persons with nondialysis chronic kidney disease (CKD), studies in patients undergoing dialysis are conflicting. It has been postulated that low SUA simply reflects poor nutritional status in dialysis patients. We here characterize the association between SUA and the risk of death in a large dialysis cohort and explore effect modification by underlying nutritional status as reflected by body composition.METHODSIn this retrospective cohort study, we included 16,057 hemodialysis (HD) patients treated during 2007 to 2016 in NephroCare centers as recorded in the European Clinical Database (EuCliD). The association between SUA, all-cause, and cardiovascular (CV)-related mortality was evaluated with competing risk models and characterized with splines. Effect modification was explored by lean tissue index (LTI) and fat tissue index (FTI).RESULTSDuring a mean of 1.8 years of follow-up, 2791 patients (17.4%) died. We found a multivariable-adjusted U-shaped pattern between SUA and all-cause mortality. Patients with SUA levels of 6.5 mg/dl (387 μmol/l) were at the lowest risk of death (subdistribution hazard ratio = 0.94 [confidence interval {CI} 0.91; 0.96]). The form of association was not meaningfully affected by underlying LTI and FTI.CONCLUSIONWe found a U-shaped pattern between SUA levels and all-cause mortality among HD patients, which was independent of the patients' body composition. Although high serum uric acid (SUA) has been consistently associated with an increased risk of death in the general population and in persons with nondialysis chronic kidney disease (CKD), studies in patients undergoing dialysis are conflicting. It has been postulated that low SUA simply reflects poor nutritional status in dialysis patients. We here characterize the association between SUA and the risk of death in a large dialysis cohort and explore effect modification by underlying nutritional status as reflected by body composition. In this retrospective cohort study, we included 16,057 hemodialysis (HD) patients treated during 2007 to 2016 in NephroCare centers as recorded in the European Clinical Database (EuCliD). The association between SUA, all-cause, and cardiovascular (CV)−related mortality was evaluated with competing risk models and characterized with splines. Effect modification was explored by lean tissue index (LTI) and fat tissue index (FTI). During a mean of 1.8 years of follow-up, 2791 patients (17.4%) died. We found a multivariable-adjusted U-shaped pattern between SUA and all-cause mortality. Patients with SUA levels of 6.5 mg/dl (387 μmol/l) were at the lowest risk of death (subdistribution hazard ratio = 0.94 [confidence interval {CI} 0.91; 0.96]). The form of association was not meaningfully affected by underlying LTI and FTI. We found a U-shaped pattern between SUA levels and all-cause mortality among HD patients, which was independent of the patients’ body composition. [Display omitted] |
| Author | Feuersenger, Astrid Winter, Anke C. Stuard, Stefano Ramos, Rosa Zawada, Adam M. Wolf, Melanie Gauly, Adelheid Fouque, Denis Carrero, Juan Jesus Canaud, Bernard |
| Author_xml | – sequence: 1 givenname: Adam M. orcidid: 0000-0001-9353-2943 surname: Zawada fullname: Zawada, Adam M. email: adam.zawada@fmc-ag.com organization: Fresenius Medical Care Deutschland GmbH, EMEA Medical Office, Bad Homburg, Germany – sequence: 2 givenname: Juan Jesus surname: Carrero fullname: Carrero, Juan Jesus organization: European Renal Nutrition (ERN) Working Group of the European Renal Association–European Dialysis Transplant Association (ERA-EDTA), London, United Kingdom – sequence: 3 givenname: Melanie surname: Wolf fullname: Wolf, Melanie organization: Fresenius Medical Care Deutschland GmbH, EMEA Medical Office, Bad Homburg, Germany – sequence: 4 givenname: Astrid surname: Feuersenger fullname: Feuersenger, Astrid organization: Fresenius Medical Care Deutschland GmbH, EMEA Medical Office, Bad Homburg, Germany – sequence: 5 givenname: Stefano surname: Stuard fullname: Stuard, Stefano organization: Fresenius Medical Care Deutschland GmbH, Global Medical Office—Clinical & Therapeutic Governance EMEA, Bad Homburg, Germany – sequence: 6 givenname: Adelheid orcidid: 0000-0002-2554-0711 surname: Gauly fullname: Gauly, Adelheid organization: Fresenius Medical Care Deutschland GmbH, EMEA Medical Office, Bad Homburg, Germany – sequence: 7 givenname: Anke C. surname: Winter fullname: Winter, Anke C. organization: Fresenius Medical Care Deutschland GmbH, EMEA Medical Office, Bad Homburg, Germany – sequence: 8 givenname: Rosa surname: Ramos fullname: Ramos, Rosa organization: Fresenius Medical Care España, S.A., Departamento Dirección Médica, Tres Cantos, Spain – sequence: 9 givenname: Denis surname: Fouque fullname: Fouque, Denis organization: European Renal Nutrition (ERN) Working Group of the European Renal Association–European Dialysis Transplant Association (ERA-EDTA), London, United Kingdom – sequence: 10 givenname: Bernard orcidid: 0000-0001-6854-2816 surname: Canaud fullname: Canaud, Bernard organization: Fresenius Medical Care Deutschland GmbH, Global Medical Office, Bad Homburg, Germany |
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| Keywords | hemodialysis body composition lean tissue index nutrition uric acid mortality risk |
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| Snippet | Although high serum uric acid (SUA) has been consistently associated with an increased risk of death in the general population and in persons with nondialysis... INTRODUCTIONAlthough high serum uric acid (SUA) has been consistently associated with an increased risk of death in the general population and in persons with... INTRODUCTION: Although high serum uric acid (SUA) has been consistently associated with an increased risk of death in the general population and in persons... |
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| SubjectTerms | body composition Clinical Research hemodialysis lean tissue index Life Sciences Medicin och hälsovetenskap mortality risk nutrition uric acid |
| Title | Serum Uric Acid and Mortality Risk Among Hemodialysis Patients |
| URI | https://dx.doi.org/10.1016/j.ekir.2020.05.021 https://www.ncbi.nlm.nih.gov/pubmed/32775819 https://search.proquest.com/docview/2432858890 https://inserm.hal.science/inserm-03237065 https://pubmed.ncbi.nlm.nih.gov/PMC7403560 http://kipublications.ki.se/Default.aspx?queryparsed=id:144396304 |
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