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Tu S, Ye H, Xin Y, Peng Y, Liu R, Guo J, Yi C, Mao H, Yang X. Early Anuria in Incident Peritoneal Dialysis Patients: Incidence, Risk Factors, and Associated Clinical Outcomes. Kidney Med 2024; 6:100882. [PMID: 39247762 PMCID: PMC11380388 DOI: 10.1016/j.xkme.2024.100882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2024] Open
Abstract
Rationale & Objective The development of anuria has been linked to worse clinical outcomes in patients undergoing peritoneal dialysis (PD). Our objective was to investigate the incidence, risk factors, and associated clinical outcomes of anuria within the first year after starting PD. Study Design Retrospective cohort study. Setting & Participants Patients who started continuous ambulatory peritoneal dialysis at our center between 2006 and 2020 were included and followed up until January 31, 2023. Exposure Age, sex, diabetes, temporary hemodialysis, angiotensin-converting enzyme inhibitors (ACEis) or angiotensin II receptor blockers (ARBs), diuretics, baseline urine volume, serum albumin, daily glucose exposure, peritonitis, and incremental PD. Outcomes The primary outcome was early anuria, defined as 24-hour urine volume ≤100 mL within the first year of PD initiation. Secondary outcomes included all-cause mortality, cardiovascular disease mortality, technique failure, and peritonitis. Analytical Approach Cox proportional hazards model. Results A total of 2,592 patients undergoing continuous ambulatory peritoneal dialysis aged 46.7 ± 14.9 years were recruited. Among them, 58.9% were male, and 24.0% had diabetes. Within the first year of PD therapy, 159 (6.13%) patients developed anuria, with a median duration of 7.53 (interquartile range, 3.93-10.0) months. Higher baseline urine volume (hazard ratio [HR], 0.93; 95% confidence interval [CI], 0.90-0.97), higher serum albumin (HR, 0.92; 95% CI, 0.88-0.95), having diabetes before PD (HR, 0.57; 95% CI, 0.35-0.92), and prescribed incremental PD (HR, 0.27; 95% CI, 0.14-0.51) were associated with a reduced risk for early anuria, whereas a higher level of daily glucose exposure (HR, 1.01; 95% CI, 1.00-1.01) was identified as a risk factor for early anuria. Subgroup analyses showed that using ACEis or ARBs was linked to a lower risk of early anuria (HR, 0.25; 95% CI, 0.09-0.69) in diabetic patients. Treating early anuria as a time-dependent covariate, early anuria was associated with a higher risk for all-cause mortality (HR, 1.69; 95% CI, 1.23-2.32) and technique failure (HR, 1.43; 95% CI, 1.00-2.04) after adjusting for confounding factors. Limitations Single-center and observational study. Conclusions Among PD patients at a single center in China, early anuria was relatively uncommon but associated with an increased risk of mortality and PD technique failure. Incremental PD, higher baseline urine output and serum albumin, and lower daily glucose exposure were associated with a lower risk of early anuria. Clinical trials are needed to evaluate the optimal PD techniques to preserve residual kidney function and maximaze outcomes.
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Affiliation(s)
- Shiyan Tu
- Department of Nephrology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, China
| | - Hongjian Ye
- Department of Nephrology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, China
| | - Yangyang Xin
- Department of Nephrology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, China
| | - Yuan Peng
- Department of Nephrology, People's Hospital of Ganzhou, Ganzhou, Jiangxi, China
| | - Ruihua Liu
- Department of Nephrology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, China
| | - Jing Guo
- Department of Nephrology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, China
| | - Chunyan Yi
- Department of Nephrology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, China
| | - Haiping Mao
- Department of Nephrology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, China
| | - Xiao Yang
- Department of Nephrology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, China
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Zhao J, Sha B, Zeng L, Dou Y, Huang H, Liang G, Pan J, Hong K, Zhou G, Yang W, Liu J. J-shaped association of serum uric acid concentrations with all-cause mortality in individuals with osteoarthritis: A prospective cohort study. Joint Bone Spine 2024; 91:105679. [PMID: 38143017 DOI: 10.1016/j.jbspin.2023.105679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 12/03/2023] [Accepted: 12/11/2023] [Indexed: 12/26/2023]
Abstract
OBJECTIVE The purpose of this study was to explore the relationship between serum uric acid (SUA) concentrations and all-cause mortality in individuals with osteoarthritis (OA). METHODS All participant data were retrieved from the National Health and Nutrition Examination Survey database. A total of 4671 participants (age range: 20 to 85 years old), including 2988 females and 1683 males, were included in this study. The determination of death outcome was based on the National Death Index (up to December 31, 2019). We explored the nonlinear relationship between SUA concentrations and all-cause mortality in OA patients by establishing a Cox proportional risk model and a two-segment Cox proportional risk model and ran an interaction test to identify the high-risk population for all-cause mortality. RESULTS During 30,645 person-years of follow-up, the number of all-cause deaths for females and males was 736 and 516, respectively. After multivariate adjustment, we found a nonlinear relationship between SUA concentrations and all-cause mortality in both females and males with OA. In addition, we found a J-shaped relationship between SUA concentrations and all-cause mortality. The SUA concentration thresholds for all-cause mortality of females and males were stable at 5.6mg/dl and 6.2mg/dl, respectively. Compared with SUA concentrations below the inflection point, the all-cause mortality risk at higher SUA concentrations in females and males with OA increased by 20% (hazard ratio [HR]: 1.2, 95% confidence interval [CI]: 1.1 to 1.2) and 25% (HR: 1.2, 95% CI: 1.12 to 1.39), respectively. CONCLUSIONS There is a nonlinear relationship between SUA concentrations and all-cause mortality in the American OA population (J-shaped association). The all-cause mortality thresholds for SUA concentrations in females and males are 5.6mg/dl and 6.2mg/dl, respectively.
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Affiliation(s)
- Jinlong Zhao
- The Second Clinical College/State Key Laboratory of Traditional Chinese Medicine Syndrome of Guangzhou University of Chinese Medicine, 510405 Guangzhou, China; The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), 510120 Guangzhou, China; The Research Team on Bone and Joint Degeneration and Injury of Guangdong Provincial Academy of Chinese Medical Sciences, 510120 Guangzhou, China
| | - Bangxin Sha
- The Fifth Clinical College of Guangzhou University of Chinese Medicine, 510405 Guangzhou, China
| | - Lingfeng Zeng
- The Second Clinical College/State Key Laboratory of Traditional Chinese Medicine Syndrome of Guangzhou University of Chinese Medicine, 510405 Guangzhou, China; The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), 510120 Guangzhou, China; The Research Team on Bone and Joint Degeneration and Injury of Guangdong Provincial Academy of Chinese Medical Sciences, 510120 Guangzhou, China
| | - Yaoxing Dou
- The Second Clinical College/State Key Laboratory of Traditional Chinese Medicine Syndrome of Guangzhou University of Chinese Medicine, 510405 Guangzhou, China; The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), 510120 Guangzhou, China; The Research Team on Bone and Joint Degeneration and Injury of Guangdong Provincial Academy of Chinese Medical Sciences, 510120 Guangzhou, China
| | - Hetao Huang
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), 510120 Guangzhou, China
| | - Guihong Liang
- The Second Clinical College/State Key Laboratory of Traditional Chinese Medicine Syndrome of Guangzhou University of Chinese Medicine, 510405 Guangzhou, China; The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), 510120 Guangzhou, China; The Research Team on Bone and Joint Degeneration and Injury of Guangdong Provincial Academy of Chinese Medical Sciences, 510120 Guangzhou, China
| | - Jianke Pan
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), 510120 Guangzhou, China
| | - Kunhao Hong
- The Fifth Clinical College of Guangzhou University of Chinese Medicine, 510405 Guangzhou, China; Guangdong Second Chinese Medicine Hospital (Guangdong Province Engineering Technology Research Institute of Traditional Chinese Medicine), 510095 Guangzhou, China
| | - Guanghui Zhou
- The Second Clinical College/State Key Laboratory of Traditional Chinese Medicine Syndrome of Guangzhou University of Chinese Medicine, 510405 Guangzhou, China
| | - Weiyi Yang
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), 510120 Guangzhou, China.
| | - Jun Liu
- The Research Team on Bone and Joint Degeneration and Injury of Guangdong Provincial Academy of Chinese Medical Sciences, 510120 Guangzhou, China; The Fifth Clinical College of Guangzhou University of Chinese Medicine, 510405 Guangzhou, China; Guangdong Second Chinese Medicine Hospital (Guangdong Province Engineering Technology Research Institute of Traditional Chinese Medicine), 510095 Guangzhou, China.
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Yan X, Gong J, Wang Z, Wu Q, Qi C, Wang F. Serum uric acid was non-linearly associated with the risk of all-cause and cardiovascular death in individuals with coronary heart disease: a large prospective cohort study. Front Endocrinol (Lausanne) 2023; 14:1278595. [PMID: 38192419 PMCID: PMC10773754 DOI: 10.3389/fendo.2023.1278595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 11/17/2023] [Indexed: 01/10/2024] Open
Abstract
Objective To investigate the association of serum uric acid (SUA) with all-cause and cardiovascular death in individuals with coronary heart disease (CHD). Methods In this prospective cohort study, 1556 individuals from the National Health and Nutrition Examination Survey (1999-2015) were included in the analysis. Multivariate COX regression analysis, restricted cubic spline plot (RCS) and threshold effect were used to investigate the association between SUA and all-cause and cardiovascular death in individuals with CHD. Results In the fully adjusted model, when SUA was regarded as a continuous variable, it was closely associated with the risk of all-cause and cardiovascular death (P < 0.01). When all participants were divided into four groups according to the quartile of SUA, compared with Q1 group, only individuals in Q4 group had higher risk of all-cause and cardiovascular death (P = 0.002 and 0.034). The following subgroup analysis showed that the association between SUA and all-cause death risk was still statistically significant in individuals over 60 years old, male, with hypertension, without diabetes and with chronic kidney disease, while the association with cardiovascular death risk only persisted in individuals over 60 years old and male (P < 0.05). Further sensitivity analysis showed that SUA was still closely associated with all-cause and cardiovascular death, whether as a continuous variable or a classified variable (P = 0.007 and 0.044). RCS analysis revealed that SUA had a nonlinear association with all-cause and cardiovascular death risk (P for nonlinearity < 0.01). Threshold effect analysis showed that SUA below 345 umol/L was negatively associated with all-cause and cardiovascular death risk (P < 0.05), while SUA above 345 umol/L was positively associated with all-cause and cardiovascular death risk (P < 0.001), and the 2-piecewise regression model was better than the 1-line regression model (P for likelihood ratio test < 0.05). Conclusion SUA had a nonlinear association with all-cause and cardiovascular death risk in individuals with CHD.
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Affiliation(s)
- Xuejiao Yan
- Department of Cardiology, The Affiliated Changzhou No.2 People’s Hospital of Nanjing Medical University, Changzhou, Jiangsu, China
| | - Jing Gong
- Department of Geriatrics, Nanjing Tongren Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Zhenwei Wang
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qiyong Wu
- Department of Thoracic and Cardiac Surgery, The Affiliated Changzhou No.2 People’s Hospital of Nanjing Medical University, Changzhou, Jiangsu, China
| | - Chunjian Qi
- Medical Research Center, The Affiliated Changzhou No.2 People’s Hospital of Nanjing Medical University, Changzhou, Jiangsu, China
| | - Fangfang Wang
- Department of Cardiology, The Affiliated Changzhou No.2 People’s Hospital of Nanjing Medical University, Changzhou, Jiangsu, China
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Hu J, Tang L, Zhan X, Peng F, Wang X, Wen Y, Feng X, Wu X, Gao X, Zhou Q, Zheng W, Su N, Tang X. Serum uric acid to creatinine ratio as a risk factor for mortality among patients on continuous ambulatory peritoneal dialysis: a multi-center retrospective study. Ren Fail 2023; 45:2273979. [PMID: 37905944 PMCID: PMC10653642 DOI: 10.1080/0886022x.2023.2273979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 10/17/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND Serum uric acid to serum creatinine ratio (SUA/Scr) has emerged as a new biomarker, which is significantly associated with several metabolic diseases. However, no study has investigated the association between SUA/Scr and mortality among patients on continuous ambulatory peritoneal dialysis (CAPD). METHODS In this multicenter retrospective cohort study, we enrolled CAPD patients in eight tertiary hospitals in China from 1 January 2005 to 31 May 2021. Cox proportional hazard models were used to determine the relationship between SUA/Scr and mortality. RESULTS A total of 2480 patients were included; the mean age was 48.9 ± 13.9 years and 56.2% were males. During 12648.0 person-years of follow-up, 527 (21.3%) patients died, of which 267 (50.7%) deaths were caused by cardiovascular disease. After multivariable adjustment for covariates, per unit increase in SUA/Scr was associated with a 62.9% (HR, 1.629 (95% confidence interval (CI) 1.420-1.867)) and 73.0% (HR, 1.730 (95% CI 1.467-2.041)) higher risk of all-cause and cardiovascular mortality. Results were similar when categorized individuals by SUA/Scr quartiles. Compared with the lowest quartile of SUA/Scr, the highest and the second highest quartile of SUA/Scr had a 2.361-fold (95% CI 1.810-3.080) and 1.325-fold (95% CI 1.003-1.749) higher risk of all-cause mortality, as well as a 3.701-fold (95% CI 2.496-5.489) and 2.074-fold (95% CI 1.387-3.100) higher risk of cardiovascular mortality. Multivariable-adjusted spline regression models showed nonlinear association of SUA/Scr with mortality in CAPD patients. CONCLUSIONS Higher levels of SUA/Scr were associated with higher risk of all-cause and cardiovascular mortality in CAPD patients.
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Affiliation(s)
- Jieping Hu
- Department of Nephrology, Dongguan Tungwah Hospital, Dongguan, China
- Department of Nephrology, Dongguan Songshan Lake Tungwah Hospital, Dongguan, China
| | - Liwen Tang
- Department of Nephrology, Dongguan Songshan Lake Tungwah Hospital, Dongguan, China
| | - Xiaojiang Zhan
- Department of Nephrology, The First Affiliated Hospital, Nanchang University, Nanchang, China
| | - Fenfen Peng
- Department of Nephrology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Xiaoyang Wang
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Yueqiang Wen
- Department of Nephrology, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Xiaoran Feng
- Department of Nephrology, Jiujiang No. 1 People’s Hospital, Jiujiang, China
| | - Xianfeng Wu
- Department of Nephrology, Shanghai Jiaotong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Xingcui Gao
- Department of Cardiology, Dongguan Songshan Lake Tungwah Hospital, Dongguan, China
| | - Qian Zhou
- Department of Medical Statistics, Clinical Trials Unit, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wei Zheng
- Department of Nephrology, Dongguan Songshan Lake Tungwah Hospital, Dongguan, China
| | - Ning Su
- Department of Hematology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xingming Tang
- Department of Nephrology, Dongguan Songshan Lake Tungwah Hospital, Dongguan, China
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Wang Y, Zhang Q, Ren P, Pan Y, Liu Y, Li C, Fan Z, Han F, Zhang X, Chen J. The significance of follow-up serum uric acid levels in predicting all-cause mortality and cardiovascular mortality in peritoneal dialysis patients. Ther Apher Dial 2023; 27:83-90. [PMID: 35670149 PMCID: PMC10084356 DOI: 10.1111/1744-9987.13892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 05/27/2022] [Accepted: 06/02/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND This study aimed to analyze the change of serum uric acid (SUA) level post peritoneal dialysis (PD), and the correlation between follow-up SUA and prognosis in patients with PD. METHODS A total of 1402 patients with PD were evaluated. We graded SUA levels into four grades at baseline, 6 months, 12 months, 18 months, and 24 months post PD, and then compared all-cause mortality and cardiovascular mortality among patients with different SUA grades at each time point. Kaplan-Meier and Cox proportional-hazards regression models were used in the analysis. RESULTS The SUA levels were 7.97 ± 1.79, 7.12 ± 1.48, 7.05 ± 1.33, 7.01 ± 1.30, and 6.93 ± 1.26 mg/dl at baseline, 6, 12, 18, and 24 months, respectively. There was significant difference on all-cause mortality among patients with PD with different graded SUA levels at 6 months post PD (p = 0.010), and the all-cause mortality was lowest in patients with the grade of 5.65 mg/dl ≤ SUA <7.13 mg/dl. CONCLUSION SUA level decreased after PD during follow-up. At 6 months post PD, the grade of 5.65 mg/dl ≤ SUA <7.13 mg/dl was appropriate for better patients' survival.
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Affiliation(s)
- Yaomin Wang
- Kidney Disease Center, The First Affiliated Hospital, Zhejiang University School of Medicine; Institute of Nephrology, Zhejiang University, Key Laboratory of Kidney Disease Prevention and Control Technology, Hangzhou, China
| | - Qilong Zhang
- Kidney Disease Center, The First Affiliated Hospital, Zhejiang University School of Medicine; Institute of Nephrology, Zhejiang University, Key Laboratory of Kidney Disease Prevention and Control Technology, Hangzhou, China.,Anji People's Hospital, Huzhou, China
| | - Pingping Ren
- Kidney Disease Center, The First Affiliated Hospital, Zhejiang University School of Medicine; Institute of Nephrology, Zhejiang University, Key Laboratory of Kidney Disease Prevention and Control Technology, Hangzhou, China
| | - Yixuan Pan
- Kidney Disease Center, The First Affiliated Hospital, Zhejiang University School of Medicine; Institute of Nephrology, Zhejiang University, Key Laboratory of Kidney Disease Prevention and Control Technology, Hangzhou, China
| | - Yi Liu
- Anji People's Hospital, Huzhou, China
| | | | | | - Fei Han
- Kidney Disease Center, The First Affiliated Hospital, Zhejiang University School of Medicine; Institute of Nephrology, Zhejiang University, Key Laboratory of Kidney Disease Prevention and Control Technology, Hangzhou, China
| | - Xiaohui Zhang
- Kidney Disease Center, The First Affiliated Hospital, Zhejiang University School of Medicine; Institute of Nephrology, Zhejiang University, Key Laboratory of Kidney Disease Prevention and Control Technology, Hangzhou, China
| | - Jianghua Chen
- Kidney Disease Center, The First Affiliated Hospital, Zhejiang University School of Medicine; Institute of Nephrology, Zhejiang University, Key Laboratory of Kidney Disease Prevention and Control Technology, Hangzhou, China
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Huang N, Liu Y, Ai Z, Zhou Q, Mao H, Yang X, Xu Y, Yu X, Chen W. Mediation of serum albumin in the association of serum potassium with mortality in Chinese dialysis patients: a prospective cohort study. Chin Med J (Engl) 2023; 136:213-220. [PMID: 36805593 PMCID: PMC10106125 DOI: 10.1097/cm9.0000000000002588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND The clinical importance of hypokalemia is likely underrecognized in Chinese dialysis patients, and whether its clinical effect was mediated by serum albumin is not fully elucidated. This study aimed to explore the association between serum potassium and mortality in dialysis patients of a Chinese nationwide multicenter cohort, taking albumin as a consideration. METHODS This was a prospective nation-wide multicenter cohort study. Restricted cubic splines were used to test the linearity of serum potassium and relationships with all-cause (AC) and cardiovascular (CV) mortality and a subsequent two-line piecewise linear model was fitted to approach the nadir. A mediation analysis was performed to examine relations of albumin to potassium and mortalities. RESULTS A total of 10,027 patients were included, of whom 6605 were peritoneal dialysis and 3422 were hemodialysis patients. In the overall population, the mean age was 51.7 ± 14.8 years, 55.3%(5546/10,027) were male, and the median dialysis vintage was 13.60 (4.70, 39.70) months. Baseline serum potassium was 4.30 ± 0.88 mmol/L. After a median follow-up period of 26.87 (14.77, 41.50) months, a U-shape was found between potassium and mortality, and a marked increase in risk at lower potassium but a moderate elevation in risk at higher potassium were observed. The nadir for AC mortality risk was estimated from piecewise linear models to be a potassium concentration of 4.0 mmol/L. Interestingly, the significance of the association between potassium and mortality was attenuated when albumin was introduced into the extended adjusted model. A subsequent significant mediation by albumin for potassium and AC and CV mortalities were found ( P < 0.001 for both), indicating that hypokalemia led to higher mortality mediated by low serum albumin, which was a surrogate of poor nutritional status and inflammation. CONCLUSIONS Associations between potassium and mortalities were U-shaped in the overall population. The nadir for AC mortality risk was at a potassium of 4.0 mmol/L. Serum albumin mediated the association between potassium and AC and CV mortalities.
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Affiliation(s)
- Naya Huang
- Department of Nephrology, The First Affiliated Hospital, Key Laboratory of Nephrology, Ministry of Health of China, Guangdong Provincial Key Laboratory of Nephrology, Sun Yat-Sen University, Guangzhou, Guangdong 510080, China
| | - Yuanying Liu
- Department of Nephrology, The First Affiliated Hospital, Key Laboratory of Nephrology, Ministry of Health of China, Guangdong Provincial Key Laboratory of Nephrology, Sun Yat-Sen University, Guangzhou, Guangdong 510080, China
| | - Zhen Ai
- Department of Nephrology, The First Affiliated Hospital, Key Laboratory of Nephrology, Ministry of Health of China, Guangdong Provincial Key Laboratory of Nephrology, Sun Yat-Sen University, Guangzhou, Guangdong 510080, China
| | - Qian Zhou
- Department of Medical Statistics, Clinical Trials Unit, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510080, China
| | - Haiping Mao
- Department of Nephrology, The First Affiliated Hospital, Key Laboratory of Nephrology, Ministry of Health of China, Guangdong Provincial Key Laboratory of Nephrology, Sun Yat-Sen University, Guangzhou, Guangdong 510080, China
| | - Xiao Yang
- Department of Nephrology, The First Affiliated Hospital, Key Laboratory of Nephrology, Ministry of Health of China, Guangdong Provincial Key Laboratory of Nephrology, Sun Yat-Sen University, Guangzhou, Guangdong 510080, China
| | - Yuanwen Xu
- Department of Nephrology, The First Affiliated Hospital, Key Laboratory of Nephrology, Ministry of Health of China, Guangdong Provincial Key Laboratory of Nephrology, Sun Yat-Sen University, Guangzhou, Guangdong 510080, China
| | - Xueqing Yu
- Department of Nephrology, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510080, China
| | - Wei Chen
- Department of Nephrology, The First Affiliated Hospital, Key Laboratory of Nephrology, Ministry of Health of China, Guangdong Provincial Key Laboratory of Nephrology, Sun Yat-Sen University, Guangzhou, Guangdong 510080, China
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Ding Z, Fan Y, Yao C, Gu L. The association between the serum uric acid to creatinine ratio and all-cause mortality in elderly hemodialysis patients. BMC Nephrol 2022; 23:177. [PMID: 35524224 PMCID: PMC9077848 DOI: 10.1186/s12882-022-02798-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 04/21/2022] [Indexed: 11/23/2022] Open
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.
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Affiliation(s)
- Zhihui Ding
- Department of Nephrology, Taizhou Second People's Hospital, Taizhou, China
| | - Yao Fan
- Division of Clinical Epidemiology, Affiliated Geriatric Hospital of Nanjing Medical University, Nanjing, China
| | - Chunlei Yao
- Department of Nephrology, Taizhou Second People's Hospital, Taizhou, China.
| | - Liubao Gu
- Division of Clinical Epidemiology, Affiliated Geriatric Hospital of Nanjing Medical University, Nanjing, China.
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Yu J, Xia X, Huang NY, Qiu YG, Yang X, Mao HP, Chen W, Huang FX. Association of Ratio of Apolipoprotein B to Apolipoprotein A1 With Survival in Peritoneal Dialysis. Front Nutr 2022; 9:801979. [PMID: 35399692 PMCID: PMC8993134 DOI: 10.3389/fnut.2022.801979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 03/02/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundAlthough the ratio of apolipoprotein B (apo B) to apolipoprotein A1 (apo A1) (apo B/apo A1) seems to be associated with mortality in hemodialysis (HD) patients, the association of apo B/apo A1 ratio with death remains not clear in peritoneal dialysis (PD) patients.AimsThe study targets to examine the relationship of apo B/apo A1 ratio with survival in patients receiving PD treatment.MethodsIn this single-center prospective observational cohort study, we enrolled 1,616 patients receiving PD treatment with a median follow-up time of 47.6 months. We used a multivariable Cox proportional hazards model to examine the relationship between apo B/apo A1 ratio and cardiovascular (CV) and all-cause mortality. The association of apo B/apo A1 ratio with atherosclerotic and non-atherosclerotic CV mortality was further evaluated by competing risk regression models.ResultsDuring the follow-up, 508 (31.4%) patients died, 249 (49.0%) died from CV events, of which 149 (59.8%) were atherosclerotic CV mortality. In multivariable models, for 1-SD increase in apo B/apo A1 ratio level, the adjusted hazard ratios for CV and all-cause mortality were 1.26 [95% confidence interval (CI), 1.07–1.47; P = 0.005] and 1.20 (95% CI, 1.07–1.35; P = 0.003), respectively. The adjusted subdistribution hazard ratios for atherosclerotic and non-atherosclerotic CV mortality were 1.43 (95% CI, 1.19–1.73; P < 0.001) and 0.85 (95% CI, 0.64–1.13; P = 0.256), respectively. For quartile analysis, patients in quartile 4 had higher CV, all-cause, and atherosclerotic CV mortality compared with those in quartile 1. Moreover, apo B/apo A1 ratio had a diabetes-related difference in CV, all-cause, and atherosclerotic CV mortality.ConclusionElevated apo B/apo A1 ratio level was significantly associated with CV, all-cause, and atherosclerotic CV mortality in patients undergoing PD. Moreover, the association was especially statistically significant in patients with diabetes.
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Affiliation(s)
- Jing Yu
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Key Laboratory of Nephrology, National Health Commission and Guangdong Province, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xi Xia
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Key Laboratory of Nephrology, National Health Commission and Guangdong Province, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Na-Ya Huang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Key Laboratory of Nephrology, National Health Commission and Guangdong Province, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ya-Gui Qiu
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Key Laboratory of Nephrology, National Health Commission and Guangdong Province, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiao Yang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Key Laboratory of Nephrology, National Health Commission and Guangdong Province, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hai-Ping Mao
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Key Laboratory of Nephrology, National Health Commission and Guangdong Province, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wei Chen
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Key Laboratory of Nephrology, National Health Commission and Guangdong Province, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- *Correspondence: Wei Chen,
| | - Feng-Xian Huang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Key Laboratory of Nephrology, National Health Commission and Guangdong Province, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Feng-Xian Huang,
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9
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Kang T, Hu Y, Huang X, Amoah AN, Lyu Q. 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. PLoS One 2022; 17:e0264340. [PMID: 35192651 PMCID: PMC8863225 DOI: 10.1371/journal.pone.0264340] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 02/08/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The association between serum uric acid (SUA) and all-cause and cardiovascular disease (CVD) mortality in peritoneal dialysis (PD) patients is controversial. Therefore, we aimed to determine the relationship between SUA and all-cause and CVD mortality in PD patients. METHOD Web of Science, EMBASE, PubMed and the Cochrane Library databases were searched from their inception to 7 April 2021. Effect estimates were presented as hazard ratios (HRs) with 95% confidence intervals (95% CIs) and pooled using random effects model. RESULT Thirteen cohort studies with 22418 patients were included in this systematic review, of which 9 were included in the meta-analysis. Before switching the reference group, pooled result for the highest SUA category was significantly greater than the median for all-cause mortality (HR = 2.41, 95% CI: 1.37-4.26). After switching the reference group, the highest SUA category did not demonstrate an increased all-cause (HR = 1.40, 95% CI: 0.95-2.05) or CVD (HR = 1.30, 95% CI: 0.72-2.34) mortality compared with the lowest SUA category. Dose-response analysis suggested a nonlinear association between SUA and all-cause mortality risk (Pnonlinearity = 0.002). CONCLUSION This meta-analysis didn't find the relationship between SUA levels and all-cause and CVD mortality risk in PD patients. More rigorously designed studies are warranted in the future.
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Affiliation(s)
- Ting Kang
- Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Youchun Hu
- Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Xuemin Huang
- Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Adwoa N. Amoah
- Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Quanjun Lyu
- Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
- Department of Nutrition, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- * E-mail:
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10
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He S, Xiong Q, Li L, Lin X, Zhao J, Guo X, He Y, Liang W, Ying C, Zuo X. Increased risk of modality failure with higher serum uric acid level in continuous ambulatory peritoneal dialysis patients: a prospective cohort study. Ren Fail 2022; 44:272-281. [PMID: 35172675 PMCID: PMC8856069 DOI: 10.1080/0886022x.2022.2035762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Abstract
BACKGROUND Peritoneal dialysis (PD) is one of the most important kidney replacement therapies for patients with end-stage kidney disease (ESKD). PD technique failure can lead to an escalated cost and increased infectious and cardiovascular risk, up and including to death. The accumulation of uric acid (UA) was associated with adverse outcomes in ESKD patients. However, the relationship between serum UA and technique failure is little explored. METHODS Here, a total of 266 continuous ambulatory peritoneal dialysis (CAPD) patients (age, 41.8 ± 12.6 years; 125 males) were enrolled and followed up for 31.7 months. Serum UA levels were examined at baseline and each visit. Subjects were divided into three groups according to their baseline serum UA concentrations. Multivariable Cox regression models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) of PD technique failure. RESULTS The level of serum UA increased gradually as time prolonged. During the follow-up period, 77 (28.9%) patients occurred PD technique failure, of which 56 (21.1%) transferred to hemodialysis (HD) and 21 (7.9%) died. Compared to the lowest UA tertile, after adjusting for potential confounders, HRs of technique failure in tertile 2 and tertile 3 were 1.82 (95% CI: 0.95-3.49) and 2.03 (95% CI: 1.05-3.92), respectively, and p for trend was 0.043. Adjusted HRs of all-cause technique failure, transferring to HD and mortality with each 1 mg/dL increase in serum UA were 1.20 (95% CI: 1.03-1.40, p = 0.019), 1.22 (95% CI: 1.01-1.48, p = 0.039), and 1.25 (95% CI: 0.94-1.67, p = 0.128), respectively. CONCLUSION Higher serum UA level predicted higher risk of technique failure in CAPD patients.
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Affiliation(s)
- Shuiqing He
- Department of Clinical Nutrition, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.,Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Qianqian Xiong
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Li Li
- Department of Clinical Nutrition, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xuechun Lin
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jing Zhao
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiaolei Guo
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yuqin He
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Wangqun Liang
- Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Chenjiang Ying
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xuezhi Zuo
- Department of Clinical Nutrition, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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11
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Huang N, Li H, Fan L, Zhou Q, Fu D, Guo L, Yi C, Yu X, Mao H. Serum Phosphorus and Albumin in Patients Undergoing Peritoneal Dialysis: Interaction and Association With Mortality. Front Med (Lausanne) 2021; 8:760394. [PMID: 34926505 PMCID: PMC8672136 DOI: 10.3389/fmed.2021.760394] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 10/29/2021] [Indexed: 12/13/2022] Open
Abstract
Hyperphosphatemia and hypoalbuminemia confer worse clinical outcomes, whether these risk factors interact to predispose to mortality is unclear. In this prospective cohort study, 2,118 patients undergoing incident continuous ambulatory peritoneal dialysis (CAPD) were enrolled and categorized into four groups based on the changing point regarding mortality at 1.5 mmol/L for serum phosphorus and 35 g/L for serum albumin. Risks of all-cause and cardiovascular mortality were examined independently and interactively in overall and subgroups. There was no association between serum phosphorus with all-cause and cardiovascular mortality, but significant interactions (p = 0.02) between phosphorus and albumin existed in overall population. Patients in subgroup with high phosphorus and low albumin were at greater risk of all-cause (HR 1.95, 95%CI 1.27–2.98, p = 0.002) but not cardiovascular mortality (HR 0.37, 95%CI 0.10–1.33, p = 0.13), as compared to those with low phosphorus and high albumin. In contrast, patients with both low parameters had a higher risk of all-cause (HR 1.75, 95%CI 1.22–2.50, p = 0.002) and cardiovascular mortality (HR 1.92, 95%CI 1.07–3.45, p = 0.03). Notably, an elevated risk of both all-cause and cardiovascular mortality was observed in those with low serum albumin, irrespective of phosphorus levels, suggesting low albumin may be useful to identify a higher-risk subgroup of patients undergoing CAPD with different serum phosphorus levels.
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Affiliation(s)
- Naya Huang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Key Laboratory of Nephrology, Ministry of Health of China, Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China
| | - Huiyan Li
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Key Laboratory of Nephrology, Ministry of Health of China, Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China
| | - Li Fan
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Key Laboratory of Nephrology, Ministry of Health of China, Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China
| | - Qian Zhou
- Department of Medical Statistics, Clinical Trials Unit, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Dongying Fu
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Key Laboratory of Nephrology, Ministry of Health of China, Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China
| | - Lin Guo
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Key Laboratory of Nephrology, Ministry of Health of China, Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China
| | - Chunyan Yi
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Key Laboratory of Nephrology, Ministry of Health of China, Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China
| | - Xueqing Yu
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Key Laboratory of Nephrology, Ministry of Health of China, Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China.,Department of Nephrology, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Haiping Mao
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Key Laboratory of Nephrology, Ministry of Health of China, Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China
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12
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Feng Q, Tang LJ, Luo DH, Wang Y, Wu N, Chen H, Chen MX, Jiang L, Jin R. Metabolic Syndrome-Related Hyperuricemia is Associated with a Poorer Prognosis in Patients with Colorectal Cancer: A Multicenter Retrospective Study. Cancer Manag Res 2021; 13:8809-8819. [PMID: 34866939 PMCID: PMC8633709 DOI: 10.2147/cmar.s338783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 11/12/2021] [Indexed: 12/23/2022] Open
Abstract
Purpose Hyperuricemia and metabolic syndrome (MetS) have been shown to correlate with prognosis in patients with malignant tumors. The present study evaluated the relationship between preoperative hyperuricemia and MetS in colorectal cancer (CRC) patients and analyzed the effect of this combination on prognosis within 5 years. Patients and Methods The study enrolled patients who had undergone radical CRC resection at three independent medical centers from January 2014 to December 2016. Patients were preoperatively categorized into four groups, those with hyperuricemia alone (H), those with MetS alone (MS), those with MetS-related hyperuricemia (MSH), and those with neither condition (control [C] group). The disease-free survival (DFS) and overall survival (OS) rates of these four groups were compared. Results The study population consisted of 1271 patients, with 114, 201, 101, and 855 patients categorized into the H, MS, MSH and C groups, respectively. Preoperative MetS was found to be significantly associated with hyperuricemia (P < 0.001). Multivariate Cox regression analysis showed that MetS-related hyperuricemia (hazard ratio [HR] = 2.728; P < 0.001) and MetS alone (HR = 1.631; P < 0.001) were independent predictors of death, whereas simple hyperuricemia was not (P > 0.1). Relative to the C group, the MSH group had the highest rate of tumor recurrence or metastasis (HR = 5.103, P < 0.001), followed by the MS (HR = 2.231, P < 0.001) group. In contrast, prognosis did not differ significantly in the H and C groups (P > 0.1). MetS was significantly associated with poor prognosis, with MetS-related hyperuricemia resulting in a significantly poorer prognosis. In contrast, hyperuricemia alone had no effect on the long-term prognosis of CRC patients. Conclusion This study highlights the prognostic importance of MetS-related hyperuricemia on the survival of patients with CRC.
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Affiliation(s)
- Qian Feng
- Department of Gastroenterology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, People's Republic of China
| | - Liang-Jie Tang
- NAFLD Research Center, Department of Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, People's Republic of China
| | - Ding-Hai Luo
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province, Taizhou, 317000, People's Republic of China
| | - Ying Wang
- Department of Gastroenterology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, People's Republic of China
| | - Nan Wu
- Department of Gastroenterology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, People's Republic of China
| | - Hao Chen
- Department of Gastroenterology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, People's Republic of China
| | - Meng-Xia Chen
- Department of Gastroenterology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, People's Republic of China
| | - Lei Jiang
- Central Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, People's Republic of China
| | - Rong Jin
- Department of Gastroenterology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, People's Republic of China.,Department of Epidemiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, People's Republic of China
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13
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Liu ZQ, Huang ZW, Kang SL, Hu CC, Chen F, He F, Lin Z, Yang F, Hu ZJ. Serum Uric Acid and Cardiovascular or All-Cause Mortality in Peritoneal Dialysis Patients: A Systematic Review and Meta-Analysis. Front Cardiovasc Med 2021; 8:751182. [PMID: 34805305 PMCID: PMC8597842 DOI: 10.3389/fcvm.2021.751182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 10/11/2021] [Indexed: 11/26/2022] Open
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.
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Affiliation(s)
- Zhi-Qiang Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Zhi-Wen Huang
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Shu-Ling Kang
- Fuzhou Center for Disease Control and Prevention, Fuzhou, China.,Department of Preventive Medicine, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Chan-Chan Hu
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Fa Chen
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Fei He
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Zheng Lin
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Feng Yang
- Department of Nephrology, Affiliated Fuzhou First Hospital of Fujian Medical University, Fuzhou, China
| | - Zhi-Jian Hu
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
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14
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Xue X, Lu CL, Jin XY, Liu XH, Yang M, Wang XQ, Cheng H, Yuan J, Liu Q, Zheng RX, Robinson N, Liu JP. Relationship between serum uric acid, all-cause mortality and cardiovascular mortality in peritoneal dialysis patients: systematic review and meta-analysis of cohort studies. BMJ Open 2021; 11:e052274. [PMID: 34663666 PMCID: PMC8524295 DOI: 10.1136/bmjopen-2021-052274] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES To analyse the relationship between serum uric acid (SUA), all-cause and cardiovascular (CV) mortality in peritoneal dialysis (PD) patients to inform clinical practice and future research. DESIGN A systematic review of observational studies. DATA SOURCES PubMed, Embase, Web of Science, the Cochrane Library, China National Knowledge Infrastructure (CNKI), SinoMed, Chinese Science and Technology Journal Database (VIP) and Wan Fang databases were searched from their inception to January 2021 for cohort and case-control studies reporting SUA and mortality in patients with PD. METHODS The Newcastle-Ottawa Quality Assessment Scale was used to appraise quality of cohort and case-control studies. Effect estimates were presented as HRs with 95% CIs in a meta-analysis using STATA V.16.0. Data not suitable for pooling were synthesised qualitatively. RESULTS Fourteen cohort studies with 24 022 patients were included. No case-control studies were identified. For prospective cohort studies, pooled results for the highest SUA category were significantly greater than the lowest for all-cause (one study; 1278participants; HR 1.79; 95% CI 1.17 to 2.75) and CV mortality (one study; 1278 participants; HR 2.63; 1.62-4.27). An increase of 1 mg/dL in SUA level was associated with a 16% increased risk of all-cause mortality (one study; 1278 participants; HR 1.16; 1.03-1.32) and 34% increased CV mortality risk (one study; 1278 participants; HR 1.34; 1.16-1.55). For retrospective cohort studies, the highest SUA category did not demonstrate an elevated all-cause (five studies; 4570 participants; HR 1.09; 0.70-1.70) or CV mortality (three studies; 3748 participants; HR 1.00; 0.44-2.31) compared with the lowest SUA category. Additionally, there was no increase in all-cause (eight studies; 11 541 participants; HR 0.94; 0.88-1.02) or CV mortality (three studies; 7427 participants; HR 0.90; 0.76-1.06) for every 1 mg/dL increase in SUA level. CONCLUSIONS Results of prospective and retrospective cohort studies were inconsistent. Consequently, prospective, multicentre, long-term follow-up studies are required to confirm the relationship between SUA and mortality in patients with PD.
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Affiliation(s)
- Xue Xue
- First Clinical College and Affiliated Hospital, Hubei University of Traditional Chinese Medicine, Wuhan, China
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Chun-Li Lu
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Xin-Yan Jin
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Xue-Han Liu
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Min Yang
- Basic Medical School, Hubei University of Traditional Chinese Medicine, Wuhan, China
| | - Xiao-Qin Wang
- Department of Nephrology, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, China
| | - Hong Cheng
- Department of Nephrology, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, China
| | - Jun Yuan
- Department of Nephrology, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, China
| | - Qiang Liu
- Department of Cardiology, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, China
| | - Ruo-Xiang Zheng
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Nicola Robinson
- Institute of Health and Social Care, London South Bank University, London, UK
| | - Jian-Ping Liu
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
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15
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He S, Xiong Q, Tian C, Li L, Zhao J, Lin X, Guo X, He Y, Liang W, Zuo X, Ying C. Inulin-type prebiotics reduce serum uric acid levels via gut microbiota modulation: a randomized, controlled crossover trial in peritoneal dialysis patients. Eur J Nutr 2021; 61:665-677. [PMID: 34491388 DOI: 10.1007/s00394-021-02669-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 08/31/2021] [Indexed: 12/19/2022]
Abstract
PURPOSE Increased levels of uric acid (UA), which is mainly excreted through the kidneys, are independently associated with higher mortality in end-stage renal disease (ESRD) patients. The uricolysis of gut microbiota plays an important role in extrarenal excretion of UA. This study aimed to examine the effect of inulin-type prebiotics (a type of fermentable dietary fiber) on intestinal microbiota modulation and serum UA levels in ESRD patients. METHODS Continuous ambulatory peritoneal dialysis (CAPD) patients were recruited to a randomized, double-blind, placebo-controlled crossover trial of 12-week inulin-type prebiotics. Participants were visited before and after treatment with prebiotics or placebo. Serum UA levels, dietary purine intake, serum xanthine oxidase (XO) activity, daily "renal excretion" of UA, and fecal UA degradation capability were measured at each visit. Fecal metagenomic analysis was conducted to assess microbial composition and function. RESULTS Sixteen participants (mean age = 37 y; 10 men and 6 women) completed the trial, and 64 specimens were analyzed. The average concentration of serum UA decreased by approximately 10% in the prebiotic intervention group in comparison to the placebo group (p = 0.047) without an increase in daily "renal excretion" of UA via urine and dialysate. There were no significant changes in purine intake or activity of XO. Notably, enhanced fecal UA degradation was observed after prebiotic intervention (p = 0.041), and the ratio of Firmicutes/Bacteroidetes, which was positively associated with fecal UA degradation, increased in the prebiotic period (p = 0.032). Furthermore, prebiotics enriched purine-degrading species in the gut microbiota, including unclassified_o_Clostridiales, Clostridium sp. CAG:7, Clostridium sp. FS41, Clostridium citroniae, Anaerostipes caccae, and Clostridium botulinum. CONCLUSIONS Inulin-type prebiotics is a promising therapeutic candidate to reduce serum UA levels in renal failure patients, and this urate-lowering effect could possibly be attributed to intestinal microbial degradation of UA. TRIAL REGISTRY This study was registered at the Chinese Clinical Trials Registry ( http://www.chictr.org.cn/ ), registration ID: ChiCTR-INR-17013739, registration date: 6th Dec 2017.
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Affiliation(s)
- Shuiqing He
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Qianqian Xiong
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Chong Tian
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Li Li
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Jing Zhao
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Xuechun Lin
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Xiaolei Guo
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Yuqin He
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Wangqun Liang
- Department of Nephrology, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xuezhi Zuo
- Department of Clinical Nutrition, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, No. 1095 Jiefang Road, Wuhan, 430030, Hubei, China.
| | - Chenjiang Ying
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan, 430030, Hubei, China.
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16
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Huang G, Wang Y, Shi Y, Ma X, Tao M, Zang X, Qi Y, Qiao C, Du L, Sheng L, Zhuang S, Liu N. The prognosis and risk factors of baseline high peritoneal transporters on patients with peritoneal dialysis. J Cell Mol Med 2021; 25:8628-8644. [PMID: 34309202 PMCID: PMC8435427 DOI: 10.1111/jcmm.16819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 07/09/2021] [Accepted: 07/13/2021] [Indexed: 11/30/2022] Open
Abstract
The relationship between baseline high peritoneal solute transport rate (PSTR) and the prognosis of peritoneal dialysis (PD) patients remains unclear. The present study combined clinical data and basic experiments to investigate the impact of baseline PSTR and the underlying molecular mechanisms. A total of 204 incident CAPD patients from four PD centres in Shanghai between 1 January 2014 and 30 September 2020 were grouped based on a peritoneal equilibration test after the first month of dialysis. Analysed with multivariate Cox and logistic regression models, baseline high PSTR was a significant risk factor for technique failure (AHR 5.70; 95% CI 1.581 to 20.548 p = 0.008). Baseline hyperuricemia was an independent predictor of mortality (AHR 1.006 95%CI 1.003 to 1.008, p < 0.001) and baseline high PSTR (AOR 1.007; 95%CI 1.003 to 1.012; p = 0.020). Since uric acid was closely related to high PSTR and adverse prognosis, the in vitro experiments were performed to explore the underlying mechanisms of which uric acid affected peritoneum. We found hyperuricemia induced epithelial‐to‐mesenchymal transition (EMT) of cultured human peritoneal mesothelial cells by activating TGF‐β1/Smad3 signalling pathway and nuclear transcription factors. Conclusively, high baseline PSTR induced by hyperuricaemia through EMT was an important reason of poor outcomes in CAPD patients.
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Affiliation(s)
- Guansen Huang
- Department of Nephrology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yi Wang
- Department of Nephrology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yingfeng Shi
- Department of Nephrology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiaoyan Ma
- Department of Nephrology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Min Tao
- Department of Nephrology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiujuan Zang
- Department of Nephrology, Shanghai Songjiang District Central Hospital, Shanghai, China
| | - Yinghui Qi
- Department of Nephrology, Shanghai Punan Hospital, Shanghai, China
| | - Cheng Qiao
- Department of Nephrology, Shanghai Punan Hospital, Shanghai, China
| | - Lin Du
- Department of Nephrology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Lili Sheng
- Department of Nephrology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Shougang Zhuang
- Department of Nephrology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.,Department of Medicine, Rhode Island Hospital and Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Na Liu
- Department of Nephrology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
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17
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Chen J, Zhong Z, Shi D, Li J, Li B, Zhang R, Zhang P, Huang N, Mao H, Li Z. Association between monocyte count to high-density lipoprotein cholesterol ratio and mortality in patients undergoing peritoneal dialysis. Nutr Metab Cardiovasc Dis 2021; 31:2081-2088. [PMID: 34039506 DOI: 10.1016/j.numecd.2021.03.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 01/25/2021] [Accepted: 03/15/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND AIMS Previous studies had demonstrated that elevated monocyte count to high-density lipoprotein cholesterol ratio (MHR), a novel marker of inflammation, was associated with higher cardiovascular events and mortality in patients with pre-dialysis chronic kidney disease, diabetes, and coronary heart disease. However, the association between MHR and mortality in patients undergoing peritoneal dialysis (PD) has received little attention. The aim of this study was to investigate the association between MHR and all-cause and cardiovascular mortality in PD patients. METHODS AND RESULTS In this single center retrospective cohort study, PD patients who had catheter insertion in our PD center from January 1, 2006 to December 31, 2016 were enrolled. All patients were divided into three groups according to the tertiles of baseline MHR levels and followed up until December 31, 2018. The associations of MHR levels with all-cause and cardiovascular mortality were assessed by using Cox proportional hazards models. Of 1584 patients, mean age was 46.02 ± 14.65 years, 60.1% were male, and 24.2% had diabetes. The mean MHR level was 0.39 ± 0.23. During a median follow up time of 45.6 (24.6-71.8) months, 349 patients died, and 181 deaths were caused by cardiovascular disease. After adjusting for confounders, the highest MHR tertile was significantly associated with all-cause and cardiovascular mortality with a hazard ratio of 1.43 (95%CI = 1.06-1.93, P = 0.019), 1.54 (95%CI = 1.01-2.35, P = 0.046), respectively. CONCLUSION Higher MHR level was an independent risk factor for all-cause and cardiovascular mortality in PD patients.
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Affiliation(s)
- Jiasi Chen
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510080, China; Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, Guangdong, 510080, China
| | - Zhong Zhong
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510080, China; Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, Guangdong, 510080, China
| | - Dianchun Shi
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510080, China; Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, Guangdong, 510080, China; Department of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, 510080, China
| | - Jianbo Li
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510080, China; Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, Guangdong, 510080, China
| | - Bin Li
- Clinical Trials Unit, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510080, China
| | - Rui Zhang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510080, China; Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, Guangdong, 510080, China
| | - Puhua Zhang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510080, China; Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, Guangdong, 510080, China
| | - Naya Huang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510080, China; Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, Guangdong, 510080, China
| | - Haiping Mao
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510080, China; Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, Guangdong, 510080, China
| | - Zhijian Li
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510080, China; Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, Guangdong, 510080, China.
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18
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Correlation analysis of low-level serum uric acid and cardiovascular events in patients on peritoneal dialysis. Int Urol Nephrol 2021; 53:2399-2408. [PMID: 34101100 PMCID: PMC8186020 DOI: 10.1007/s11255-021-02902-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 05/25/2021] [Indexed: 12/16/2022]
Abstract
Background The impact of serum uric acid (SUA) on development of cardiovascular disease (CVD) in patients undergoing peritoneal dialysis (PD) remains controversial, especially the impact of hypouricemia (HUA) on CVD. The aim of our study was to investigate the influence of low-level SUA on cardiovascular (CV) events in PD patients. Methods A retrospective cohort study was conducted.728 PD patients from February 1, 2010 to May 31, 2019 were enrolled. All demographic and laboratory data were collected at baseline and 6 months after PD treatment. The study cohort was divided into four groups according to SUA level (μmol/L) after 6 months of PD: Group1 (< 360), Group2 (360–420), Group3 (420–480), Group4 (≥ 480). The clinical characteristics of each group were analyzed. With Group2 as reference, logistic regression analysis was performed to investigate the correlation between SUA levels and risk of CV events in patients undergoing PD. Use Kaplan–Meier method to generate CV events risk graph. Results 728 patients were enrolled in this study, including 403 (55.4%) males and 325 (44.6%) females, with an average age of 48.66 ± 13.98 years; of which 158 (21.7%) patients developed CV events. Multivariate COX regression showed that after adjusting for multiple clinical factors, Group1 (HR = 1.92, 95% CI 1.17–3.15, P = 0.01), Group3 (HR = 1.89, 95% CI 1.13–3.15, P = 0.015), and Group4 (HR = 2.38, 95% CI 1.35–4.19, P = 0.003) are all independent risk factors for developing CV events. The Kaplan–Meier risk curve of CV events showed that the risk of CV events in the Group1, Group3 and Group4 were significantly higher (Log-Rank = 12.67; P = 0.005). Restricted cubic spline (RCS) showed that SUA level is non-linearly associated with the risk of CV events, showing an U-shaped curve (\documentclass[12pt]{minimal}
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\begin{document}$$\chi_{4}^{2}$$\end{document}χ42=13.3 P = 0.01). Conclusions Our study suggested that patients with SUA level less than 360 μmol/L also exhibited the higher risk for developing CV events, an U-shaped association between SUA level and risk of CV events in patients undergoing PD. Both SUA levels below 360 μmol/L and above 420 μmol/L were found to be significant risk factors for developing CV events in patients undergoing long-term PD.
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19
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Tian X, Wang A, Zuo Y, Chen S, Zhang L, Wu S, Luo Y. Visit-to-visit variability of serum uric acid measurements and the risk of all-cause mortality in the general population. Arthritis Res Ther 2021; 23:74. [PMID: 33663587 PMCID: PMC7931538 DOI: 10.1186/s13075-021-02445-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 02/11/2021] [Indexed: 11/16/2022] Open
Abstract
Background Evidence on longitudinal variability of serum uric acid (SUA) and risk of all-cause mortality in the general population is limited, as many prior studies focused on a single measurement of SUA. Methods A total of 53,956 participants in the Kailuan study who underwent three health examinations during 2006 to 2010 were enrolled. Variability of SUA was measured using the coefficient of variation (primary index), standard deviation, average real variability, and variability independent of the mean. Cox proportional hazard regressions were used to calculate the hazard ratio (HR) and 95% confidence interval (CI) for the association of variability of SUA with subsequent risk of all-cause mortality, considering its magnitude and the direction and across different baseline SUA categories. Results Over a median follow-up of 7.04 years, 2728 participants died. The highest variability of SUA was associated with an increased risk of all-cause mortality, the HR was 1.33 (95% CI, 1.20–1.49) compared with the lowest variability. In this group, both a large fall (HR, 1.28; 95% CI, 1.14–1.44) and rise (HR, 1.18; 95% 1.05–1.32) in SUA were related to risk of all-cause mortality. These associations were similar across different baseline SUA categories. Consistent results were observed in alternative measures of SUA variability. Moreover, individuals with higher variability in SUA were more related to common risk factors than those with stable SUA. Conclusions Higher variability in SUA was independently associated with the risk of all-cause mortality irrespective of baseline SUA and direction of variability in the general population.
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Affiliation(s)
- Xue Tian
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No.10 Xitoutiao, You'anmen Wai, Fengtai District, Beijing, 100069, China.,Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Anxin Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yingting Zuo
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No.10 Xitoutiao, You'anmen Wai, Fengtai District, Beijing, 100069, China.,Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Shuohua Chen
- Department of Cardiology, Kailuan Hospital, North China University of Science and Technology, 57 Xinhua East Rd, Tangshan, 063000, China
| | - Licheng Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No.10 Xitoutiao, You'anmen Wai, Fengtai District, Beijing, 100069, China.,Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Shouling Wu
- Department of Cardiology, Kailuan Hospital, North China University of Science and Technology, 57 Xinhua East Rd, Tangshan, 063000, China.
| | - Yanxia Luo
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No.10 Xitoutiao, You'anmen Wai, Fengtai District, Beijing, 100069, China. .,Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China.
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20
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Liu R, Peng Y, Wu H, Diao X, Ye H, Huang X, Yi C, Mao H, Huang F, Yu X, Yang X. Uric acid to high-density lipoprotein cholesterol ratio predicts cardiovascular mortality in patients on peritoneal dialysis. Nutr Metab Cardiovasc Dis 2021; 31:561-569. [PMID: 33223397 DOI: 10.1016/j.numecd.2020.10.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 10/05/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Serum uric acid (UA) and high-density lipoprotein cholesterol (HDL-C) disorders are both considered as risk factors of cardiovascular mortality. The predictive value of UA to HDL-C ratio (UHR) has been validated in diabetes. However, association of UHR with cardiovascular (CV) mortality is undetermined in peritoneal dialysis (PD) patients. METHODS AND RESULTS In this retrospective cohort study, we enrolled 1953 eligible incident patients who commenced PD treatment on our hospital from January 1, 2006 to December 31, 2015, and followed up until December 31, 2019. Of the participants, 14.9% were older than 65 years (mean age 47.3 ± 15.2 years), 24.6% were diabetics, and 59.4% were male. Patients were categorized into quartiles according to baseline UHR level. Multivariate Cox Proportional Regression analysis was applied to explore the association of UHR with mortality. Overall, 567 patients died during a median follow-up period of 61.3 months, of which 274 (48.3%) were attributed to CV death. The mean baseline UHR was 16.4 ± 6.7%. Compared to quartile 2 UHR, hazard ratios (HRs) for the highest quartile UHR were 1.35 (95% confidence interval [CI] 1.06-1.78; P = 0.017) and 1.46 (95% CI 1.00-2.12; P = 0.047) for all-cause and CV mortality, respectively. Subgroup analysis showed that association of UHR with CV mortality was remarkable among PD patients with age ≥65 years, malnutrition (albumin <35 g/L), diabetes, and CVD history. CONCLUSIONS An elevated UHR predicted increased risk of all-cause and CV mortality in PD patients.
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Affiliation(s)
- Ruihua Liu
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China; Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, 510080, China
| | - Yuan Peng
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China; Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, 510080, China
| | - Haishan Wu
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China; Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, 510080, China
| | - Xiangwen Diao
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China; Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, 510080, China
| | - Hongjian Ye
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China; Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, 510080, China
| | - Xuan Huang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China; Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, 510080, China
| | - Chunyan Yi
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - Haiping Mao
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China; Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, 510080, China
| | - Fengxian Huang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China; Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, 510080, China
| | - Xueqing Yu
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China; Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, 510080, China
| | - Xiao Yang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China; Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, 510080, China.
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21
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Chao CT, Lin SH. Uremic Vascular Calcification: The Pathogenic Roles and Gastrointestinal Decontamination of Uremic Toxins. Toxins (Basel) 2020; 12:toxins12120812. [PMID: 33371477 PMCID: PMC7767516 DOI: 10.3390/toxins12120812] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/11/2020] [Accepted: 12/11/2020] [Indexed: 12/16/2022] Open
Abstract
Uremic vascular calcification (VC) commonly occurs during advanced chronic kidney disease (CKD) and significantly increases cardiovascular morbidity and mortality. Uremic toxins are integral within VC pathogenesis, as they exhibit adverse vascular influences ranging from atherosclerosis, vascular inflammation, to VC. Experimental removal of these toxins, including small molecular (phosphate, trimethylamine-N-oxide), large molecular (fibroblast growth factor-23, cytokines), and protein-bound ones (indoxyl sulfate, p-cresyl sulfate), ameliorates VC. As most uremic toxins share a gut origin, interventions through gastrointestinal tract are expected to demonstrate particular efficacy. The “gastrointestinal decontamination” through the removal of toxin in situ or impediment of toxin absorption within the gastrointestinal tract is a practical and potential strategy to reduce uremic toxins. First and foremost, the modulation of gut microbiota through optimizing dietary composition, the use of prebiotics or probiotics, can be implemented. Other promising strategies such as reducing calcium load, minimizing intestinal phosphate absorption through the optimization of phosphate binders and the inhibition of gut luminal phosphate transporters, the administration of magnesium, and the use of oral toxin adsorbent for protein-bound uremic toxins may potentially counteract uremic VC. Novel agents such as tenapanor have been actively tested in clinical trials for their potential vascular benefits. Further advanced studies are still warranted to validate the beneficial effects of gastrointestinal decontamination in the retardation and treatment of uremic VC.
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Affiliation(s)
- Chia-Ter Chao
- Nephrology Division, Department of Medicine, National Taiwan University Hospital BeiHu Branch, Taipei 10845, Taiwan;
- Graduate Institute of Toxicology, National Taiwan University College of Medicine, Taipei 100233, Taiwan
- Nephrology Division, Department of Internal Medicine, National Taiwan University College of Medicine, Taipei 100233, Taiwan
| | - Shih-Hua Lin
- Department of Internal Medicine, Tri-Service General Hospital and National Defense Medical Center, Taipei 11490, Taiwan
- Correspondence:
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22
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Xiao X, Yi C, Peng Y, Ye H, Wu H, Wu M, Huang X, Yu X, Yang X. The Association between Serum Uric Acid and Appendicular Skeletal Muscle Mass and the Effect of Their Interaction on Mortality in Patients on Peritoneal Dialysis. Kidney Blood Press Res 2020; 45:969-981. [PMID: 33190132 DOI: 10.1159/000510746] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 08/06/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Serum uric acid (SUA) has been revealed to be positively associated with the body composition parameters in hemodialysis patients, but few studies have investigated that in patients on peritoneal dialysis (PD). The aim of this study was to identify the relationship between SUA and appendicular skeletal muscle mass (ASM) and the effect of their interaction on mortality in PD patients. METHODS This was a single-center retrospective cohort study. Patients who underwent multifrequency bioelectrical impedance analysis between January 1, 2013, and December 31, 2016, and had data on SUA values were enrolled. All patients were followed up until December 31, 2019. RESULTS In total, 802 prevalent PD patients (57.9% male), with mean age of 46.2 ± 14.2 years were enrolled. The average SUA and ASM were 6.8 ± 1.3 mg/dL and 21.2 ± 4.9 kg. According to multiple linear regression models, SUA was positively associated with relative ASM in middle-aged and older PD patients (standardized coefficients [β] 0.117; 95% confidence interval [CI] 0.027, 0.200; p = 0.010). Further sex-stratified analysis showed that the association existed only in males (β 0.161; 95% CI 0.017, 0.227; p = 0.023). Moreover, the presence of hyperuricemia was found to predict lower risk of all-cause mortality (hazard ratio [HR] 0.514, 95% CI 0.272, 0.970; p = 0.040) only in patients with lower relative ASM. And, the adjusted HR of every 1 mg/dL elevated SUA level was 0.770 (95% CI 0.609, 0.972; p = 0.028) for all-cause mortality in the lower relative ASM subgroup. CONCLUSIONS There exists a positive association between the SUA and ASM, and the ASM significantly affected the association between SUA and all-cause PD mortality.
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Affiliation(s)
- Xi Xiao
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Nephrology, Committee of Health and Guangdong Province, Guangzhou, China
| | - Chunyan Yi
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Nephrology, Committee of Health and Guangdong Province, Guangzhou, China
| | - Yuan Peng
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Nephrology, Committee of Health and Guangdong Province, Guangzhou, China
| | - Hongjian Ye
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Nephrology, Committee of Health and Guangdong Province, Guangzhou, China
| | - Haishan Wu
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Nephrology, Committee of Health and Guangdong Province, Guangzhou, China
| | - Meiju Wu
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Nephrology, Committee of Health and Guangdong Province, Guangzhou, China
| | - Xuan Huang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Nephrology, Committee of Health and Guangdong Province, Guangzhou, China
| | - Xueqing Yu
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Nephrology, Committee of Health and Guangdong Province, Guangzhou, China
| | - Xiao Yang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China, .,Key Laboratory of Nephrology, Committee of Health and Guangdong Province, Guangzhou, China,
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23
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Yang Y, Qin X, Li Y, Yang S, Chen J, He Y, Huang Y, Lin Z, Li Y, Kong Y, Lu Y, Zhao Y, Wan Q, Wang Q, Huang S, Liu Y, Liu A, Liu F, Hou FF, Liang M. Relationship between Serum Uric Acid and Mortality Risk in Hemodialysis Patients: A Multicenter Prospective Cohort Study. Am J Nephrol 2020; 51:823-832. [PMID: 33070128 DOI: 10.1159/000509258] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 06/08/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Several studies have reported that low serum uric acid (SUA) levels are related to increased risk of mortality in maintenance hemodialysis (MHD) patients. However, the possible detrimental effects of high SUA on the mortality risk have not been well examined. Moreover, the possible effect modifiers for the SUA-mortality association have not been fully investigated. To address the aforementioned gap, we aimed to explore the nonlinear relationship between SUA levels and all-cause and cardiovascular disease (CVD) mortality risk, and to examine any possible effect modifiers in MHD patients. METHODS We conducted a multicenter, prospective cohort study among 1,018 MHD patients from 8 hemodialysis centers. The primary outcome was all-cause mortality, and the secondary outcomes were CVD mortality and non-CVD mortality. RESULTS The mean value for SUA in the total population was 8.5 ± 1.9 mg/dL. The lowest and highest quintiles of SUA were <7.0 and >10.1 mg/dL, respectively. Over a median follow-up of 45.6 months, 343 deaths were recorded, of which 202 (58.9%) were due to CVD. When SUA was assessed as quintiles, a significantly higher risk of all-cause mortality was found in patients in quintile 1 (<7.0 mg/dL; hazard ratio [HR], 1.33; 95% confidence interval [CI]: 1.02-1.73) or quintile 5 (≥10.1 mg/dL; HR, 1.47; 95% CI: 1.09-2.00), compared to those in quintiles 2-4 (7-10.1 mg/dL). Moreover, the U-shaped SUA-mortality association was mainly found in those with lower C-reactive protein levels (<3 compared with ≥3 mg/L; p for interaction = 0.018). Similar trends were found for CVD mortality and non-CVD mortality. CONCLUSION There was a U-shaped relationship between SUA levels and the risk of all-cause mortality, CVD mortality, and non-CVD mortality in MHD patients.
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Affiliation(s)
- Yaya Yang
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xianhui Qin
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yumin Li
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Shenglin Yang
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Junzhi Chen
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yanhuan He
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yan Huang
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zizhen Lin
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Youbao Li
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yaozhong Kong
- The First People's Hospital of Foshan, Foshan, China
| | - Yongxin Lu
- People's Hospital of Yuxi City, Yuxi, China
| | | | - Qijun Wan
- Shenzhen Second People's Hospital, Shenzhen, China
| | - Qi Wang
- Huadu District People's Hospital of Guangzhou, Guangzhou, China
| | - Sheng Huang
- Southern Medical University Affiliated Nanhai Hospital, Foshan, China
| | - Yan Liu
- Nephrology Department, Guangzhou Red Cross Hospital, Medical College of Jinan University, Guangzhou, China
| | - Aiqun Liu
- The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Fanna Liu
- Jinan University First Affiliated Hospital, Guangzhou, China
| | - Fan Fan Hou
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Min Liang
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China,
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24
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Chen W, Huang N, Mao H, Yang X, Zhou Q, Jiang L, Ding J, Feng Q, Yu X. Rationale and design for Lowering-hyperUricaemia treatment on cardiovascular outcoMes In peritoNeal diAlysis patients: a prospective, multicentre, double-blind, randomised controlled trial (LUMINA). BMJ Open 2020; 10:e037842. [PMID: 33040002 PMCID: PMC7552848 DOI: 10.1136/bmjopen-2020-037842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION The prevalence of hyperuricaemia in peritoneal dialysis patients is quite high. Studies have demonstrated a correlation between hyperuricaemia and cardiovascular disease and treatment of hyperuricaemia reportedly reduces cardiovascular risk in patients with chronic kidney disease. However, whether hyperuricaemia treatment benefits cardiovascular outcomes in continuous ambulatory peritoneal dialysis (CAPD) patients is not yet known. METHODS AND ANALYSES This prospective, multicentre, double-blind, randomised controlled trial was designed to evaluate the effects of hyperuricaemia treatment on cardiovascular event risk in CAPD patients. Based on a power of 80%, with type I error α=0.05, two-sided test and 1:1 parallel control study, considering a dropout rate of 20%, a total of 548 eligible patients are expected to be randomly assigned to either the hyperuricaemia treatment group (febuxostat) or control group (placebo). ETHICS AND DISSEMINATION This study has been approved by the Medical Ethics Committee of the First Affiliated Hospital, Sun Yat-sen University and the ethics committees of other participating institutions. Written informed consent will be obtained from potential trial participants or authorised surrogates.The findings of the study will be disseminated through publications in peer-reviewed journals, and presentations at national and international conferences. TRIAL REGISTRATION NUMBER NCT03200210. 25 June 2017. The trial was started on 13 July 2017, and is expected to end by 31 December 2022. Till 20 Jan 2020, a total of 548 patients have been recruited. PROTOCOL VERSION The protocol version number and date are YLT-1604-V2.0 and 15 December 2016.
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Affiliation(s)
- Wei Chen
- Department of Nephrology, Sun Yat-sen University First Affiliated Hospital,National Health Commission Key Laboratory of Nephrology (Sun Yat-sen University), Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, Guangdong, China
| | - Naya Huang
- Department of Nephrology, Sun Yat-sen University First Affiliated Hospital,National Health Commission Key Laboratory of Nephrology (Sun Yat-sen University), Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, Guangdong, China
| | - Haiping Mao
- Department of Nephrology, Sun Yat-sen University First Affiliated Hospital,National Health Commission Key Laboratory of Nephrology (Sun Yat-sen University), Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, Guangdong, China
| | - Xiao Yang
- Department of Nephrology, Sun Yat-sen University First Affiliated Hospital,National Health Commission Key Laboratory of Nephrology (Sun Yat-sen University), Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, Guangdong, China
| | - Qian Zhou
- Department of Medical Statistics, Clinical Trials Unit, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China
| | - Lanping Jiang
- Department of Nephrology, Sun Yat-sen University First Affiliated Hospital,National Health Commission Key Laboratory of Nephrology (Sun Yat-sen University), Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, Guangdong, China
| | - Jun Ding
- Medical Department, Wanbang Pharmaceutical Marketing and Distribution Co, Shanghai, China
| | - Qiong Feng
- Department of Nephrology, Sun Yat-sen University First Affiliated Hospital,National Health Commission Key Laboratory of Nephrology (Sun Yat-sen University), Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, Guangdong, China
| | - Xueqing Yu
- Department of Nephrology, Sun Yat-sen University First Affiliated Hospital,National Health Commission Key Laboratory of Nephrology (Sun Yat-sen University), Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, Guangdong, China
- Department of Nephrology, Guangdong Provincial People's Hospital, Guangzhou, Guangdong, China
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25
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Harada M, Fujii K, Yamada Y, Tsukada W, Tsukada M, Hashimoto K, Kamijo Y. Relationship between serum uric acid level and vascular injury markers in hemodialysis patients. Int Urol Nephrol 2020; 52:1581-1591. [PMID: 32557375 DOI: 10.1007/s11255-020-02531-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 06/01/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE It has been reported that hyperuricemia causes vascular endothelial injury. Most hemodialysis patients present with hyperuricemia and also with vascular injury, resulting in cardiovascular diseases (CVD). However, the association of serum uric acid (sUA) with vascular injury markers in hemodialysis patients remains unclear. This study aimed to investigate this and discuss the mechanism by which uric acid causes vascular injury. METHODS We enrolled 48 Japanese maintenance hemodialysis patients without any history of CVD. The association between sUA level and three vascular injury markers (reactive hyperemia index [RHI], ankle-brachial index [ABI], and cardio ankle vascular index [CAVI]) was investigated by linear- and logistic regression analyses. RESULTS The median natural logarithm RHI (LnRHI) was 0.36. Linear regression analysis revealed a significant positive correlation between sUA level and LnRHI (β = 0.42, p = 0.001) in all patients. Moreover, a significant, strongly positive correlation was observed between sUA and LnRHI in patients who were treated with xanthine oxidase inhibitors (XOIs) (β = 0.75, p = 0.001). Further, the linear analysis showed a significant negative correlation between sUA level and CAVI in patients who were treated with XOIs (β = - 0.52, p = 0.049). sUA level was not significantly associated with ABI abnormality. CONCLUSIONS It is possible that a high level of sUA is significantly associated with better vascular endothelial function and condition of vascular tone in hemodialysis patients who were treated with XOIs. The findings suggest a significant paradox between sUA level and vascular endothelial function in hemodialysis patients; however, the opposite has been reported in patients without hemodialysis.
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Affiliation(s)
- Makoto Harada
- Department of Nephrology, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, 390-8621, Japan. .,Department of Nephrology and Urology, Jisyukai Ueda Kidney Clinic, 322 Sumiyoshi, Ueda, 386-0002, Japan.
| | - Kazuaki Fujii
- Department of Nephrology, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, 390-8621, Japan.,Department of Nephrology and Urology, Jisyukai Ueda Kidney Clinic, 322 Sumiyoshi, Ueda, 386-0002, Japan
| | - Yosuke Yamada
- Department of Nephrology, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, 390-8621, Japan.,Department of Nephrology and Urology, Jisyukai Ueda Kidney Clinic, 322 Sumiyoshi, Ueda, 386-0002, Japan
| | - Wataru Tsukada
- Department of Nephrology and Urology, Jisyukai Ueda Kidney Clinic, 322 Sumiyoshi, Ueda, 386-0002, Japan
| | - Manabu Tsukada
- Department of Nephrology and Urology, Jisyukai Ueda Kidney Clinic, 322 Sumiyoshi, Ueda, 386-0002, Japan
| | - Koji Hashimoto
- Department of Nephrology, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, 390-8621, Japan
| | - Yuji Kamijo
- Department of Nephrology, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, 390-8621, Japan
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26
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Sugano N, Maruyama Y, Ohno I, Wada A, Shigematsu T, Masakane I, Yokoo T, Nitta K. Effect of uric acid levels on mortality in Japanese peritoneal dialysis patients. Perit Dial Int 2020; 41:320-327. [DOI: 10.1177/0896860820929476] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Background: Unlike the situation in the general population, most studies of patients receiving hemodialysis have reported lower uric acid (UA) as associated with higher mortality. However, the relationship between UA level and mortality remains unclear among patients receiving peritoneal dialysis (PD). Methods: We collected baseline data for 4742 prevalent PD patients (age, 63 ± 14 years; male, 61.5%; diabetes, 29.1%; median dialysis duration, 28 months) from a nationwide dialysis registry in Japan at the end of 2012. One-year all-cause and cardiovascular (CV) mortality and mortality caused by infectious disease were assessed using Cox regression analysis and competing-risks regression analysis, respectively. We used multiple imputation to deal with missing covariate data. Results: Within 1 year, 379 patients (8.0%) died, including 129 patients (2.7%) from CV causes and 95 patients (2.0%) from infectious disease. In multivariate analysis, serum UA, treated as a continuous variable, was not associated with any outcome. Conversely, both lower (<297 µmol/L) and higher (≥476 µmol/L) UA levels were independently associated with higher all-cause mortality compared to the reference group (416 to <446 µmol/L) in analyses where serum UA was treated as a categorical variable. Body mass index (BMI) affected the association between serum UA and all-cause mortality (interaction p = 0.049). Conclusions: A U-shaped relationship appears to exist between UA levels and all-cause mortality among Japanese PD patients. Additionally, lower BMI significantly enhanced the effect of UA levels on mortality.
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Affiliation(s)
- Naoki Sugano
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Yukio Maruyama
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
- Committee of Renal Data Registry, Japanese Society for Dialysis Therapy, Tokyo, Japan
| | - Iwao Ohno
- Division of General Medicine, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Atsushi Wada
- Committee of Renal Data Registry, Japanese Society for Dialysis Therapy, Tokyo, Japan
| | - Takashi Shigematsu
- Committee of Renal Data Registry, Japanese Society for Dialysis Therapy, Tokyo, Japan
| | - Ikuto Masakane
- Committee of Renal Data Registry, Japanese Society for Dialysis Therapy, Tokyo, Japan
| | - Takashi Yokoo
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Kosaku Nitta
- Committee of Renal Data Registry, Japanese Society for Dialysis Therapy, Tokyo, Japan
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27
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Xia X, Qiu Y, Yu J, Lin T, Lu M, Yi C, Lin J, Ye H, Chen W, Mao H, Yang X, Huang F. Ten-year survival of patients treated with peritoneal dialysis: A prospective observational cohort study. Perit Dial Int 2020; 40:573-580. [PMID: 32489134 DOI: 10.1177/0896860820927534] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Few studies evaluated over 5-year outcomes of dialysis patients. This study examined 10-year all-cause mortality and death-censored technique failure in a cohort of incident peritoneal dialysis (PD) individuals. METHODS Five hundred and thirty-three incident PD individuals from 2006 to 2008 were prospectively followed up for more than 10 years until 2018. Clinical characteristics at PD initiation were collected. The primary outcome was all-cause mortality, and the secondary outcome was death-censored technique failure. Cox hazards models were fit using clinical characteristics at PD initiation. RESULTS The mean age starting PD for these participants was 48 ± 16 years; 130 (24%) patients had diabetic nephropathy. During follow-up, 208 patients died, and 84 patients experienced technique failures. The 1, 3, 5, and 10 years' survival rates for incident PD patients were 93%, 81%, 64%, and 36%, respectively, and the technical survival rates were 98%, 93%, 85%, and 62%, respectively. Mortality risk was much higher after 3 years on PD. The peritonitis rate was 0.19 episodes per patient-year, and 7 (1.3%) patients had encapsulating peritoneal sclerosis (EPS) giving an incidence rate of 3.1 of 1000 patient-years. The main causes of death were cardiovascular events (97 of 208, 47%), and technique failure was mainly due to peritonitis (41 of 84, 49%). Older age, higher Charlson comorbidity index, and lower level of education were strongly associated with mortality, and diabetic nephropathy was an independent risk factor for technique failure. CONCLUSIONS The 10-year's survival and technique survival rates of incident PD patients were 36% and 62%. Long-term PD can be continued successfully with improved outcomes and low risk for EPS.
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Affiliation(s)
- Xi Xia
- 196531Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China.,Key Laboratory of Nephrology, National Health Commission of China and Guangdong Province, Guangzhou, People's Republic of China
| | - Yagui Qiu
- 196531Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China.,Key Laboratory of Nephrology, National Health Commission of China and Guangdong Province, Guangzhou, People's Republic of China
| | - Jing Yu
- 196531Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China.,Key Laboratory of Nephrology, National Health Commission of China and Guangdong Province, Guangzhou, People's Republic of China
| | - Tong Lin
- 196531Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China.,Key Laboratory of Nephrology, National Health Commission of China and Guangdong Province, Guangzhou, People's Republic of China
| | - Miaoqing Lu
- 196531Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China.,Key Laboratory of Nephrology, National Health Commission of China and Guangdong Province, Guangzhou, People's Republic of China
| | - Chunyan Yi
- 196531Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China.,Key Laboratory of Nephrology, National Health Commission of China and Guangdong Province, Guangzhou, People's Republic of China
| | - Jianxiong Lin
- 196531Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China.,Key Laboratory of Nephrology, National Health Commission of China and Guangdong Province, Guangzhou, People's Republic of China
| | - Hongjian Ye
- 196531Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China.,Key Laboratory of Nephrology, National Health Commission of China and Guangdong Province, Guangzhou, People's Republic of China
| | - Wei Chen
- 196531Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China.,Key Laboratory of Nephrology, National Health Commission of China and Guangdong Province, Guangzhou, People's Republic of China
| | - Haiping Mao
- 196531Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China.,Key Laboratory of Nephrology, National Health Commission of China and Guangdong Province, Guangzhou, People's Republic of China
| | - Xiao Yang
- 196531Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China.,Key Laboratory of Nephrology, National Health Commission of China and Guangdong Province, Guangzhou, People's Republic of China
| | - Fengxian Huang
- 196531Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China.,Key Laboratory of Nephrology, National Health Commission of China and Guangdong Province, Guangzhou, People's Republic of China
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28
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Xiao X, Ye H, Yi C, Lin J, Peng Y, Huang X, Wu M, Wu H, Mao H, Yu X, Yang X. Roles of peritoneal clearance and residual kidney removal in control of uric acid in patients on peritoneal dialysis. BMC Nephrol 2020; 21:148. [PMID: 32334567 PMCID: PMC7183606 DOI: 10.1186/s12882-020-01800-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 04/07/2020] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND There have been few systematic studies regarding clearance of uric acid (UA) in patients undergoing peritoneal dialysis (PD). This study investigated peritoneal UA removal and its influencing factors in patients undergoing PD. METHODS This cross-sectional study enrolled patients who underwent peritoneal equilibration test and assessment of Kt/V from April 1, 2018 to August 31, 2019. Demographic data and clinical and laboratory parameters were collected, including UA levels in dialysate, blood, and urine. RESULTS In total, 180 prevalent patients undergoing PD (52.8% men) were included. Compared with the normal serum UA (SUA) group, the hyperuricemia group showed significantly lower peritoneal UA clearance (39.1 ± 6.2 vs. 42.0 ± 8.0 L/week/1.73m2; P = 0.008). Furthermore, higher transporters (high or high-average) exhibited greater peritoneal UA clearance, compared with lower transporters (low or low-average) (42.0 ± 7.0 vs. 36.4 ± 5.6 L/week/1.73 m2; P < 0.001). Among widely used solute removal indicators, peritoneal creatinine clearance showed the best performance for prediction of higher peritoneal UA clearance in receiver operating characteristic curve analysis [area under curve (AUC) 0.96; 95% confidence interval [CI], 0.93-0.99]. Peritoneal UA clearance was independently associated with continuous SUA [standardized coefficient (β), - 0.32; 95% CI, - 6.42 to - 0.75] and hyperuricemia [odds ratio (OR), 0.86; 95% CI, 0.76-0.98] status, only in patients with lower (≤2.74 mL/min/1.73 m2) measured glomerular filtration rate (mGFR). In those patients with lower mGFR, lower albumin level (β - 0.24; 95%CI - 7.26 to - 0.99), lower body mass index (β - 0.29; 95%CI - 0.98 to - 0.24), higher transporter status (β 0.24; 95%CI 0.72-5.88) and greater dialysis dose (β 0.24; 95%CI 0.26-3.12) were independently associated with continuous peritoneal UA clearance. Furthermore, each 1 kg/m2 decrease in body mass index (OR 0.79; 95% CI 0.63-0.99), each 1 g/dL decrease in albumin level (OR 0.08; 95%CI 0.01-0.47), and each 0.1% increase in average glucose concentration in dialysate (OR 1.56; 95%CI 1.11-2.19) were associated with greater peritoneal UA clearance (> 39.8 L/week/1.73m2). CONCLUSIONS For patients undergoing PD who exhibited worse residual kidney function, peritoneal clearance dominated in SUA balance. Increasing dialysis dose or average glucose concentration may aid in controlling hyperuricemia in lower transporters.
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Affiliation(s)
- Xi Xiao
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, 58th, Zhongshan Road II, Guangzhou, 510080, China.,Key Laboratory of Nephrology, Committee of Health and Guangdong Province, Guangzhou, 510080, China
| | - Hongjian Ye
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, 58th, Zhongshan Road II, Guangzhou, 510080, China.,Key Laboratory of Nephrology, Committee of Health and Guangdong Province, Guangzhou, 510080, China
| | - Chunyan Yi
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, 58th, Zhongshan Road II, Guangzhou, 510080, China.,Key Laboratory of Nephrology, Committee of Health and Guangdong Province, Guangzhou, 510080, China
| | - Jianxiong Lin
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, 58th, Zhongshan Road II, Guangzhou, 510080, China.,Key Laboratory of Nephrology, Committee of Health and Guangdong Province, Guangzhou, 510080, China
| | - Yuan Peng
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, 58th, Zhongshan Road II, Guangzhou, 510080, China.,Key Laboratory of Nephrology, Committee of Health and Guangdong Province, Guangzhou, 510080, China
| | - Xuan Huang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, 58th, Zhongshan Road II, Guangzhou, 510080, China.,Key Laboratory of Nephrology, Committee of Health and Guangdong Province, Guangzhou, 510080, China
| | - Meiju Wu
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, 58th, Zhongshan Road II, Guangzhou, 510080, China.,Key Laboratory of Nephrology, Committee of Health and Guangdong Province, Guangzhou, 510080, China
| | - Haishan Wu
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, 58th, Zhongshan Road II, Guangzhou, 510080, China.,Key Laboratory of Nephrology, Committee of Health and Guangdong Province, Guangzhou, 510080, China
| | - Haiping Mao
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, 58th, Zhongshan Road II, Guangzhou, 510080, China.,Key Laboratory of Nephrology, Committee of Health and Guangdong Province, Guangzhou, 510080, China
| | - Xueqing Yu
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, 58th, Zhongshan Road II, Guangzhou, 510080, China.,Key Laboratory of Nephrology, Committee of Health and Guangdong Province, Guangzhou, 510080, China
| | - Xiao Yang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, 58th, Zhongshan Road II, Guangzhou, 510080, China. .,Key Laboratory of Nephrology, Committee of Health and Guangdong Province, Guangzhou, 510080, China.
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29
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Albu A, Para I, Porojan M. Uric Acid and Arterial Stiffness. Ther Clin Risk Manag 2020; 16:39-54. [PMID: 32095074 PMCID: PMC6995306 DOI: 10.2147/tcrm.s232033] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 12/01/2019] [Indexed: 12/21/2022] Open
Abstract
Hyperuricemia is usually associated with hypertension, diabetes mellitus, metabolic syndrome and chronic kidney disease. Accumulating data from epidemiological studies indicate an association of increased uric acid (UA) with cardiovascular diseases. Possible pathogenic mechanisms include enhancement of oxidative stress and systemic inflammation caused by hyperuricemia. Arterial stiffness may be one of the possible pathways between hyperuricemia and cardiovascular disease, but a clear relationship between increased UA and vascular alterations has not been confirmed. The review summarizes the epidemiological studies investigating the relationship between UA and arterial stiffness and highlights the results of interventional studies evaluating arterial stiffness parameters in patients treated with UA-lowering drugs.
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Affiliation(s)
| | - Ioana Para
- 4th Department of Internal Medicine, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Association of Serum Uric Acid Concentration and Its Change with Cardiovascular Death and All-Cause Mortality. DISEASE MARKERS 2020; 2020:7646384. [PMID: 32076464 PMCID: PMC7008257 DOI: 10.1155/2020/7646384] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 11/29/2019] [Accepted: 12/23/2019] [Indexed: 02/07/2023]
Abstract
Objective There is no consensus on the role of abnormal uric acid (UA) levels in the prognosis of patients undergoing hemodialysis. We therefore aimed to investigate the effects of changes in UA concentration on the risk of all-cause death and cardiac death in such patients. Method In this retrospective cohort study, patients admitted to two hemodialysis centers performing maintenance hemodialysis (MHD) in Wuhan First Hospital and Fourth Hospital Hemodialysis Center from January 1, 2007, to October 31, 2017, were included. Results In all, 325 patients undergoing MHD aged 59.7 ± 14.7 years, including 195 men (60%), were enrolled, with a median follow-up of 37 months. Serum UA (p < 0.001) was significantly higher in the surviving group than in the death group. No significant difference was found in UA variability (p < 0.001) was significantly higher in the surviving group than in the death group. No significant difference was found in UA variability (p < 0.001) was significantly higher in the surviving group than in the death group. No significant difference was found in UA variability (p < 0.001) was significantly higher in the surviving group than in the death group. No significant difference was found in UA variability (p < 0.001) was significantly higher in the surviving group than in the death group. No significant difference was found in UA variability (p < 0.001) was significantly higher in the surviving group than in the death group. No significant difference was found in UA variability (p < 0.001) was significantly higher in the surviving group than in the death group. No significant difference was found in UA variability (p < 0.001) was significantly higher in the surviving group than in the death group. No significant difference was found in UA variability ( Conclusion Low UA levels were closely related to all-cause mortality in patients undergoing MHD. Although UA levels had no significant effect on cardiac death, they had a good predictive value for long-term prognosis in patients on MHD.
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Zhan X, Yang Y, Chen Y, Wei X, Xiao J, Zhang L, Yan C, Qiu P, Liu S, Hu Q, Chen Q, Wang Y. Serum alkaline phosphatase levels correlate with long-term mortality solely in peritoneal dialysis patients with residual renal function. Ren Fail 2019; 41:718-725. [PMID: 31409217 PMCID: PMC6713195 DOI: 10.1080/0886022x.2019.1646662] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 06/13/2019] [Accepted: 07/14/2019] [Indexed: 12/23/2022] Open
Abstract
Introduction: Increased serum alkaline phosphatase (ALP) is predictive of a higher mortality in patients with end-stage renal disease. However, it remains unknown whether residual renal function (RRF) influences the outcome-association of serum ALP among peritoneal dialysis (PD) patients. Methods: A total of 650 incident PD patients receiving PD catheter implantation in an institute between 1 November 2005 and 28 February 2017 were retrospectively enrolled. These patients were divided into groups with and without RRF (RRF and non-RRF groups) and those with serum ALP levels in tertiles. The Kaplan-Meier method and multivariate Cox proportional hazard models were used to analyze their outcomes based on RRF and serum ALP levels. Results: These 650 patients had a mean age of 49.4 ± 14.0 years old, their median ALP level was 74 U/L (interquartile range (IQR): 59-98). After 28-month (IQR: 14-41) follow-up, 80 patients in RRF group and 40 patients in non-RRF group died. PD patients with the highest serum ALP tertile had significant lower survival (p = .014), when compared to other patients in the RRF group. However, this relationship was not observed in patients in the non-RRF group. After multivariate adjustment, in the RRF group, patients with the highest ALP tertile had a significantly higher risk of mortality (hazard ratio (HR): 2.26, 95% confidence interval (CI): 1.06-4.82, p = .034). Each 10-U/L increase in ALP level was associated with a 4% (HR: 1.04, 95% CI: 1.00-1.08, p = .045) higher mortality risk. Conclusions: Higher serum ALP level is associated with increased mortality solely in PD patients with RRF.
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Affiliation(s)
- Xiaojiang Zhan
- Department of Nephrology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yuting Yang
- Department of Nephrology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yanbing Chen
- Department of Nephrology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xin Wei
- Department of Nephrology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jun Xiao
- Department of Nephrology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Li Zhang
- Department of Nephrology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Caixia Yan
- Department of Nephrology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Panlin Qiu
- Department of Nephrology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Siyi Liu
- Department of Nephrology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Qinglan Hu
- Department of Nephrology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Qinkai Chen
- Department of Nephrology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yu Wang
- Department of Nephrology, The First Affiliated Hospital of Nanchang University, Nanchang, China
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Rahimi-Sakak F, Maroofi M, Rahmani J, Bellissimo N, Hekmatdoost A. Serum uric acid and risk of cardiovascular mortality: a systematic review and dose-response meta-analysis of cohort studies of over a million participants. BMC Cardiovasc Disord 2019; 19:218. [PMID: 31615412 PMCID: PMC6792332 DOI: 10.1186/s12872-019-1215-z] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 09/30/2019] [Indexed: 01/09/2023] Open
Abstract
Background Cardiovascular disease (CVD) is the leading cause of death worldwide. Some studies have suggested anassociation between serum uric acid levels and cardiovascular mortality; however, the results have not been summarized in a meta-analysis. Methods A comprehensive search of all related studies until April 2018was performed in MEDLINE/PubMed and Scopus databases DerSimonianand Laird random-effects models were used to combine hazard ratios (HRs) with 95% confidence intervals (CIs). Dose-response analysis was also carried out. Results Thirty-two studies containing forty-four arms with 1,134,073 participants reported association between uric acid and risk of CVD mortality were included in our analysis. Pooled results showed a significant positive association between uric acid levels and risk of CVD mortality (HR 1.45, 95% CI 1.33–1.58, I2 = 79%). Sub-group analysis showed this relationshipwasstronger in women compared to men. Moreover, there was a significant non-linear association between uric acid levels and the risk of CVD mortality (r = 0.0709, p = 0.001). Conclusion Our analysis indicates a positive dose-response association between SUA and CVD mortality risk.
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Affiliation(s)
- Fatemeh Rahimi-Sakak
- Student Research Committee, Faculty of Nutrition and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahsa Maroofi
- Student Research Committee, Faculty of Nutrition and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Jamal Rahmani
- Student Research Committee, Faculty of Nutrition and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nick Bellissimo
- School of Nutrition, Ryerson University, Toronto, Ontario, Canada
| | - Azita Hekmatdoost
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, ShahidBeheshti University of Medical Sciences, Tehran, Iran.
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Valdivielso JM, Rodríguez-Puyol D, Pascual J, Barrios C, Bermúdez-López M, Sánchez-Niño MD, Pérez-Fernández M, Ortiz A. Atherosclerosis in Chronic Kidney Disease: More, Less, or Just Different? Arterioscler Thromb Vasc Biol 2019; 39:1938-1966. [PMID: 31412740 DOI: 10.1161/atvbaha.119.312705] [Citation(s) in RCA: 157] [Impact Index Per Article: 31.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Patients with chronic kidney disease (CKD) are at an increased risk of premature mortality, mainly from cardiovascular causes. The association between CKD on hemodialysis and accelerated atherosclerosis was described >40 years ago. However, more recently, it has been suggested that the increase in atherosclerosis risk is actually observed in early CKD stages, remaining stable thereafter. In this regard, interventions targeting the pathogenesis of atherosclerosis, such as statins, successful in the general population, have failed to benefit patients with very advanced CKD. This raises the issue of the relative contribution of atherosclerosis versus other forms of cardiovascular injury such as arteriosclerosis or myocardial injury to the increased cardiovascular risk in CKD. In this review, the pathophysiogical contributors to atherosclerosis in CKD that are shared with the general population, or specific to CKD, are discussed. The NEFRONA study (Observatorio Nacional de Atherosclerosis en NEFrologia) prospectively assessed the prevalence and progression of subclinical atherosclerosis (plaque in vascular ultrasound), confirming an increased prevalence of atherosclerosis in patients with moderate CKD. However, the adjusted odds ratio for subclinical atherosclerosis increased with CKD stage, suggesting a contribution of CKD itself to subclinical atherosclerosis. Progression of atherosclerosis was closely related to CKD progression as well as to the baseline presence of atheroma plaque, and to higher phosphate, uric acid, and ferritin and lower 25(OH) vitamin D levels. These insights may help design future clinical trials of stratified personalized medicine targeting atherosclerosis in patients with CKD. Future primary prevention trials should enroll patients with evidence of subclinical atherosclerosis and should provide a comprehensive control of all known risk factors in addition to testing any additional intervention or placebo.
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Affiliation(s)
- José M Valdivielso
- From the Vascular & Renal Translational Research Group and UDETMA, IRBLleida. Spanish Research Network for Renal Diseases (RedInRen. ISCIII), Lleida, Spain (J.M.V., M.B.-L.)
| | - Diego Rodríguez-Puyol
- Nephrology Unit, Fundación para la investigación del Hospital Universitario Príncipe de Asturias, RedInRen, Alcalá de Henares, Madrid, Spain (D.R.-P.)
| | - Julio Pascual
- Department of Nephrology, Institute Mar for Medical Research, Hospital del Mar, RedInRen, Barcelona, Spain (J.P., C.B.)
| | - Clara Barrios
- Department of Nephrology, Institute Mar for Medical Research, Hospital del Mar, RedInRen, Barcelona, Spain (J.P., C.B.)
| | - Marcelino Bermúdez-López
- From the Vascular & Renal Translational Research Group and UDETMA, IRBLleida. Spanish Research Network for Renal Diseases (RedInRen. ISCIII), Lleida, Spain (J.M.V., M.B.-L.)
| | - Maria Dolores Sánchez-Niño
- IIS-Fundacion Jimenez Diaz, School of Medicine, University Autonoma of Madrid, FRIAT and RedInRen, Madrid, Spain (M.D.S.-N., A.O.)
| | | | - Alberto Ortiz
- IIS-Fundacion Jimenez Diaz, School of Medicine, University Autonoma of Madrid, FRIAT and RedInRen, Madrid, Spain (M.D.S.-N., A.O.)
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High serum uric acid level is a mortality risk factor in peritoneal dialysis patients: a retrospective cohort study. Nutr Metab (Lond) 2019; 16:52. [PMID: 31388342 PMCID: PMC6670192 DOI: 10.1186/s12986-019-0379-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 07/19/2019] [Indexed: 02/07/2023] Open
Abstract
Background The results remain controversial with regards to the impact of serum uric acid on clinical outcomes from peritoneal dialysis population. The aim of our study was to investigate the influence of serum uric acid levels on mortality in peritoneal dialysis patients. Methods Data on 9405 peritoneal dialysis patients from the Zhejiang Renal Data system were retrospectively analyzed. All demographic and laboratory data were recorded at baseline. The study cohort was divided into quintiles according to baseline uric acid level (mg/dL): Q1 (< 6.06), Q2 (6.06–6.67), Q3 (6.68–7.27) (reference), Q4 (7.28–8.03), and Q5 (≥8.04). Hazards ratio (HR) of all-cause and cardiovascular mortality was calculated. Results Mean serum uric acid was 7.07 ± 1.25 mg/dL. During a median follow-up of 29.4 (range, 3.0 to 115.4) months, 1226 (13.0%) patients died, of which 515 (5.5%) died of cardiovascular events. The Kaplan-Meier survival curves showed that patients in the middle uric acid quintile (Q3: 6.68–7.27) exhibited the highest patient and cardiovascular survival rates (log-rank test P < 0.05). Multivariate Cox regression analysis showed that, using Q3 as the reference, in the fully adjusted model, a higher uric acid level (Q4: 7.28–8.03, and Q5: ≥8.04) was significantly associated with higher all-cause mortality (Model 3; Q4: HR, 1.335, 95% CI, 1.073 to 1.662, P = 0.009; Q5: HR, 1.482, 95% CI, 1.187 to 1.849, P = 0.001), but not with cardiovascular mortality. The adverse effect of higher uric acid level (≥7.28 mg/dL) on all-cause mortality was more prominent in groups such as male, hypoalbuminemia, normal weight, non-diabetes mellitus at baseline rather than in their counterparts respectively. Conclusions A higher uric acid level was an independent risk factor for all-cause mortality in peritoneal dialysis patients. Electronic supplementary material The online version of this article (10.1186/s12986-019-0379-y) contains supplementary material, which is available to authorized users.
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Chang W, Uchida S, Qi P, Zhang W, Wang X, Liu Y, Han Y, Li J, Xu H, Hao J. Decline in serum uric acid predicts higher risk for mortality in peritoneal dialysis patients-a propensity score analysis. J Nephrol 2019; 33:591-599. [PMID: 31321744 DOI: 10.1007/s40620-019-00632-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 07/13/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND The level of serum uric acid (SUA) in treatment follow-up is associated with mortality in peritoneal dialysis (PD) patients, but it remains unknown if the longitudinal change in SUA affects mortality. METHODS 309 PD patients who were not using UA-lowering agents were enrolled. The longitudinal change in SUA was estimated by comparing the values between the run-in and follow-up periods. Based the calculated values, the patients were divided into SUA decliner and SUA non-decliner. A propensity score (PS) was calculated using the parameters measured in run-in period. After PS matching, the time-to-event analysis was performed for all-cause death. RESULTS After PS matching, 86 patients of each group were left. A higher mortality of 19/86 existed in SUA decliner compared with SUA non-decliner which is 3/86 (p < 0.001). Kaplan-Meier analysis in sub-cohort showed worse survival in the SUA decliner. Standard and stratified Cox regression analysis both showed SUA decline to be an independent risk factor for all-cause death in PD patients. CONCLUSIONS The decline in SUA in the follow-up may predict the all-cause mortality of PD patients, the reason of which may result from reducing scavenging effects of SUA or may reflect general condition. More studies need to be done.
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Affiliation(s)
- Wenxiu Chang
- Department of Nephrology, Tianjin First Center Hospital, No. 24 Fukang Road, Nankai District, Tianjin, 300192, China.
| | - Shunya Uchida
- Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - PingPing Qi
- Department of Nephrology, Tianjin First Center Hospital, No. 24 Fukang Road, Nankai District, Tianjin, 300192, China
| | - Wenyu Zhang
- Department of Nephrology, Tianjin First Center Hospital, No. 24 Fukang Road, Nankai District, Tianjin, 300192, China
| | - Xichao Wang
- Department of Nephrology, Tianjin First Center Hospital, No. 24 Fukang Road, Nankai District, Tianjin, 300192, China
| | - Ying Liu
- Department of Nephrology, Tianjin First Center Hospital, No. 24 Fukang Road, Nankai District, Tianjin, 300192, China
| | - Yingying Han
- Department of Nephrology, Tianjin First Center Hospital, No. 24 Fukang Road, Nankai District, Tianjin, 300192, China
| | - Jinping Li
- Department of Nephrology, Tianjin First Center Hospital, No. 24 Fukang Road, Nankai District, Tianjin, 300192, China
| | - Haiyan Xu
- Department of Nephrology, Tianjin First Center Hospital, No. 24 Fukang Road, Nankai District, Tianjin, 300192, China
| | - Jie Hao
- Department of Nephrology, Tianjin First Center Hospital, No. 24 Fukang Road, Nankai District, Tianjin, 300192, China
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Geraci G, Buccheri D, Zanoli L, Fatuzzo P, Di Natale K, Zammuto MM, Nardi E, Geraci C, Mancia E, Zambelli G, Piraino D, Signorelli SS, Granata A, Cottone S, Mule G. Renal haemodynamics and coronary atherosclerotic burden are associated in patients with hypertension and mild coronary artery disease. Exp Ther Med 2019; 17:3255-3263. [PMID: 30906482 DOI: 10.3892/etm.2019.7279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 02/11/2019] [Indexed: 12/11/2022] Open
Abstract
Intrarenal hemodynamic alterations are independent predictors of cardiovascular events in different populations. It has been hypothesized that there is an association between renal hemodynamics and coronary atherosclerotic burden in patients with hypertension. Therefore, the present study examined the associations between renal hemodynamics, coronary atherosclerotic burden and carotid atherosclerotic disease. A total of 130 patients with hypertension aged between 30-80 years who had been referred for an elective coronary angiography were enrolled in the present study. A duplex ultrasound of the intrarenal vasculature was performed to evaluate the resistive index (RI), pulsatility index (PI) and acceleration time (AT). The carotid intima-media thickness was additionally assessed. A coronary angiography was performed to detect the atherosclerotic burden using the Gensini Score (GS). Based on the GS values, subjects were divided into quintiles (I: ≤9; II: 9-17; III: 17-30; IV: 30-44; and V: GS >44) as well as in subjects with mild (GS ≤30) or severe coronary disease (GS >30). A weak significant difference in PI was identified among quintiles (P=0.041), whereas, RI and AT did not differ significantly. PI was associated with GS in the group with low coronary atherosclerotic burden (GS ≤30; P=0.047), whereas, no association was detected in subjects with GS >30. This association remained following adjustment for age and left ventricular ejection fraction (P=0.025). In conclusion, renal vascular alterations were associated with coronary atherosclerotic burden in patients with hypertension with mild coronary disease.
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Affiliation(s)
- Giulio Geraci
- Unit of Nephrology and Hypertension-European Society of Hypertension Excellence Centre, Paolo Giaccone University Hospital, I-90127 Palermo, Italy
| | - Dario Buccheri
- Unit of Interventional Cardiology, Hospital San Giovanni di Dio, I-92100 Agrigento, Italy
| | - Luca Zanoli
- Department of Clinical and Experimental Medicine, University of Catania, I-95100 Catania, Italy
| | - Pasquale Fatuzzo
- Department of Clinical and Experimental Medicine, University of Catania, I-95100 Catania, Italy
| | - Katia Di Natale
- Department of Interventional Cardiology, Paolo Giaccone University Hospital, I-90100 Palermo, Italy
| | - Marta M Zammuto
- Unit of Nephrology and Hypertension-European Society of Hypertension Excellence Centre, Paolo Giaccone University Hospital, I-90127 Palermo, Italy
| | - Emilio Nardi
- Unit of Nephrology and Hypertension-European Society of Hypertension Excellence Centre, Paolo Giaccone University Hospital, I-90127 Palermo, Italy
| | - Calogero Geraci
- Unit of Cardiology, S. Elia Hospital, I-93100 Caltanissetta, Italy
| | - Ettore Mancia
- Unit of Nephrology and Hypertension-European Society of Hypertension Excellence Centre, Paolo Giaccone University Hospital, I-90127 Palermo, Italy
| | - Giulia Zambelli
- Department of Interventional Cardiology, Paolo Giaccone University Hospital, I-90100 Palermo, Italy
| | - Davide Piraino
- Department of Interventional Cardiology, Paolo Giaccone University Hospital, I-90100 Palermo, Italy
| | - Salvatore S Signorelli
- Department of Clinical and Experimental Medicine, University of Catania, I-95100 Catania, Italy
| | - Antonio Granata
- Department of Nephrology and Dialysis, Hospital San Giovanni di Dio, I-92100 Agrigento, Italy
| | - Santina Cottone
- Unit of Nephrology and Hypertension-European Society of Hypertension Excellence Centre, Paolo Giaccone University Hospital, I-90127 Palermo, Italy
| | - Giuseppe Mule
- Unit of Nephrology and Hypertension-European Society of Hypertension Excellence Centre, Paolo Giaccone University Hospital, I-90127 Palermo, Italy
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Lu J, Sun M, Wu X, Yuan X, Liu Z, Qu X, Ji X, Merriman TR, Li C. Urate-lowering therapy alleviates atherosclerosis inflammatory response factors and neointimal lesions in a mouse model of induced carotid atherosclerosis. FEBS J 2019; 286:1346-1359. [PMID: 30690853 PMCID: PMC6849826 DOI: 10.1111/febs.14768] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 11/10/2018] [Accepted: 01/23/2019] [Indexed: 12/18/2022]
Abstract
Hyperuricemia (HU) is a cause of gout. Clinical studies show a link between HU and cardiovascular disease. However, the role of soluble serum urate (SU) on atherosclerosis development remains elusive. We aimed to use a new HU mouse model [Uricase/Uox knockout (KO)] to further investigate the relationship between HU and atherosclerosis. A mouse model by perivascular collar placement of induced carotid atherosclerosis was established in male Uox-KO mice. The Uox-KO mice had elevated SU levels and enhanced levels of atherosclerosis inflammatory response proteins. In contrast, Uox-KO mice with carotid atherosclerosis showed severe neointimal changes in histology staining consistent with increases in intimal area and increases in proliferating cell nuclear antigen (PCNA)- and F4/80-positive cells. Allopurinol reduced neointimal areas induced by the perivascular collar in hyperuricemic mice, accompanied by decreased expression of PCNA- and F4/80-positive cells. Urate-lowering treatment alleviated atherosclerosis inflammatory response factors and reactive oxygen species (ROS) intensities in both collar placement Uox-KO mice and urate-stimulated human umbilical vein endothelial cells (HUVECs). In vitro results using HUVECs showed ROS was induced by urate and ROS induction was abrogated using antioxidants. These data demonstrate that urate per se does not trigger atherosclerosis intima lesions in male mice. Urate worsens carotid neointimal lesions induced by the perivascular collar and urate-lowering therapy partially abrogates the effects. The current study warrants clinical studies on the possible benefits of urate-lowering therapy in atherosclerosis patients with HU.
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Affiliation(s)
- Jie Lu
- Institute of Metabolic Diseases, Qingdao University, China.,Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, The Affiliated Hospital of Qingdao University, China.,Department of Endocrinology and Metabolic Diseases, The Affiliated Hospital of Qingdao University, China
| | - Mingshu Sun
- Institute of Metabolic Diseases, Qingdao University, China.,Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, The Affiliated Hospital of Qingdao University, China.,Department of Rheumatology and Clinical Immunology, The Affiliated Hospital of Qingdao University, China
| | - Xinjiang Wu
- Institute of Metabolic Diseases, Qingdao University, China
| | - Xuan Yuan
- Institute of Metabolic Diseases, Qingdao University, China
| | - Zhen Liu
- Institute of Metabolic Diseases, Qingdao University, China.,Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, The Affiliated Hospital of Qingdao University, China
| | - Xiaojie Qu
- Institute of Metabolic Diseases, Qingdao University, China.,Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, The Affiliated Hospital of Qingdao University, China.,Department of Endocrinology and Metabolic Diseases, The Affiliated Hospital of Qingdao University, China
| | - Xiaopeng Ji
- Institute of Metabolic Diseases, Qingdao University, China.,Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, The Affiliated Hospital of Qingdao University, China
| | - Tony R Merriman
- Department of Biochemistry, University of Otago, Dunedin, New Zealand
| | - Changgui Li
- Institute of Metabolic Diseases, Qingdao University, China.,Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, The Affiliated Hospital of Qingdao University, China.,Department of Endocrinology and Metabolic Diseases, The Affiliated Hospital of Qingdao University, China
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Abstract
Cardiovascular disease (CVD) is highly prevalent in the peritoneal dialysis (PD) population, affecting up to 60% of cohorts. CVD is the primary cause of death in up to 40% of PD patients in Australia, New Zealand, and the United States. Cardiovascular mortality rates are reported to be approximately 14 per 100 patient-years, which are 10- to 20-fold greater than those of age- and sex-matched controls. The excess risk of CVD is related to a combination of traditional risk factors (such as hypertension, dyslipidemia, obesity, smoking, sedentary lifestyle, and insulin resistance), nontraditional (kidney disease-related) risk factors (such as anemia, chronic volume overload, inflammation, malnutrition, hyperuricemia, and mineral and bone disorder), and PD-specific risk factors (such as dialysis solutions, glycation end products, hypokalemia, residual kidney function, and ultrafiltration failure). Interventions targeting these factors may mitigate cardiovascular risk, although high-level clinical evidence is lacking. This review summarizes the evidence relating to cardiovascular interventions targeting modifiable CVD risk factors in PD patients, as well as highlighting the key recommendations of the International Society for Peritoneal Dialysis Cardiovascular and Metabolic Guidelines.
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An Inverse Relationship between Hyperuricemia and Mortality in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis. J Clin Med 2018; 7:jcm7110416. [PMID: 30400636 PMCID: PMC6262420 DOI: 10.3390/jcm7110416] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 10/16/2018] [Accepted: 10/22/2018] [Indexed: 02/07/2023] Open
Abstract
Background: The results have been inconsistent with regards to the impact of uric acid (UA) on clinical outcomes both in the general population and in patients with chronic kidney disease. The aim of this study was to study the influence of serum UA levels on mortality in patients undergoing continuous ambulatory peritoneal dialysis. Methods: Data on 492 patients from a single peritoneal dialysis unit were retrospectively analyzed. The mean age of the patients was 53.5 ± 15.3 years, with 52% being female (n = 255). The concomitant comorbidities at the start of continuous ambulatory peritoneal dialysis (CAPD) encompassed diabetes mellitus (n = 179, 34.6%), hypertension (n = 419, 85.2%), and cardiovascular disease (n = 186, 37.9%). The study cohort was divided into sex-specific tertiles according to baseline UA level. A Cox proportional hazard model was used to calculate hazard ratios (HRs) of all-cause, cardiovascular, and infection-associated mortality with adjustments for demographic and laboratory data, medications, and comorbidities. Results: Multivariate Cox regression analysis showed that, using UA tertile 1 as the reference, the adjusted HR of all-cause, cardiovascular, and infection-associated mortality for tertile 3 was 0.4 (95% confidence interval (CI) 0.24⁻0.68, p = 0.001), 0.4 (95% CI 0.2⁻0.81, p = 0.01), and 0.47 (95% CI 0.19⁻1.08, p = 0.1). In the fully adjusted model, the adjusted HRs of all-cause, cardiovascular, and infection-associated mortality for each 1-mg/dL increase in UA level were 0.84 (95% CI, 0.69⁻0.9, p = 0.07), 0.79 (95% CI, 0.61⁻1.01, p = 0.06), and 0.79 (95% CI, 0.48⁻1.21, p = 0.32) for men and 0.57 (95% CI, 0.44⁻0.73, p < 0.001), 0.6 (95% CI, 0.41⁻0.87, p = 0.006), and 0.41 (95% CI, 0.26⁻0.6, p < 0.001) for women, respectively. Conclusions: Higher UA levels are associated with lower risks of all-cause, cardiovascular and infection-associated mortality in women treated with continuous ambulatory peritoneal dialysis.
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Cai L, Yu J, Yu J, Peng Y, Ullah H, Yi C, Lin J, Yang X, Yu X. Prognostic value of inflammation-based prognostic scores on outcome in patients undergoing continuous ambulatory peritoneal dialysis. BMC Nephrol 2018; 19:297. [PMID: 30367618 PMCID: PMC6204053 DOI: 10.1186/s12882-018-1092-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 10/09/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Inflammation-based prognostic scores have been used as outcome predictors in patients with cancer or on hemodialysis. However, their role in patients on continuous ambulatory peritoneal dialysis (CAPD) remains unclear. This study aimed to examine the prognostic value of inflammation-based composite scores for mortality in CAPD patients. METHODS This study was conducted in CAPD patients enrolled from January 1, 2006 to December 31, 2014 and followed until December 31, 2016. Three inflammation-based prognostic scores, including Glasgow prognostic score (GPS), prognostic nutritional index (PNI), and prognostic index (PI), were conducted in this study. The associations between these scores and all-cause or cardiovascular mortality were evaluated by Kaplan-Meier method and Cox proportional hazards models. The areas under the curve (AUC) of receiver-operating characteristic (ROC) analysis were used to determine the predictive values of mortality. RESULTS A total of 1501 patients were included. During a median follow-up of 38.7 (range, 21.6-62.3) months, 346 (23.1%) patients died, of which 168 (48.6%) were due to cardiovascular diseases (CVD). After adjustment for confounders, the results showed that elevated GPS, PNI, and PI scores were all independently associated with all-cause [GPS: Score 1: hazard ratio(HR) 3.94, 95% confidence interval(CI) 2.90-5.35; Score 2: HR 7.56, 95% CI 5.35-10.67; PNI: HR 1.82, 95% CI 1.36-2.43; PI: Score 1: HR 2.08, 95% CI 1.63-2.65; Score 2: HR 3.03, 95% CI 2.00-4.60)] and CVD mortality(GPS: Score 1: HR 4.41, 95% CI 2.76-7.03; Score 2: HR 9.64, 95% CI 5.72-16.26; PNI: HR 1.63, 95% CI 1.06-2.51; PI: Score 1: HR 2.57, 95% CI 1.81-3.66, Score 2: HR 3.85, 95% CI 1.99-7.46).The AUC values of GPS score were 0.798 (95% CI0.770-0.826) for all-cause mortality and 0.781 (95% CI 0.744-0.817) for CVD mortality, both of which significantly higher than those of PNI and PI scores (P < 0.001, respectively). CONCLUSIONS All elevated GPS, PNI, and PI scores were independently associated with all-cause and CVD mortality. The GPS score showed better predictive value than PNI and PI scores in CAPD patients.
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Affiliation(s)
- Lu Cai
- Department of Nephrology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080 China
- Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, China
| | - Jianwen Yu
- Department of Nephrology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080 China
- Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, China
| | - Jing Yu
- Department of Nephrology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080 China
- Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, China
| | - Yuan Peng
- Department of Nephrology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080 China
- Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, China
| | - Habib Ullah
- Department of Nephrology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080 China
- Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, China
| | - Chunyan Yi
- Department of Nephrology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080 China
- Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, China
| | - Jianxiong Lin
- Department of Nephrology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080 China
- Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, China
| | - Xiao Yang
- Department of Nephrology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080 China
- Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, China
| | - Xueqing Yu
- Department of Nephrology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080 China
- Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, China
- Institute of Nephrology, Guangdong Medical University, Zhanjiang, China
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Wang Y, Xiong L, Xu Q, Li W, Peng X, Shen J, Qiu Y, Yu X, Mao H. Association of left ventricular systolic dysfunction with mortality in incident peritoneal dialysis patients. Nephrology (Carlton) 2018; 23:927-932. [DOI: 10.1111/nep.13154] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Yating Wang
- Department of Nephrology, The First Affiliated HospitalSun Yat‐Sen University Guangzhou China
- Key Laboratory of NephrologyMinistry of Health of China Guangzhou China
- Guangdong Provincial Key Laboratory of Nephrology Guangzhou China
| | - Liping Xiong
- Department of Nephrology, The Sixth Affiliated HospitalSun Yat‐Sen University Guangzhou China
| | - Qingdong Xu
- Department of NephrologyJiangmen Central Hospital Jiangmen China
| | - Wei Li
- Department of Nephrology, The First Affiliated HospitalSun Yat‐Sen University Guangzhou China
- Key Laboratory of NephrologyMinistry of Health of China Guangzhou China
- Guangdong Provincial Key Laboratory of Nephrology Guangzhou China
| | - Xuan Peng
- Department of Nephrology, The First Affiliated HospitalSun Yat‐Sen University Guangzhou China
- Key Laboratory of NephrologyMinistry of Health of China Guangzhou China
- Guangdong Provincial Key Laboratory of Nephrology Guangzhou China
| | - Jiani Shen
- Department of Nephrology, The First Affiliated HospitalSun Yat‐Sen University Guangzhou China
- Key Laboratory of NephrologyMinistry of Health of China Guangzhou China
- Guangdong Provincial Key Laboratory of Nephrology Guangzhou China
| | - Yagui Qiu
- Department of Nephrology, The First Affiliated HospitalSun Yat‐Sen University Guangzhou China
- Key Laboratory of NephrologyMinistry of Health of China Guangzhou China
- Guangdong Provincial Key Laboratory of Nephrology Guangzhou China
| | - Xueqing Yu
- Department of Nephrology, The First Affiliated HospitalSun Yat‐Sen University Guangzhou China
- Key Laboratory of NephrologyMinistry of Health of China Guangzhou China
- Guangdong Provincial Key Laboratory of Nephrology Guangzhou China
| | - Haiping Mao
- Department of Nephrology, The First Affiliated HospitalSun Yat‐Sen University Guangzhou China
- Key Laboratory of NephrologyMinistry of Health of China Guangzhou China
- Guangdong Provincial Key Laboratory of Nephrology Guangzhou China
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Luo Q, Xia X, Lin Z, Lin J, Yang X, Huang F, Yu X. Very early withdrawal from treatment in patients starting peritoneal dialysis. Ren Fail 2018; 40:8-14. [PMID: 29297246 PMCID: PMC6014309 DOI: 10.1080/0886022x.2017.1419965] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Introduction: Very early withdrawal from treatment in patients undergoing peritoneal dialysis (PD) is an increasingly important, but poorly understood, issue. Here, we identified the reasons and risk factors for very early withdrawal from PD. Methods: Incident PD patients from The First Affiliated Hospital of Sun Yat-sen University above 18 years who started treatment between January 1 2006 and December 31 2011 were included. Cessation of PD therapy within the first 90 days after beginning dialysis was classified as very early withdrawal. Results: Totally 1444 patients were enrolled. Of these, 71 (4.9%) withdrew from PD therapy during the first 90 days. Primary reasons for very early withdrawal included death (34 patients, 47.9%), transplantation (21 patients, 29.6%) and transfer to hemodialysis (14 patients, 19.7%). The leading reasons for death were cardiovascular and infectious disease, accounting for 41.2% (14 patients) and 23.5% (8 patients) of total deaths, respectively. Dialysate leakage (six patients, 42.9%) and catheter dysfunction (five patients, 35.7%) were the main reasons for transfer to hemodialysis. In multivariate analysis, predictors for very early PD withdrawal were older age (per decade increasing; hazard ratio [HR], 1.22; 95% confidence interval [CI], 1.03–1.45; p = .019), higher systolic blood pressure (per 10 mmHg increasing; HR, 1.35; 95% CI, 1.20–1.50; p < .001), lower hemoglobin (per 10 g/l increasing; HR, 0.67; 95% CI, 0.57–0.78; p < .001), lower high-density lipoprotein cholesterol (HR, 0.24; 95% CI, 0.10–0.54; p = .001) and lower residual urine volume (per 100 ml/d increasing; HR, 0.90; 95% CI, 0.84–0.95; p = .001). Conclusions: Death was the primary reason for very early withdrawal from PD. Risk factors for very early withdrawal from PD were older in age, had higher systolic blood pressure, lower hemoglobin, lower high-density lipoprotein cholesterol and lower residual urine volume.
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Affiliation(s)
- Qimei Luo
- a Department of Nephrology , The First Affiliated Hospital, Sun Yat-sen University , Guangzhou , China.,b Key Laboratory of Nephrology , Ministry of Health , Guangzhou , China
| | - Xi Xia
- a Department of Nephrology , The First Affiliated Hospital, Sun Yat-sen University , Guangzhou , China.,b Key Laboratory of Nephrology , Ministry of Health , Guangzhou , China
| | - Zhenchuan Lin
- a Department of Nephrology , The First Affiliated Hospital, Sun Yat-sen University , Guangzhou , China.,b Key Laboratory of Nephrology , Ministry of Health , Guangzhou , China
| | - Jianxiong Lin
- a Department of Nephrology , The First Affiliated Hospital, Sun Yat-sen University , Guangzhou , China.,b Key Laboratory of Nephrology , Ministry of Health , Guangzhou , China
| | - Xiao Yang
- a Department of Nephrology , The First Affiliated Hospital, Sun Yat-sen University , Guangzhou , China.,b Key Laboratory of Nephrology , Ministry of Health , Guangzhou , China
| | - Fengxian Huang
- a Department of Nephrology , The First Affiliated Hospital, Sun Yat-sen University , Guangzhou , China.,b Key Laboratory of Nephrology , Ministry of Health , Guangzhou , China
| | - Xueqing Yu
- a Department of Nephrology , The First Affiliated Hospital, Sun Yat-sen University , Guangzhou , China.,b Key Laboratory of Nephrology , Ministry of Health , Guangzhou , China
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Murea M, Tucker BM. The physiology of uric acid and the impact of end-stage kidney disease and dialysis. Semin Dial 2018; 32:47-57. [DOI: 10.1111/sdi.12735] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Mariana Murea
- Department of Internal Medicine; Section on Nephrology; Wake Forest School of Medicine; Winston-Salem NC USA
| | - Bryan M. Tucker
- Department of Internal Medicine; Section on Nephrology; Wake Forest School of Medicine; Winston-Salem NC USA
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44
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Kume S, Nagasu H, Nangaku M, Nishiyama A, Nakamoto H, Kashihara N. Summary of the 2018 ISN Frontiers Meeting: Kidney Disease and Cardiovascular Disease. Kidney Int Rep 2018. [PMCID: PMC6035142 DOI: 10.1016/j.ekir.2018.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
International Society of Nephrology (ISN) Frontiers meetings build on the success of the ISN Nexus and Forefronts series by bringing together basic scientists, clinicians, and practitioners in a unique setting. This new event was organized to make more innovative science available to a global audience by removing regional barriers in accessing the latest knowledge. The first ISN Frontiers meeting was organized in partnership between the Japanese Society of Nephrology and the Japanese Society for Dialysis Therapy, which was held in Tokyo in February 2018. The meeting focused on the topic “Kidney Disease & Cardiovascular Disease,” which covered a broad range of scientific and clinical fields, including nephrology, cardiovascular diseases, dialysis, transplantation, chronic kidney disease (CKD)–mineral bone disease (MBD), diabetes, pediatric nephrology, nutrition, pharmacology, and nursing. A total of 1584 active physicians and scientists from 64 countries attended the meeting, and a number of leading physician scientists from different and related disciplines of clinical and basic research described and reviewed recent discoveries. This report summarizes the main highlights of the meeting lectures.
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Affiliation(s)
- Shinji Kume
- Department of Medicine, Shiga University of Medical Science, Shiga, Japan
- Correspondence: Shinji Kume, Department of Medicine, Shiga University of Medical Science, Tsukinowa-cho, Seta, Otsu, Shiga 520-2192, Japan.
| | - Hajime Nagasu
- Department of Nephrology and Hypertension, Kawasaki Medical School, Okayama, Japan
| | - Masaomi Nangaku
- Department of Nephrology and Endocrinology, The University of Tokyo, Tokyo, Japan
| | - Akira Nishiyama
- Department of Pharmacology, Kagawa University, Kagawa, Japan
| | - Hidetomo Nakamoto
- Department of General Internal Medicine, Saitama Medical University, Saitama, Japan
| | - Naoki Kashihara
- Department of Nephrology and Hypertension, Kawasaki Medical School, Okayama, Japan
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45
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Park C, Obi Y, Streja E, Rhee CM, Catabay CJ, Vaziri ND, Kovesdy CP, Kalantar-Zadeh K. Serum uric acid, protein intake and mortality in hemodialysis patients. Nephrol Dial Transplant 2018; 32:1750-1757. [PMID: 28064158 DOI: 10.1093/ndt/gfw419] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 11/02/2016] [Indexed: 02/07/2023] Open
Abstract
Background The association between serum uric acid (SUA) and mortality has been conflicting among studies using hemodialysis (HD) patients. Given the close link between purine and protein in foods, we hypothesized that normalized protein catabolic rate (nPCR), a dietary protein intake surrogate, modifies the SUA-mortality association in the HD population. Methods We identified 4298 patients who initiated HD and had one or more SUA measurement in a contemporary cohort of HD patients over 5 years (1 January 2007-31 December 2011), and examined survival probability according to the first uric acid measurement, adjusting for dialysis vintage, case-mix and malnutrition-inflammation complex-related variables. Results Mean SUA concentration was 6.6 ± 1.8 mg/dL. There was a consistent association of higher SUA with better nutritional status and lower all-cause mortality irrespective of adjusted models (Ptrend < 0.001). In the case-mix adjusted model, the highest SUA category (≥8.0 mg/dL) compared with the reference group (>6.0-7.0 mg/dL) showed no significant mortality risk [hazard ratio (HR) 0.90, 95% confidence interval (CI) 0.72-1.13], while the lowest category (<5.0 mg/dL) was associated with higher mortality (HR 1.42, 95% CI 1.16-1.72). The hypouricemia-mortality association was significantly modified by nPCR (Pinteraction = 0.001). Mortality risk of low SUA (<5.0 mg/dL) persisted among patients with low nPCR (<0.9 g/kg/day; HR 1.73, 95% CI 1.42-2.10) but not with high nPCR (≥0.9 g/kg/day; HR 0.99, 95% CI 0.74-1.33). Conclusions SUA may be a nutritional marker in HD patients. Contrary to the general population, low but not high SUA is associated with higher all-cause mortality in HD patients, especially in those with low protein intake. Nutritional features of SUA warrant additional studies.
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Affiliation(s)
- Christina Park
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, School of Medicine, Orange, CA, USA
| | - Yoshitsugu Obi
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, School of Medicine, Orange, CA, USA
| | - Elani Streja
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, School of Medicine, Orange, CA, USA
| | - Connie M Rhee
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, School of Medicine, Orange, CA, USA
| | - Christina J Catabay
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, School of Medicine, Orange, CA, USA
| | - Nosratola D Vaziri
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, School of Medicine, Orange, CA, USA
| | - Csaba P Kovesdy
- Division of Nephrology, University of Tennessee Health Science Center, Memphis, TN, USA.,Nephrology Section, Memphis VA Medical Center, Memphis, TN, USA
| | - Kamyar Kalantar-Zadeh
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, School of Medicine, Orange, CA, USA.,Fielding School of Public Health at UCLA, Los Angeles, CA.,Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA, USA
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46
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Kim CS, Jin DC, Yun YC, Bae EH, Ma SK, Kim SW. Relationship between serum uric acid and mortality among hemodialysis patients: Retrospective analysis of Korean end-stage renal disease registry data. Kidney Res Clin Pract 2017; 36:368-376. [PMID: 29285429 PMCID: PMC5743046 DOI: 10.23876/j.krcp.2017.36.4.368] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 08/27/2017] [Accepted: 09/07/2017] [Indexed: 12/22/2022] Open
Abstract
Background It is thought that hyperuricemia might lower the risk of mortality among hemodialysis patients, unlike in the general population, but the evidence is controversial. The aim of the current study was to evaluate the impact of serum uric acid level on the long-term clinical outcomes of hemodialysis patients in Korea. Methods Retrospective analysis was performed on data from the End-Stage Renal Disease Registry of the Korean Society of Nephrology. This included data for 7,333 patients (mean age, 61 ± 14 years; 61% male) who received hemodialysis from January 2001 through April 2015. Initial laboratory data were used in the analysis. Results The mean serum uric acid level in this study was 7.1 ± 1.7 mg/dL. Body mass index, normalized protein catabolic rate, albumin, and cholesterol were positively correlated with serum uric acid level after controlling for age and sex. After controlling for demographic data, comorbidities, and residual renal function, a higher uric acid level was independently associated with a significantly lower all-cause mortality (hazard ratio [HR], 0.90 per 1 mg/dL increase in uric acid level; 95% confidence interval [CI], 0.83-0.97; P = 0.008), but not cardiovascular mortality (HR, 0.90; 95% CI, 0.80-1.01; P = 0.078). Comparing uric acid levels in the highest and lowest quintiles, the HR for all-cause mortality was 0.65 (95% CI, 0.42-0.99; P = 0.046). Conclusion Hyperuricemia was strongly associated with a lower risk of all-cause mortality, but there seems to be no significant association between serum uric acid level and cardiovascular mortality among Korean hemodialysis patients with end-stage renal disease.
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Affiliation(s)
- Chang Seong Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Dong-Chan Jin
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young Cheol Yun
- Department of Rehabilitation, Presbyterian Medical Center, Jeonju, Korea
| | - Eun Hui Bae
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Seong Kwon Ma
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Soo Wan Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
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Yan X, Yang X, Xie X, Xiang S, Zhang X, Shou Z, Chen J. Association Between Comprehensive Nutritional Scoring System (CNSS) and Outcomes of Continuous Ambulatory Peritoneal Dialysis Patients. Kidney Blood Press Res 2017; 42:1225-1237. [PMID: 29248920 DOI: 10.1159/000485926] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 12/03/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS The presence of protein-energy wasting (PEW) among dialysis patients is a crucial risk factor for outcomes. The complicated pathogenesis of PEW makes it difficult to assess and treat. This single-center retrospective study focuses on the association between nutritional markers and the outcomes of continuous ambulatory peritoneal dialysis(CAPD) patients, aiming to establish a practical comprehensive nutritional scoring system for CAPD patients. METHODS 924 patients who initiated peritoneal dialysis in our center from January 1st,2005 to December 31st,2015 were enrolled. Comprehensive nutritional scoring system(CNSS) was based on items including SGA, BMI, ALB, TC, MAC and TSF. We divide patients into 3 groups according to their CNSS score. Outcomes including mortality, hospitalization days and hospitalization frequency were compared between 3 grades. RESULTS The CNSS grade correlated significantly with hospitalization days (P<0.05). Both categorized CNSS grade (HR:0.56; 95% CI:0.41-0.78; P = 0.001) and continuous CNSS score (HR:0.87; 95% CI: 0.80-0.94; P = 0.001) independently protect PD patients from all-cause mortality. CONCLUSION CNSS provides an integrated scoring system with significant associations with hospitalization and mortality in PD patients. The CNSS grade differentiates patients with malnutritional risk and independently predicts high risk of morbidity and mortality.
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Affiliation(s)
- Xingqun Yan
- aKidney Disease Center, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xin Yang
- aKidney Disease Center, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xishao Xie
- aKidney Disease Center, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Shilong Xiang
- aKidney Disease Center, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiaohui Zhang
- aKidney Disease Center, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Zhangfei Shou
- bKidney Disease Center, International Hospital of Zhejiang University, Shulan (Hangzhou) Hospital,, Hangzhou, China
| | - Jianghua Chen
- aKidney Disease Center, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Nie S, Feng Z, Tang L, Wang X, He Y, Fang J, Li S, Yang Y, Mao H, Jiao J, Liu W, Cao N, Wang W, Sun J, Shao F, Li W, He Q, Jiang H, Lin H, Fu P, Zhang X, Liu Y, Wu Y, Xi C, Liang M, Qu Z, Zhu J, Wu G, Zheng Y, Na Y, Li Y, Li W, Cai G, Chen X. Risk Factor Analysis for AKI Including Laboratory Indicators: a Nationwide Multicenter Study of Hospitalized Patients. Kidney Blood Press Res 2017; 42:761-773. [PMID: 29136619 DOI: 10.1159/000484234] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 06/16/2017] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND/AIMS Risk factor studies for acute kidney injury (AKI) in China are lacking, especially those regarding non-traditional risk factors, such as laboratory indicators. METHODS All adult patients admitted to 38 tertiary and 22 secondary hospitals in China in any one month between July and December 2014 were surveyed. AKI patients were screened according to the Kidney Disease: Improving Global Outcomes' definition of AKI. Logistic regression was used to analyze the risk factors for AKI, and Cox regression was used to analyze the risk of in-hospital mortality for AKI patients; additionally, a propensity score analysis was used to reconfirm the risk factors among laboratory indicators for mortality. RESULTS The morbidity of AKI was 0.97%. Independent risk factors for AKI were advancing age, male gender, hypertension, and chronic kidney disease. All-cause mortality was 16.5%. The predictors of mortality in AKI patients were advancing age, tumor, higher uric acid level and increases in Acute Physiologic Assessment and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores. The hazard ratio (HR) for mortality with uric acid levels > 9.1 mg/dl compared with ≤ 5.2 mg/dl was 1.78 (95% CI: 1.23 to 2.58) for the AKI patients as a group, and was 1.73 (95% CI: 1.24 to 2.42) for a propensity score-matched set. CONCLUSION In addition to traditional risk factors, uric acid level is an independent predictor of all-cause mortality after AKI.
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Affiliation(s)
- Sasa Nie
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing, China
| | - Zhe Feng
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing, China
| | - Li Tang
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing, China
| | - Xiaolong Wang
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing, China
| | - Yani He
- Department of Nephrology, Daping Hospital, the Third Military Medical University, Chongqing, China
| | - Jingai Fang
- Department of Nephrology, the First Hospital of Shanxi Medical University, Taiyuan, China
| | - Suhua Li
- Department of Nephrology, the First Affiliate Hospital of Xinjiang Medical University, Urumqi, China
| | - Yibin Yang
- Department of Nephrology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Huijuan Mao
- Department of Nephrology, the Jiangsu Province Hospital, Nanjing, China
| | - Jundong Jiao
- Department of Nephrology, the Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Wenhu Liu
- Department of Nephrology, Beiijng Freindship Hospital, Capital Medical University, Beijing, China
| | - Ning Cao
- Department of blood purification, General Hospital of Shenyang Military Area Command, Shenyang, China
| | - Wenge Wang
- Department of Nephrology, Lanzhou University Second hospital, Lanzhou, China
| | - Jifeng Sun
- Department of Nephrology, Tangdu Hospital, The Fourth Military Medical University, Xi'an, China
| | - Fengmin Shao
- Department of Nephrology, Henan Provincial People's Hospital, Zhengzhou University, Zhengzhou, China
| | - Wenge Li
- Department of Nephrology, China-Japan Friendship Hospital, Beijing, China
| | - Qiang He
- Department of Nephrology, Zhejiang Provincial People's Hospital, Hangzhou, China
| | - Hongli Jiang
- Blood purification center, the First Affiliated Hospital of Xian Jiaotong University, Xi'an, China
| | - Hongli Lin
- Department of Nephrology, the First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Ping Fu
- Department of Nephrology, West China Hospital of Sichuan University, Chengdu, China
| | - Xinzhou Zhang
- Department of Nephrology, Shenzhen People's Hospital, Shenzhen, China
| | - Yinghong Liu
- Department of Nephrology, the Second Xiangya Hospital, Central South University, Changsha, China
| | - Yonggui Wu
- Department of Nephrology, the Frist Affiliated Hospital of Anhui Medical university, Hefei, China
| | - ChunSheng Xi
- Department of Nephrology, the Lanzhou Military General Hospital, Lanzhou, China
| | - Meng Liang
- Department of Nephrology, Chenggong Hospital Xiamen University, Xiamen, China
| | - Zhijie Qu
- Department of Nephrology, the Second Hospital of Jilin University, Changchun, China
| | - Jun Zhu
- Department of Nephrology, the Chengdu Military General Hospital, Chengdu, China
| | - Guangli Wu
- Department of Nephrology, the Bethune international peace hospital of PLA, Shijiazhuang, China
| | - Yali Zheng
- Department of Nephrology, Ningxia People's Hospital, Yinchuan, China
| | - Yu Na
- Department of Nephrology, the 306th Hospital of PLA, Beijing, China
| | - Ying Li
- Department of Nephrology, the Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Wei Li
- Department of Nephrology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Guangyan Cai
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing, China
| | - Xiangmei Chen
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing, China
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Kang E, Hwang SS, Kim DK, Oh KH, Joo KW, Kim YS, Lee H. Sex-specific Relationship of Serum Uric Acid with All-cause Mortality in Adults with Normal Kidney Function: An Observational Study. J Rheumatol 2017; 44:380-387. [PMID: 28089980 DOI: 10.3899/jrheum.160792] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2016] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To explain the clinical effect of serum uric acid (SUA) levels as a risk factor for mortality, considering exclusion of kidney function. METHODS Participants aged over 40 years who underwent health checkups were recruited. Individuals with estimated glomerular filtrations rates < 60 ml/min/1.73 m2 and who received laboratory study and colonoscopy on the same day were excluded. RESULTS SUA levels were higher in men than in women (5.7 ± 1.2 mg/dl for men and 4.2 ± 0.9 mg/dl for women, p < 0.001). During 12.3 ± 3.6 years of followup, 1402 deaths occurred among 27,490 participants. About 6.9% of men and 3.1% of women died. The overall mortality rate had a U-shaped association with SUA levels, a U-shaped association in men, and no association in women. There was a significant interaction of sex for the SUA-mortality association (p for interaction = 0.049); therefore, survival analysis was conducted by sex. In men, the lower SUA group had a higher mortality rate after adjustment (SUA ≤ 4.0 mg/dl, adjusted HR 1.413, 95% CI 1.158-1.724, p = 0.001) compared with the reference group (SUA 4.1-6.0 mg/dl). A higher SUA contributed to an insignificant increased mortality in men (> 8.0 mg/dl, adjusted HR 1.140, 95% CI 0.794-1.636, p = 0.479). Women failed to show any significant association between SUA and mortality. CONCLUSION This study provided novel evidence that SUA-mortality association differed by sex. We demonstrated that a lower SUA was an independent risk factor for all-cause mortality in men with normal kidney function.
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Affiliation(s)
- Eunjeong Kang
- From the Department of Internal Medicine, Seoul National University Hospital; Department of Internal Medicine, Seoul National University College of Medicine; Kidney Research Institute, Seoul National University College of Medicine, Seoul; Department of Social and Preventive Medicine, Inha University School of Medicine, Incheon, Korea.,E. Kang, MD, Department of Internal Medicine, Seoul National University Hospital, and Department of Internal Medicine, Seoul National University College of Medicine; S.S. Hwang, MD, PhD, Department of Social and Preventive Medicine, Inha University School of Medicine; D.K. Kim, MD, PhD, Department of Internal Medicine, Seoul National University Hospital, and Department of Internal Medicine, Seoul National University College of Medicine, and Kidney Research Institute, Seoul National University College of Medicine; K.H. Oh, MD, PhD, Department of Internal Medicine, Seoul National University Hospital, and Kidney Research Institute, Seoul National University College of Medicine; K.W. Joo, MD, PhD, Department of Internal Medicine, Seoul National University Hospital, and Department of Internal Medicine, Seoul National University College of Medicine, and Kidney Research Institute, Seoul National University College of Medicine; Y.S. Kim, MD, PhD, Department of Internal Medicine, Seoul National University Hospital, and Department of Internal Medicine, Seoul National University College of Medicine, and Kidney Research Institute, Seoul National University College of Medicine; H. Lee, MD, Department of Internal Medicine, Seoul National University Hospital, and Department of Internal Medicine, Seoul National University College of Medicine, and Kidney Research Institute, Seoul National University College of Medicine
| | - Seung-Sik Hwang
- From the Department of Internal Medicine, Seoul National University Hospital; Department of Internal Medicine, Seoul National University College of Medicine; Kidney Research Institute, Seoul National University College of Medicine, Seoul; Department of Social and Preventive Medicine, Inha University School of Medicine, Incheon, Korea.,E. Kang, MD, Department of Internal Medicine, Seoul National University Hospital, and Department of Internal Medicine, Seoul National University College of Medicine; S.S. Hwang, MD, PhD, Department of Social and Preventive Medicine, Inha University School of Medicine; D.K. Kim, MD, PhD, Department of Internal Medicine, Seoul National University Hospital, and Department of Internal Medicine, Seoul National University College of Medicine, and Kidney Research Institute, Seoul National University College of Medicine; K.H. Oh, MD, PhD, Department of Internal Medicine, Seoul National University Hospital, and Kidney Research Institute, Seoul National University College of Medicine; K.W. Joo, MD, PhD, Department of Internal Medicine, Seoul National University Hospital, and Department of Internal Medicine, Seoul National University College of Medicine, and Kidney Research Institute, Seoul National University College of Medicine; Y.S. Kim, MD, PhD, Department of Internal Medicine, Seoul National University Hospital, and Department of Internal Medicine, Seoul National University College of Medicine, and Kidney Research Institute, Seoul National University College of Medicine; H. Lee, MD, Department of Internal Medicine, Seoul National University Hospital, and Department of Internal Medicine, Seoul National University College of Medicine, and Kidney Research Institute, Seoul National University College of Medicine
| | - Dong Ki Kim
- From the Department of Internal Medicine, Seoul National University Hospital; Department of Internal Medicine, Seoul National University College of Medicine; Kidney Research Institute, Seoul National University College of Medicine, Seoul; Department of Social and Preventive Medicine, Inha University School of Medicine, Incheon, Korea.,E. Kang, MD, Department of Internal Medicine, Seoul National University Hospital, and Department of Internal Medicine, Seoul National University College of Medicine; S.S. Hwang, MD, PhD, Department of Social and Preventive Medicine, Inha University School of Medicine; D.K. Kim, MD, PhD, Department of Internal Medicine, Seoul National University Hospital, and Department of Internal Medicine, Seoul National University College of Medicine, and Kidney Research Institute, Seoul National University College of Medicine; K.H. Oh, MD, PhD, Department of Internal Medicine, Seoul National University Hospital, and Kidney Research Institute, Seoul National University College of Medicine; K.W. Joo, MD, PhD, Department of Internal Medicine, Seoul National University Hospital, and Department of Internal Medicine, Seoul National University College of Medicine, and Kidney Research Institute, Seoul National University College of Medicine; Y.S. Kim, MD, PhD, Department of Internal Medicine, Seoul National University Hospital, and Department of Internal Medicine, Seoul National University College of Medicine, and Kidney Research Institute, Seoul National University College of Medicine; H. Lee, MD, Department of Internal Medicine, Seoul National University Hospital, and Department of Internal Medicine, Seoul National University College of Medicine, and Kidney Research Institute, Seoul National University College of Medicine
| | - Kook-Hwan Oh
- From the Department of Internal Medicine, Seoul National University Hospital; Department of Internal Medicine, Seoul National University College of Medicine; Kidney Research Institute, Seoul National University College of Medicine, Seoul; Department of Social and Preventive Medicine, Inha University School of Medicine, Incheon, Korea.,E. Kang, MD, Department of Internal Medicine, Seoul National University Hospital, and Department of Internal Medicine, Seoul National University College of Medicine; S.S. Hwang, MD, PhD, Department of Social and Preventive Medicine, Inha University School of Medicine; D.K. Kim, MD, PhD, Department of Internal Medicine, Seoul National University Hospital, and Department of Internal Medicine, Seoul National University College of Medicine, and Kidney Research Institute, Seoul National University College of Medicine; K.H. Oh, MD, PhD, Department of Internal Medicine, Seoul National University Hospital, and Kidney Research Institute, Seoul National University College of Medicine; K.W. Joo, MD, PhD, Department of Internal Medicine, Seoul National University Hospital, and Department of Internal Medicine, Seoul National University College of Medicine, and Kidney Research Institute, Seoul National University College of Medicine; Y.S. Kim, MD, PhD, Department of Internal Medicine, Seoul National University Hospital, and Department of Internal Medicine, Seoul National University College of Medicine, and Kidney Research Institute, Seoul National University College of Medicine; H. Lee, MD, Department of Internal Medicine, Seoul National University Hospital, and Department of Internal Medicine, Seoul National University College of Medicine, and Kidney Research Institute, Seoul National University College of Medicine
| | - Kwon Wook Joo
- From the Department of Internal Medicine, Seoul National University Hospital; Department of Internal Medicine, Seoul National University College of Medicine; Kidney Research Institute, Seoul National University College of Medicine, Seoul; Department of Social and Preventive Medicine, Inha University School of Medicine, Incheon, Korea.,E. Kang, MD, Department of Internal Medicine, Seoul National University Hospital, and Department of Internal Medicine, Seoul National University College of Medicine; S.S. Hwang, MD, PhD, Department of Social and Preventive Medicine, Inha University School of Medicine; D.K. Kim, MD, PhD, Department of Internal Medicine, Seoul National University Hospital, and Department of Internal Medicine, Seoul National University College of Medicine, and Kidney Research Institute, Seoul National University College of Medicine; K.H. Oh, MD, PhD, Department of Internal Medicine, Seoul National University Hospital, and Kidney Research Institute, Seoul National University College of Medicine; K.W. Joo, MD, PhD, Department of Internal Medicine, Seoul National University Hospital, and Department of Internal Medicine, Seoul National University College of Medicine, and Kidney Research Institute, Seoul National University College of Medicine; Y.S. Kim, MD, PhD, Department of Internal Medicine, Seoul National University Hospital, and Department of Internal Medicine, Seoul National University College of Medicine, and Kidney Research Institute, Seoul National University College of Medicine; H. Lee, MD, Department of Internal Medicine, Seoul National University Hospital, and Department of Internal Medicine, Seoul National University College of Medicine, and Kidney Research Institute, Seoul National University College of Medicine
| | - Yon Su Kim
- From the Department of Internal Medicine, Seoul National University Hospital; Department of Internal Medicine, Seoul National University College of Medicine; Kidney Research Institute, Seoul National University College of Medicine, Seoul; Department of Social and Preventive Medicine, Inha University School of Medicine, Incheon, Korea.,E. Kang, MD, Department of Internal Medicine, Seoul National University Hospital, and Department of Internal Medicine, Seoul National University College of Medicine; S.S. Hwang, MD, PhD, Department of Social and Preventive Medicine, Inha University School of Medicine; D.K. Kim, MD, PhD, Department of Internal Medicine, Seoul National University Hospital, and Department of Internal Medicine, Seoul National University College of Medicine, and Kidney Research Institute, Seoul National University College of Medicine; K.H. Oh, MD, PhD, Department of Internal Medicine, Seoul National University Hospital, and Kidney Research Institute, Seoul National University College of Medicine; K.W. Joo, MD, PhD, Department of Internal Medicine, Seoul National University Hospital, and Department of Internal Medicine, Seoul National University College of Medicine, and Kidney Research Institute, Seoul National University College of Medicine; Y.S. Kim, MD, PhD, Department of Internal Medicine, Seoul National University Hospital, and Department of Internal Medicine, Seoul National University College of Medicine, and Kidney Research Institute, Seoul National University College of Medicine; H. Lee, MD, Department of Internal Medicine, Seoul National University Hospital, and Department of Internal Medicine, Seoul National University College of Medicine, and Kidney Research Institute, Seoul National University College of Medicine
| | - Hajeong Lee
- From the Department of Internal Medicine, Seoul National University Hospital; Department of Internal Medicine, Seoul National University College of Medicine; Kidney Research Institute, Seoul National University College of Medicine, Seoul; Department of Social and Preventive Medicine, Inha University School of Medicine, Incheon, Korea. .,E. Kang, MD, Department of Internal Medicine, Seoul National University Hospital, and Department of Internal Medicine, Seoul National University College of Medicine; S.S. Hwang, MD, PhD, Department of Social and Preventive Medicine, Inha University School of Medicine; D.K. Kim, MD, PhD, Department of Internal Medicine, Seoul National University Hospital, and Department of Internal Medicine, Seoul National University College of Medicine, and Kidney Research Institute, Seoul National University College of Medicine; K.H. Oh, MD, PhD, Department of Internal Medicine, Seoul National University Hospital, and Kidney Research Institute, Seoul National University College of Medicine; K.W. Joo, MD, PhD, Department of Internal Medicine, Seoul National University Hospital, and Department of Internal Medicine, Seoul National University College of Medicine, and Kidney Research Institute, Seoul National University College of Medicine; Y.S. Kim, MD, PhD, Department of Internal Medicine, Seoul National University Hospital, and Department of Internal Medicine, Seoul National University College of Medicine, and Kidney Research Institute, Seoul National University College of Medicine; H. Lee, MD, Department of Internal Medicine, Seoul National University Hospital, and Department of Internal Medicine, Seoul National University College of Medicine, and Kidney Research Institute, Seoul National University College of Medicine.
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50
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Chen MY, Zhao CC, Li TT, Zhu Y, Yu TP, Bao YQ, Li LX, Jia WP. Serum uric acid levels are associated with obesity but not cardio-cerebrovascular events in Chinese inpatients with type 2 diabetes. Sci Rep 2017; 7:40009. [PMID: 28051185 PMCID: PMC5209679 DOI: 10.1038/srep40009] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 11/30/2016] [Indexed: 12/14/2022] Open
Abstract
We aim to explore the associations between serum uric acid (SUA) and obesity and cardio-cerebrovascular events (CCEs) in Chinese inpatients with type 2 diabetes mellitus (T2DM). 2 962 inpatients with T2DM were stratified into quartile based on SUA concentrations. There were significant increases in the prevalence of both obesity (32.6%, 41.9%, 50.1%, and 62.8%, respectively, p < 0.001 for trend) and severe obesity (0.4%, 0.6%, 0.8%, and 1.3%, respectively, p < 0.001 for trend) across the SUA quartiles. A fully adjusted multiple logistic regression analysis revealed that SUA quartiles were independently associated with the presence of obesity (p < 0.001). The prevalence of CCEs was significantly higher in the obese diabetics than in the nonobese diabetics (16.8% vs. 13.2%, p = 0.027). After controlling for multiple confounding factors, BMI levels were also significantly correlated with the presence of CCEs (p = 0.020). However, there was no significant association of SUA quartiles/SUA levels with the presence of CCEs in T2DM. This study suggested that SUA levels were independently associated with obesity but not with CCEs in patients with T2DM. In selected populations such as subjects with T2DM, the role of uric acid in cardiovascular complications might be attributable to other cardiovascular risk factors, such as obesity.
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Affiliation(s)
- Ming-Yun Chen
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital; Shanghai Clinical Center for Diabetes; Shanghai Diabetes Institute; Shanghai Key Laboratory. of Diabetes Mellitus; Shanghai Key Clinical Center for Metabolic Disease; 600 Yishan Road, Shanghai 200233, China
| | - Cui-Chun Zhao
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital; Shanghai Clinical Center for Diabetes; Shanghai Diabetes Institute; Shanghai Key Laboratory. of Diabetes Mellitus; Shanghai Key Clinical Center for Metabolic Disease; 600 Yishan Road, Shanghai 200233, China.,Department of VIP, Shanghai Jiao Tong University Affiliated Sixth People's Hospital; 600 Yishan Road, Shanghai 200233, China
| | - Ting-Ting Li
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital; Shanghai Clinical Center for Diabetes; Shanghai Diabetes Institute; Shanghai Key Laboratory. of Diabetes Mellitus; Shanghai Key Clinical Center for Metabolic Disease; 600 Yishan Road, Shanghai 200233, China
| | - Yue Zhu
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital; Shanghai Clinical Center for Diabetes; Shanghai Diabetes Institute; Shanghai Key Laboratory. of Diabetes Mellitus; Shanghai Key Clinical Center for Metabolic Disease; 600 Yishan Road, Shanghai 200233, China
| | - Tian-Pei Yu
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital; Shanghai Clinical Center for Diabetes; Shanghai Diabetes Institute; Shanghai Key Laboratory. of Diabetes Mellitus; Shanghai Key Clinical Center for Metabolic Disease; 600 Yishan Road, Shanghai 200233, China
| | - Yu-Qian Bao
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital; Shanghai Clinical Center for Diabetes; Shanghai Diabetes Institute; Shanghai Key Laboratory. of Diabetes Mellitus; Shanghai Key Clinical Center for Metabolic Disease; 600 Yishan Road, Shanghai 200233, China
| | - Lian-Xi Li
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital; Shanghai Clinical Center for Diabetes; Shanghai Diabetes Institute; Shanghai Key Laboratory. of Diabetes Mellitus; Shanghai Key Clinical Center for Metabolic Disease; 600 Yishan Road, Shanghai 200233, China
| | - Wei-Ping Jia
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital; Shanghai Clinical Center for Diabetes; Shanghai Diabetes Institute; Shanghai Key Laboratory. of Diabetes Mellitus; Shanghai Key Clinical Center for Metabolic Disease; 600 Yishan Road, Shanghai 200233, China
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