Lower serum uric acid level predicts mortality in dialysis patients

Eunjin Bae, Hyun Jeong Cho, Nara Shin, Sun Moon Kim, Seung Hee Yang, Dong Ki Kim, Yong Lim Kim, Shin Wook Kang, Chul Woo Yang, Nam Ho Kim, Yon Su Kim, Hajeong Lee

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Abstract

We evaluated the impact of serum uric acid (SUA) on mortality in patients with chronic dialysis. A total of 4132 adult patients on dialysis were enrolled prospectively between August 2008 and September 2014. Among them, we included 1738 patients who maintained dialysis for at least 3 months and had available SUA in the database. We categorized the time averaged-SUA (TA-SUA) into 5 groups:<5.5, 5.5-6.4, 6.5-7.4, 7.5-8.4, and ≥8.5mg/dL. Cox regression analysis was used to calculate the hazard ratio (HR) of all-cause mortality according to SUA group. The mean TA-SUA level was slightly higher in men than in women. Patients with lower TA-SUA level tended to have lower body mass index (BMI), phosphorus, serum albumin level, higher proportion of diabetes mellitus (DM), and higher proportion of malnourishment on the subjective global assessment (SGA). During a median follow-up of 43.9 months, 206 patients died. Patients with the highest SUA had a similar risk to the middle 3 TA-SUA groups, but the lowest TA-SUA group had a significantly elevated HR for mortality. The lowest TA-SUA group was significantly associated with increased all-cause mortality (adjusted HR, 1.720; 95% confidence interval, 1.007-2.937; P=0.047) even after adjusting for demographic, comorbid, nutritional covariables, and medication use that could affect SUA levels. This association was prominent in patients with well nourishment on the SGA, a preserved serum albumin level, a higher BMI, and concomitant DM although these parameters had no significant interaction in the TA-SUA-mortality relationship except DM. In conclusion, a lower TA-SUA level<5.5mg/dL predicted all-cause mortality in patients with chronic dialysis.

Original languageEnglish
Article numbere3701
JournalMedicine (United States)
Volume95
Issue number24
DOIs
Publication statusPublished - 2016 Jun 21

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Uric Acid
Dialysis
Mortality
Serum
Diabetes Mellitus
Serum Albumin
Body Mass Index
Malnutrition
Phosphorus
Regression Analysis
Demography
Databases
Confidence Intervals

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Bae, E., Cho, H. J., Shin, N., Kim, S. M., Yang, S. H., Kim, D. K., ... Lee, H. (2016). Lower serum uric acid level predicts mortality in dialysis patients. Medicine (United States), 95(24), [e3701]. https://doi.org/10.1097/MD.0000000000003701
Bae, Eunjin ; Cho, Hyun Jeong ; Shin, Nara ; Kim, Sun Moon ; Yang, Seung Hee ; Kim, Dong Ki ; Kim, Yong Lim ; Kang, Shin Wook ; Yang, Chul Woo ; Kim, Nam Ho ; Kim, Yon Su ; Lee, Hajeong. / Lower serum uric acid level predicts mortality in dialysis patients. In: Medicine (United States). 2016 ; Vol. 95, No. 24.
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Bae, E, Cho, HJ, Shin, N, Kim, SM, Yang, SH, Kim, DK, Kim, YL, Kang, SW, Yang, CW, Kim, NH, Kim, YS & Lee, H 2016, 'Lower serum uric acid level predicts mortality in dialysis patients', Medicine (United States), vol. 95, no. 24, e3701. https://doi.org/10.1097/MD.0000000000003701

Lower serum uric acid level predicts mortality in dialysis patients. / Bae, Eunjin; Cho, Hyun Jeong; Shin, Nara; Kim, Sun Moon; Yang, Seung Hee; Kim, Dong Ki; Kim, Yong Lim; Kang, Shin Wook; Yang, Chul Woo; Kim, Nam Ho; Kim, Yon Su; Lee, Hajeong.

In: Medicine (United States), Vol. 95, No. 24, e3701, 21.06.2016.

Research output: Contribution to journalArticle

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T1 - Lower serum uric acid level predicts mortality in dialysis patients

AU - Bae, Eunjin

AU - Cho, Hyun Jeong

AU - Shin, Nara

AU - Kim, Sun Moon

AU - Yang, Seung Hee

AU - Kim, Dong Ki

AU - Kim, Yong Lim

AU - Kang, Shin Wook

AU - Yang, Chul Woo

AU - Kim, Nam Ho

AU - Kim, Yon Su

AU - Lee, Hajeong

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N2 - We evaluated the impact of serum uric acid (SUA) on mortality in patients with chronic dialysis. A total of 4132 adult patients on dialysis were enrolled prospectively between August 2008 and September 2014. Among them, we included 1738 patients who maintained dialysis for at least 3 months and had available SUA in the database. We categorized the time averaged-SUA (TA-SUA) into 5 groups:<5.5, 5.5-6.4, 6.5-7.4, 7.5-8.4, and ≥8.5mg/dL. Cox regression analysis was used to calculate the hazard ratio (HR) of all-cause mortality according to SUA group. The mean TA-SUA level was slightly higher in men than in women. Patients with lower TA-SUA level tended to have lower body mass index (BMI), phosphorus, serum albumin level, higher proportion of diabetes mellitus (DM), and higher proportion of malnourishment on the subjective global assessment (SGA). During a median follow-up of 43.9 months, 206 patients died. Patients with the highest SUA had a similar risk to the middle 3 TA-SUA groups, but the lowest TA-SUA group had a significantly elevated HR for mortality. The lowest TA-SUA group was significantly associated with increased all-cause mortality (adjusted HR, 1.720; 95% confidence interval, 1.007-2.937; P=0.047) even after adjusting for demographic, comorbid, nutritional covariables, and medication use that could affect SUA levels. This association was prominent in patients with well nourishment on the SGA, a preserved serum albumin level, a higher BMI, and concomitant DM although these parameters had no significant interaction in the TA-SUA-mortality relationship except DM. In conclusion, a lower TA-SUA level<5.5mg/dL predicted all-cause mortality in patients with chronic dialysis.

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