1
|
Zhang A, Qi L, Zhang Y, Ren Z, Zhao C, Wang Q, Ren K, Bai J, Cao N. Development of a prediction model to estimate the 5-year risk of cardiovascular events and all-cause mortality in haemodialysis patients: a retrospective study. PeerJ 2022; 10:e14316. [PMID: 36389426 PMCID: PMC9653067 DOI: 10.7717/peerj.14316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 10/07/2022] [Indexed: 11/10/2022] Open
Abstract
Background Cardiovascular disease (CVD) is a major cause of mortality in patients on haemodialysis. The development of a prediction model for CVD risk is necessary to help make clinical decisions for haemodialysis patients. This retrospective study aimed to develop a prediction model for the 5-year risk of CV events and all-cause mortality in haemodialysis patients in China. Methods We retrospectively enrolled 398 haemodialysis patients who underwent dialysis at the dialysis facility of the General Hospital of Northern Theater Command in June 2016 and were followed up for 5 years. The composite outcome was defined as CV events and/or all-cause death. Multivariable logistic regression with backwards stepwise selection was used to develop our new prediction model. Results Seven predictors were included in the final model: age, male sex, diabetes, history of CV events, no arteriovenous fistula at dialysis initiation, a monocyte/lymphocyte ratio greater than 0.43 and a serum uric acid level less than 436 mmol/L. Discrimination and calibration were satisfactory, with a C-statistic above 0.80. The predictors lay nearly on the 45-degree line for agreement with the outcome in the calibration plot. A simple clinical score was constructed to provide the probability of 5-year CV events or all-cause mortality. Bootstrapping validation showed that the new model also has similar discrimination and calibration. Compared with the Framingham risk score (FRS) and a similar model, our model showed better performance. Conclusion This prognostic model can be used to predict the long-term risk of CV events and all-cause mortality in haemodialysis patients. An MLR greater than 0.43 is an important prognostic factor.
Collapse
Affiliation(s)
- Aihong Zhang
- Department of Blood Purification, General Hospital of Northern Theater Command, Shenyang, Liaoning, China,Department of Nephrology, Xi’an People’s Hospital (Xi’an Fourth Hospital), Xi’an, China,Postgraduate College, Dalian Medical University, Dalian, Liaoning, China
| | - Lemuge Qi
- Department of Blood Purification, General Hospital of Northern Theater Command, Shenyang, Liaoning, China,Postgraduate College, China Medical University, Shenyang, Liaoning, China
| | - Yanping Zhang
- Department of Blood Purification, General Hospital of Northern Theater Command, Shenyang, Liaoning, China
| | - Zhuo Ren
- Department of Blood Purification, General Hospital of Northern Theater Command, Shenyang, Liaoning, China
| | - Chen Zhao
- Department of Blood Purification, General Hospital of Northern Theater Command, Shenyang, Liaoning, China
| | - Qian Wang
- Department of Blood Purification, General Hospital of Northern Theater Command, Shenyang, Liaoning, China
| | - Kaiming Ren
- Department of Blood Purification, General Hospital of Northern Theater Command, Shenyang, Liaoning, China
| | - Jiuxu Bai
- Department of Blood Purification, General Hospital of Northern Theater Command, Shenyang, Liaoning, China
| | - Ning Cao
- Department of Blood Purification, General Hospital of Northern Theater Command, Shenyang, Liaoning, China
| |
Collapse
|
2
|
Zhang SX, Yu YL, Tang ST, Lo K, Feng YQ, Chen JY. Association of serum uric acid levels with cardiovascular and all-cause mortality in hypertensive patients in China: a cohort study. Postgrad Med J 2022:7146674. [PMID: 37117041 DOI: 10.1136/pmj-2021-141313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 08/20/2022] [Indexed: 11/04/2022]
Abstract
PurposeThe present study aimed to assess the association of elevated serum uric acid (SUA) and hypouricemia with all-cause mortality and cardiovascular mortality in Chinese hypertensive patients.MethodsIn the present prospective cohort, 9325 hypertensive patients from Dongguan, China were enrolled from 2014 to 2018 for analysis. Participants were categorised by quintiles of SUA. The HRs and 95% CIs for the association between SUA, all-cause and cardiovascular mortality were evaluated using the multivariate Cox regression model. After adjusting for multiple confounders, restricted cubic spline analysis was conducted to demonstrate the shape of relationship.ResultsAfter a median follow-up of 4.18 years for 9325 participants, there were 409 (4.4%) and 151 (1.6%) reported cases of all-cause and cardiovascular mortality, respectively. By using the third quintile of SUA (6.68 mg/dL to <7.55 mg/dL for men, 5.63 mg/dL to <6.42 mg/dL for women) as reference, the highest quintiles of SUA were associated with an elevated risk of all cause (HR: 1.34, 95% CI 1.00 to 1.80) in the crude model, but the association was not significant after adjusting for multiple comparisons. The association between low SUA and mortality and the dose–response analysis on the non-linearity of SUA–mortality relationship were not statistically significant.ConclusionsAlthough the association between SUA levels, all-cause and cardiovascular disease mortality did not appear to be significant among Chinese hypertensive patients, the findings might be confounded by their medical conditions. Further studies are needed to verify the optimal SUA levels for hypertensive patients.
Collapse
Affiliation(s)
- Shu-Xian Zhang
- Department of Cardiology, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
- Department of Cardiology, Guangdong Provincial People's Hospital, Guangzhou, Guangdong, China
| | - Yu-Ling Yu
- Department of Cardiology, Guangdong Provincial People's Hospital, Guangzhou, Guangdong, China
| | - Song-Tao Tang
- Department of Cardiology, Community Health Center of Liaobu County, Dongguan, Guangdong, China
| | - Kenneth Lo
- Department of Cardiology, Guangdong Provincial People's Hospital, Guangzhou, Guangdong, China
- Department of Applied Biology and Chemical Technology, The Hong Kong Polytechnic University, Hong Kong, China
- Department of Epidemiology, Centre for Global Cardiometabolic Health, Brown University, Providence, Rhode Island, USA
| | - Ying-Qing Feng
- Department of Cardiology, Guangdong Provincial People's Hospital, Guangzhou, Guangdong, China
| | - Ji-Yan Chen
- Department of Cardiology, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
- Department of Cardiology, Guangdong Provincial People's Hospital, Guangzhou, Guangdong, China
| |
Collapse
|
3
|
Alkilany R, Einstadter D, Antonelli M. Urate-lowering therapy for patients with gout on hemodialysis. Int J Rheum Dis 2022; 25:769-774. [PMID: 35570645 PMCID: PMC9542196 DOI: 10.1111/1756-185x.14334] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/19/2022] [Accepted: 04/29/2022] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Gout is the most common form of inflammatory arthritis and is caused by deposition of monosodium urate crystals resulting from a high burden of uric acid (UA). High UA burden also has been associated with increased morbidity and mortality in the general population and progression to chronic kidney disease. In persons with gout and end-stage renal disease (ESRD), prior studies suggest that UA levels decrease after initiation of hemodialysis (HD). We evaluated UA level and the use of urate-lowering therapies (ULTs) in patients with gout and ESRD on HD. METHODS We performed a retrospective review of patients with gout and ESRD seen at a large urban public hospital (The MetroHealth System). We extracted data from the medical record (Epic) for patients diagnosed with gout and ESRD on HD. The main outcomes were the UA level and the use of ULTs before and after HD initiation. RESULTS We identified 131 patients with gout on HD. Of these, 21 patients had crystal proven gout diagnosis, 10 of whom had data on UA level pre-HD and post-HD and were included in the analysis. For the total sample (N = 21), the mean age was 65 years, 7 were female and 20 were African American. Mean pre-HD and post-HD UA levels were 8.4 and 3.98 mg/dL respectively. Twenty-one patients were receiving ULT pre-HD, 11 discontinued post-HD. CONCLUSION Among patients with gout and ESRD, we observed a decrease in UA level associated with initiation of HD. For this group, discontinuation of ULTs may be appropriate.
Collapse
Affiliation(s)
- Reem Alkilany
- Department of MedicineDivision of RheumatologyMetroHealth Medical Center/Case Western Reserve UniversityClevelandOhioUSA
| | - Douglas Einstadter
- Center for Health Care Research and Policy, and Department of Internal MedicineMetroHealth Medical Center/Case Western Reserve UniversityClevelandOhioUSA
| | - Maria Antonelli
- Department of MedicineDivision of RheumatologyMetroHealth Medical Center/Case Western Reserve UniversityClevelandOhioUSA
| |
Collapse
|
4
|
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.
Collapse
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:
| |
Collapse
|
5
|
Crawley WT, Jungels CG, Stenmark KR, Fini MA. U-shaped association of uric acid to overall-cause mortality and its impact on clinical management of hyperuricemia. Redox Biol 2022; 51:102271. [PMID: 35228125 PMCID: PMC8889273 DOI: 10.1016/j.redox.2022.102271] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 02/12/2022] [Accepted: 02/14/2022] [Indexed: 12/12/2022] Open
Abstract
Serum uric acid (SUA) is significantly elevated in obesity, gout, type 2 diabetes mellitus, and the metabolic syndrome and appears to contribute to the renal, cardiovascular and pulmonary comorbidities that are associated with these disorders. Most previous studies have focused on the pathophysiologic effects of high levels of uric acid (hyperuricemia). More recently, research has also shifted to the impact of hypouricemia, with multiple studies showing the potentially damaging effects that can be caused by abnormally low levels of SUA. Along with these observations, recent inconclusive data from human studies evaluating the treatment of hyperuricemia with xanthine oxidoreductase (XOR) inhibitors have added to the debate about the causal role of UA in human disease processes. SUA, which is largely derived from hepatic degradation of purines, appears to exert both systemic pro-inflammatory effects that contribute to disease and protective antioxidant properties. XOR, which catalyzes the terminal two steps of purine degradation, is the major source of both reactive oxygen species (O2.-, H2O2) and UA. This review will summarize the evidence that both elevated and low SUA may be risk factors for renal, cardiovascular and pulmonary comorbidities. It will also discuss the mechanisms through which modulation of either XOR activity or SUA may contribute to vascular redox hemostasis. We will address future research studies to better account for the differential effects of high versus low SUA in the hope that this will identify new evidence-based approaches for the management of hyperuricemia.
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
Maloberti A, Biolcati M, Ruzzenenti G, Giani V, Leidi F, Monticelli M, Algeri M, Scarpellini S, Nava S, Soriano F, Oreglia J, Sacco A, Morici N, Oliva F, Piani F, Borghi C, Giannattasio C. The Role of Uric Acid in Acute and Chronic Coronary Syndromes. J Clin Med 2021; 10:jcm10204750. [PMID: 34682873 PMCID: PMC8540994 DOI: 10.3390/jcm10204750] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 10/12/2021] [Accepted: 10/13/2021] [Indexed: 12/14/2022] Open
Abstract
Uric acid (UA) is the final product of the catabolism of endogenous and exogenous purine nucleotides. While its association with articular gout and kidney disease has been known for a long time, new data have demonstrated that UA is also related to cardiovascular (CV) diseases. UA has been identified as a significant determinant of many different outcomes, such as all-cause and CV mortality, and also of CV events (mainly Acute Coronary Syndromes (ACS) and even strokes). Furthermore, UA has been related to the development of Heart Failure, and to a higher mortality in decompensated patients, as well as to the onset of atrial fibrillation. After a brief introduction on the general role of UA in CV disorders, this review will be focused on UA's relationship with CV outcomes, as well as on the specific features of patients with ACS and Chronic Coronary Syndrome. Finally, two issues which remain open will be discussed: the first is about the identification of a CV UA cut-off value, while the second concerns the possibility that the pharmacological reduction of UA is able to lower the incidence of CV events.
Collapse
Affiliation(s)
- Alessandro Maloberti
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy; (M.B.); (G.R.); (V.G.); (F.L.); (M.M.); (C.G.)
- Cardiology 4, ASST GOM Niguarda Hospital, 20121 Milan, Italy; (M.A.); (S.S.)
- Correspondence: ; Tel.: +39-026-444-2141; Fax: +39-026-444-2566
| | - Marco Biolcati
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy; (M.B.); (G.R.); (V.G.); (F.L.); (M.M.); (C.G.)
- Cardiology 4, ASST GOM Niguarda Hospital, 20121 Milan, Italy; (M.A.); (S.S.)
| | - Giacomo Ruzzenenti
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy; (M.B.); (G.R.); (V.G.); (F.L.); (M.M.); (C.G.)
- Cardiology 4, ASST GOM Niguarda Hospital, 20121 Milan, Italy; (M.A.); (S.S.)
| | - Valentina Giani
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy; (M.B.); (G.R.); (V.G.); (F.L.); (M.M.); (C.G.)
- Cardiology 4, ASST GOM Niguarda Hospital, 20121 Milan, Italy; (M.A.); (S.S.)
| | - Filippo Leidi
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy; (M.B.); (G.R.); (V.G.); (F.L.); (M.M.); (C.G.)
- Cardiology 4, ASST GOM Niguarda Hospital, 20121 Milan, Italy; (M.A.); (S.S.)
| | - Massimiliano Monticelli
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy; (M.B.); (G.R.); (V.G.); (F.L.); (M.M.); (C.G.)
- Cardiology 4, ASST GOM Niguarda Hospital, 20121 Milan, Italy; (M.A.); (S.S.)
| | - Michela Algeri
- Cardiology 4, ASST GOM Niguarda Hospital, 20121 Milan, Italy; (M.A.); (S.S.)
| | - Sara Scarpellini
- Cardiology 4, ASST GOM Niguarda Hospital, 20121 Milan, Italy; (M.A.); (S.S.)
| | - Stefano Nava
- Cardiology 1, ASST GOM Niguarda Hospital, 20121 Milan, Italy; (S.N.); (F.S.); (J.O.); (A.S.); (N.M.); (F.O.)
| | - Francesco Soriano
- Cardiology 1, ASST GOM Niguarda Hospital, 20121 Milan, Italy; (S.N.); (F.S.); (J.O.); (A.S.); (N.M.); (F.O.)
| | - Jacopo Oreglia
- Cardiology 1, ASST GOM Niguarda Hospital, 20121 Milan, Italy; (S.N.); (F.S.); (J.O.); (A.S.); (N.M.); (F.O.)
| | - Alice Sacco
- Cardiology 1, ASST GOM Niguarda Hospital, 20121 Milan, Italy; (S.N.); (F.S.); (J.O.); (A.S.); (N.M.); (F.O.)
| | - Nuccia Morici
- Cardiology 1, ASST GOM Niguarda Hospital, 20121 Milan, Italy; (S.N.); (F.S.); (J.O.); (A.S.); (N.M.); (F.O.)
| | - Fabrizio Oliva
- Cardiology 1, ASST GOM Niguarda Hospital, 20121 Milan, Italy; (S.N.); (F.S.); (J.O.); (A.S.); (N.M.); (F.O.)
| | - Federica Piani
- School of Medicine and Surgery, University of Bologna—IRCCS Policlinico S. Orsola, 40138 Bologna, Italy; (F.P.); (C.B.)
| | - Claudio Borghi
- School of Medicine and Surgery, University of Bologna—IRCCS Policlinico S. Orsola, 40138 Bologna, Italy; (F.P.); (C.B.)
| | - Cristina Giannattasio
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy; (M.B.); (G.R.); (V.G.); (F.L.); (M.M.); (C.G.)
- Cardiology 4, ASST GOM Niguarda Hospital, 20121 Milan, Italy; (M.A.); (S.S.)
| |
Collapse
|
8
|
Lower serum uric acid level predicts mortality in dialysis patients: Erratum. Medicine (Baltimore) 2021; 100:e27274. [PMID: 34664884 PMCID: PMC8448022 DOI: 10.1097/md.0000000000027274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
9
|
The Association Between Uric Acid and Symmetric Dimethylarginine Levels in the Patients Undergoing Twice-weekly Hemodialysis. Nephrourol Mon 2021. [DOI: 10.5812/numonthly.117476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Uric acid (UA) levels are associated with increased risk of cardiovascular events and mortality in hemodialysis patients. However, there are still conflicting data on the mechanism of increased risks related to uric acid levels. Objectives: This study assessed the association between uric acid levels and symmetric dimethylarginine (SDMA), as a marker of cardiovascular disease, in the subjects undergoing hemodialysis twice weekly. Methods: This was a cross-sectional study conducted in a tertiary hospital in Jakarta, Indonesia. We included all the adults who underwent hemodialysis twice weekly for at least three months in our hospital. Subjects already on uric acid lowering therapy, pregnant or lactating women and those with a history of malignancy were excluded. Uric acid and SDMA levels were measured at the same time in pre-dialysis venous blood samples. Bivariate analysis was performed using the Mann-Whitney U test or one-way ANOVA. Results: A total of 126 subjects were included. The median level of UA was 8.4 mg/dL (IQR: 2.6, min: 4.1, max: 13.6), and 72 subjects (57.14%) had UA levels of 8 mg/dL or higher. The median SDMA level was 535.5 (312.7) mmol/dL (min: 119.7, max: 1895.5). Subjects with UA levels > 8 mg/dL had significantly higher SDMA levels compared to subjects with UA levels < 8 mg/dL (550.1 (IQR: 357.25) vs 491.35 (IQR: 181.1), P: 0.0475). Conclusions: In twice-weekly hemodialysis patients, UA levels above 8 mg/dL were associated with increased SDMA levels.
Collapse
|
10
|
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.
Collapse
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
| |
Collapse
|
11
|
Ren X, Gao J, Han T, Sun C. Association between risk of type 2 diabetes and changes in energy intake at breakfast and dinner over 14 years: a latent class trajectory analysis from the China health and nutrition Survey, 1997-2011. BMJ Open 2021; 11:e046183. [PMID: 34266840 PMCID: PMC8286767 DOI: 10.1136/bmjopen-2020-046183] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE This study aimed to investigate the association between the trajectories of energy consumption at dinner versus breakfast and the risk of type 2 diabetes (T2D). DESIGN Cohort study. SETTING The study was conducted in China. PARTICIPANTS A total of 10 727 adults, including 5239 men and 5488 women, with a mean age of 42.7±11.2 years and a mean follow-up time of 9.1 years, met the study criteria and completed a questionnaire about energy intake and diabetes status from the China Health and Nutrition Survey in 1997-2011. PRIMARY OUTCOME MEASURES Participants were divided into subgroups based on the trajectories of the ratio of energy consumption at dinner versus breakfast. Cox multivariate regression models were used to explore the associations between different trajectories and the risk of T2D after adjustment for confounders and their risk factors. Mediation analysis was performed to explore the intermediary effect of triacylglycerol (TG), total cholesterol (TC), uric acid (UA) and apolipoprotein B (ApoB) between the trajectories and the risk of T2D. RESULTS For energy consumption at dinner versus breakfast, compared with a low-stable trajectory, the adjusted HR of T2D in low-increasing from early-stage trajectory was 1.29 (95% CI 1.04 to 1.60). TG, TC, UA and ApoB were significantly higher in low-increasing from early-stage trajectory than other trajectories and play partial regulation roles between trajectories and T2D. CONCLUSIONS This study emphasised the harmful effect of a gradual increase in the ratio of energy consumption at dinner versus breakfast from early stage on the development of T2D and partially mediated by TG, TC, UA and ApoB, highlighting that it is necessary to intake more energy at breakfast compared with dinner to prevent T2D in adults.
Collapse
Affiliation(s)
- Xiyun Ren
- Department of Nutrition and Food Hygiene, Harbin Medical University, Harbin, China
| | - Jian Gao
- Department of Nutrition and Food Hygiene, Harbin Medical University, Harbin, China
| | - Tianshu Han
- Department of Nutrition and Food Hygiene, Harbin Medical University, Harbin, China
| | - Changhao Sun
- Department of Nutrition and Food Hygiene, Harbin Medical University, Harbin, China
| |
Collapse
|
12
|
Inaba M, Okuno S, Ohno Y. Importance of Considering Malnutrition and Sarcopenia in Order to Improve the QOL of Elderly Hemodialysis Patients in Japan in the Era of 100-Year Life. Nutrients 2021; 13:nu13072377. [PMID: 34371887 PMCID: PMC8308469 DOI: 10.3390/nu13072377] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/02/2021] [Accepted: 07/08/2021] [Indexed: 02/06/2023] Open
Abstract
In the current aging society of Japan, malnutrition and resultant sarcopenia have been widely identified as important symptomatic indicators of ill health and can cause impairments of longevity and quality of life in older individuals. Elderly individuals are recommended to have sufficient calorie and protein intake so as to enjoy a satisfactory quality of life, including maintaining activities of daily living in order to avoid emaciation and sarcopenia. The prevalence of emaciation and sarcopenia in elderly hemodialysis (HD) patients in Japan is higher than in non-HD elderly subjects due to the presence of malnutrition and sarcopenia associated with chronic kidney disease (CKD). Furthermore, comorbidities, such as diabetes and osteoporosis, induce malnutrition and sarcopenia in HD patients. This review presents findings regarding the mechanisms of the development of these early symptomatic conditions and their significance for impaired QOL and increased mortality in elderly HD patients.
Collapse
Affiliation(s)
- Masaaki Inaba
- Department of Nephrology, Osaka City University Medical School, 1-4-3 Asahi-machi, Abeno-ku, Osaka 543-8585, Japan
- Kidney Center, Ohno Memorial Hospital, 1-26-10, Minami-Horie, Nishi-ku, Osaka 550-0015, Japan;
- Correspondence:
| | - Senji Okuno
- Kidney Center, Shirasagi Hospital, 7-11-23, Higashisumiyoshi-ku, Osaka 546-0002, Japan;
| | - Yoshiteru Ohno
- Kidney Center, Ohno Memorial Hospital, 1-26-10, Minami-Horie, Nishi-ku, Osaka 550-0015, Japan;
| |
Collapse
|
13
|
de Arriba G, Avila GG, Guinea MT, Alia IM, Herruzo JA, Ruiz BR, Tejeiro RD, Rubio MEL, Poyatos CV, Roldán CG. Mortality of hemodialysis patients is associated with their clinical situation at the start of treatment. Nefrologia 2021; 41:461-466. [PMID: 36165115 DOI: 10.1016/j.nefroe.2021.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 11/09/2020] [Indexed: 06/16/2023] Open
Abstract
INTRODUCTION Previous reports have shown very high mortality among hemodialyisis patients. Our goal was to analyze the mortality of patients in the Renal Registry of Patients who remained exclusively on hemodialysis treatment. METHODS The cohort of patients who started treatment in the community of Castilla-La Mancha between 2010 and 2012 and remained on hemodialysis treatment was analysed until the end of 2017. Age, sex, primary kidney disease, vascular access, hemoglobin, Charlson index and serum albumin were included. RESULTS Mortality rate was 63,4% after 5 years and 76% at the end of the study, with no difference between males and females, and was linked to an older age, urgent onset or in those with acute deterioration of chronic kidney disease, the use of catheters or albumin less than 3.5 g/dl. CONCLUSIONS Mortality in patients who remain on hemodialysis is very high and is associated with non-modifiable factors such as age but also others that we can prevent or treat such as type of vascular access or nutrition status at the beginning of treatment.
Collapse
Affiliation(s)
- Gabriel de Arriba
- Hospital Universitario de Guadalajara, Guadalajara, Spain; Departamento de Medicina y Especialidades Médicas de la Universidad de Alcalá, Madrid, Spain; Registro de Enfermos Renales de Castilla-La Mancha (RERCLM), Spain.
| | - Gonzalo Gutiérrez Avila
- Consejería de Sanidad, Junta de Comunidades de Castilla-La Mancha, Toledo, Spain; Registro de Enfermos Renales de Castilla-La Mancha (RERCLM), Spain
| | - Marta Torres Guinea
- Hospital Virgen de la Salud de Toledo, Toledo, Spain; Registro de Enfermos Renales de Castilla-La Mancha (RERCLM), Spain
| | - Inmaculada Moreno Alia
- Consejería de Sanidad, Junta de Comunidades de Castilla-La Mancha, Toledo, Spain; Registro de Enfermos Renales de Castilla-La Mancha (RERCLM), Spain
| | - José Antonio Herruzo
- Centros de Diálisis Asyter, Toledo, Spain; Registro de Enfermos Renales de Castilla-La Mancha (RERCLM), Spain
| | - Begoña Rincón Ruiz
- Hospital Virgen de la Luz de Cuenca, Cuenca, Spain; Registro de Enfermos Renales de Castilla-La Mancha (RERCLM), Spain
| | - Rafael Díaz Tejeiro
- Hospital Virgen de la Salud de Toledo, Toledo, Spain; Registro de Enfermos Renales de Castilla-La Mancha (RERCLM), Spain
| | - Maria Esperanza López Rubio
- Hospital General Universitario de Albacete, Albacete, Spain; Registro de Enfermos Renales de Castilla-La Mancha (RERCLM), Spain
| | - Carmen Vozmediano Poyatos
- Hospital General Universitario de Ciudad Real, Ciudad Real, Spain; Registro de Enfermos Renales de Castilla-La Mancha (RERCLM), Spain
| | - Carmina Gómez Roldán
- Hospital General Universitario de Albacete, Albacete, Spain; Registro de Enfermos Renales de Castilla-La Mancha (RERCLM), Spain
| |
Collapse
|
14
|
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}
\usepackage{amsmath}
\usepackage{wasysym}
\usepackage{amsfonts}
\usepackage{amssymb}
\usepackage{amsbsy}
\usepackage{mathrsfs}
\usepackage{upgreek}
\setlength{\oddsidemargin}{-69pt}
\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.
Collapse
|
15
|
Mortality of hemodialysis patients is associated with their clinical situation at the start of treatment. Nefrologia 2021. [PMID: 33663811 DOI: 10.1016/j.nefro.2020.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Previous reports have shown very high mortality among hemodialyisis patients. Our goal was to analyze the mortality of patients in the Renal Registry of Patients who remained exclusively on hemodialysis treatment. METHODS The cohort of patients who started treatment in the community of Castilla-La Mancha between 2010 and 2012 and remained on hemodialysis treatment was analysed until the end of 2017. Age, sex, primary kidney disease, vascular access, hemoglobin, Charlson index and serum albumin were included. RESULTS Mortality rate was 63.4% after 5 years and 76% at the end of the study, with no difference between males and females, and was linked to an older age, urgent onset or in those with acute deterioration of chronic kidney disease, the use of catheters or albumin less than 3.5g/dl. CONCLUSIONS Mortality in patients who remain on hemodialysis is very high and is associated with non-modifiable factors such as age but also others that we can prevent or treat such as type of vascular access or nutrition status at the beginning of treatment.
Collapse
|
16
|
Wang H, Liu J, Xie D, Liu H, Zhen L, Guo D, Liu X. Elevated serum uric acid and risk of cardiovascular or all-cause mortality in maintenance hemodialysis patients: A meta-analysis. Nutr Metab Cardiovasc Dis 2021; 31:372-381. [PMID: 33485730 DOI: 10.1016/j.numecd.2020.11.017] [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: 08/11/2020] [Revised: 11/08/2020] [Accepted: 11/17/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND AIMS Studies have shown inconsistent results about the association between serum uric acid (SUA) levels and mortality in hemodialysis patients. We performed this meta-analysis to determine whether higher SUA values comprised a risk factor of cardiovascular or all-cause mortality in maintenance hemodialysis patients. METHODS AND RESULTS Pubmed, Embase and the Cochrane library were searched up to August 31, 2020 for the longitudinal studies that investigated the association between the elevated SUA and cardiovascular or all-cause mortality risk in maintenance hemodialysis patients. Pooled adjusted hazard ratios (HR) and corresponding 95% confidence interval (CI) were calculated using a random-effects model. We included 10 studies with an overall sample of 264,571 patients with hemodialysis in this meta-analysis. Patients with the highest SUA were associated with a decreased risk of cardiovascular mortality (HR = 0.72, 95% CI 0.59-0.87) compared with patients with the lowest SUA after adjustment for potential confounders in a random effects model. Moreover, for each increase of 1 mg/dl of SUA, the overall risks of all-cause and cardiovascular mortality decreased by 6% and 9%, respectively (HR = 0.94, 95% CI 0.90-0.99; HR = 0.91, 95% CI 0.89-0.94). CONCLUSION Elevated SUA levels are strongly and independently associated with lower risk of cardiovascular mortality in maintenance hemodialysis patients. More designed studies, especially randomized controlled trials, should be conducted to determine whether high SUA levels is an independent risk factor of all-cause mortality in hemodialysis patients.
Collapse
Affiliation(s)
- Huifang Wang
- Department of Nephrology, the Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong, China
| | - Jun Liu
- Department of Nephrology, the Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong, China
| | - Demin Xie
- Department of Nephrology, the Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong, China
| | - Hang Liu
- Department of Nephrology, the Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong, China
| | - Li Zhen
- Department of Nephrology, the Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong, China
| | - Dandan Guo
- Department of Nephrology, the Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong, China
| | - Xuemei Liu
- Department of Nephrology, the Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong, China.
| |
Collapse
|
17
|
Yang C, Ma X, Zhao W, Chen Y, Lin H, Luo D, Zhang J, Lou T, Peng Y, Peng H. A longitudinal analysis of the relationship between serum uric acid and residual renal function loss in peritoneal dialysis patients. Ren Fail 2021; 42:447-454. [PMID: 32401146 PMCID: PMC7269070 DOI: 10.1080/0886022x.2020.1761387] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background Hyperuricemia occurs frequently in patients with continuous ambulatory peritoneal dialysis (CAPD). This study aimed to evaluate the impact of serum uric acid (UA) over time on residual renal function (RRF) loss in a cohort of patients with CAPD. Methods A total of 201 patients who started CAPD therapy between January 1, 2008 and April 30, 2016 were included in this single-center, retrospective cohort study. All patients were followed up until December 31, 2016. The median follow-up time was 23.43 ± 16.60 months. RRF loss was represented as the time to anuria. Results Eighty-six patients developed anuria within 5 years. Multivariate Cox regression analysis showed that time-averaged serum UA and peritonitis were independent risk factors for RRF loss, while weekly Kt/V urea was a protective factor. Cox proportional hazard regression models showed that both patients with time-averaged uric acid (TA-UA) < 6.77 mg/dL [hazard ratio (HR) = 1.165, 95% confidence interval (CI) 1.054–1.387; p < 0.05] and those with TA-UA≥ 7.64 mg/dL (HR = 1.184, 95% CI 1.045–2.114; p < 0.05) had a higher risk of RRF than those with TA-UA in the range of 6.77–7.64 mg/dL. Penalized spline smoothing also showed a U-shaped relationship between continuous UA and RRF loss. Conclusion The present study demonstrated that both high and low serum UA over time were associated with RRF loss in patients with CAPD.
Collapse
Affiliation(s)
- Chiehlun Yang
- Nephrology Division, Department of Medicine, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Xinxin Ma
- Nephrology Division, Department of Medicine, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Wenbo Zhao
- Nephrology Division, Department of Medicine, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Yanru Chen
- Nephrology Division, Department of Medicine, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Hongchun Lin
- Nephrology Division, Department of Medicine, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Dan Luo
- Nephrology Division, Department of Medicine, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Jun Zhang
- Nephrology Division, Department of Medicine, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Tanqi Lou
- Nephrology Division, Department of Medicine, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Yu Peng
- Nephrology Division, Department of Medicine, Guangdong Province Traditional Chinese Medical Hospital, Guangzhou, Guangdong, China
| | - Hui Peng
- Nephrology Division, Department of Medicine, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| |
Collapse
|
18
|
Inaba M, Kumeda Y, Yamada S, Toi N, Hamai C, Noguchi K, Yasuda E, Furumitsu Y, Emoto M, Ohno Y. Association of higher arterial ketone body ratio (acetoacetate/β-hydroxybutyrate) with relevant nutritional marker in hemodialysis patients. BMC Nephrol 2020; 21:510. [PMID: 33238897 PMCID: PMC7690103 DOI: 10.1186/s12882-020-02173-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 11/17/2020] [Indexed: 01/22/2023] Open
Abstract
Background An association of higher levels of β-hydroxybutyrate (β-HB) in serum with greater mortality in hemodialysis (HD) patients has been reported. This study examined the significance of arterial ketone body ratio (AcAc/β-HB), a relevant marker of energy state, in HD patients. Methods The levels of arterial AcAc and β-HB, and AcAc/β-HB ratio were determined in 49 HD patients just before undergoing an HD session. Additionally, changes in those levels during the session were examined to investigate their associations with clinical nutritional markers. Results Arterial β-HB, but not AcAc, was significantly higher at the baseline in 25 patients with type 2 diabetes mellitus (T2DM) as compared to 24 non-DM patients, with a significant reduction in arterial AcAc/β-HB ratio seen in those with DM. Although the arterial AcAc/β-HB ratio before the HD session was significantly higher in the non-DM group, it did not differ significantly after the session between the groups, indicating a faster rate of β-HB disappearance from circulation in non-DM HD patients during the interdialytic period. Multiple regression analysis, which included age, gender, presence/absence of DM, log HD duration, log β-HB, and log AcAc/β-HB ratio as independent variables, revealed an independent and significant association of log AcAc/ β-HB ratio, but not log β-HB, with serum albumin and uric acid. Conclusion We found that a decreased AcAc/β-HB ratio resulting from increased β-HB, but not increased β-HB itself, was a significant factor independently associated with decreased levels of serum albumin and uric acid, known to be related to higher mortality in HD patients. Furthermore, it is possible that higher mortality in DM HD patients can be explained by reduced arterial AcAc/β-HB ratio.
Collapse
Affiliation(s)
- Masaaki Inaba
- Kidney Center, Ohno Memorial Hospital, 1-26-10, Minami-Horie, Nishi-ku, Osaka, 550-0015, Japan.
| | - Yasuro Kumeda
- Dialysis Center, Minami-Osaka Hospital, 1-18-18, Higashi-kagaya, Suminoe-ku, Osaka, 559-0012, Japan
| | - Shinsuke Yamada
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Norikazu Toi
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Chie Hamai
- Dialysis Center, Minami-Osaka Hospital, 1-18-18, Higashi-kagaya, Suminoe-ku, Osaka, 559-0012, Japan
| | - Koichi Noguchi
- Dialysis Center, Minami-Osaka Hospital, 1-18-18, Higashi-kagaya, Suminoe-ku, Osaka, 559-0012, Japan
| | - Eikichi Yasuda
- Dialysis Center, Minami-Osaka Hospital, 1-18-18, Higashi-kagaya, Suminoe-ku, Osaka, 559-0012, Japan
| | - Yutaka Furumitsu
- Kidney Center, Ohno Memorial Hospital, 1-26-10, Minami-Horie, Nishi-ku, Osaka, 550-0015, Japan
| | - Masanori Emoto
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Yoshiteru Ohno
- Kidney Center, Ohno Memorial Hospital, 1-26-10, Minami-Horie, Nishi-ku, Osaka, 550-0015, Japan
| |
Collapse
|
19
|
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.
Collapse
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,
| |
Collapse
|
20
|
Morinaga J, Kakuma T, Fukami H, Hayata M, Uchimura K, Mizumoto T, Kakizoe Y, Miyoshi T, Shiraishi N, Adachi M, Izumi Y, Kuwabara T, Okadome Y, Sato M, Horiguchi H, Sugizaki T, Kadomatsu T, Miyata K, Tajiri S, Tajiri T, Tomita K, Kitamura K, Oike Y, Mukoyama M. Circulating angiopoietin-like protein 2 levels and mortality risk in patients receiving maintenance hemodialysis: a prospective cohort study. Nephrol Dial Transplant 2020; 35:854-860. [PMID: 31840173 DOI: 10.1093/ndt/gfz236] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 10/10/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Patients undergoing hemodialysis treatment have a poor prognosis, as many develop premature aging. Systemic inflammatory conditions often underlie premature aging phenotypes in uremic patients. We investigated whether angiopoietin-like protein 2 (ANGPTL 2), a factor that accelerates the progression of aging-related and noninfectious inflammatory diseases, was associated with increased mortality risk in hemodialysis patients. METHODS We conducted a multicenter prospective cohort study of 412 patients receiving maintenance hemodialysis and evaluated the relationship between circulating ANGPTL2 levels and the risk for all-cause mortality. Circulating ANGPTL2 levels were log-transformed to correct for skewed distribution and analyzed as a continuous variable. RESULTS Of 412 patients, 395 were included for statistical analysis. Time-to-event data analysis showed high circulating ANGPTL2 levels were associated with an increased risk for all-cause mortality after adjustment for age, sex, hemodialysis vintage, nutritional status, metabolic parameters and circulating high-sensitivity C-reactive protein levels {hazard ratio [HR] 2.04 [95% confidence interval (CI) 1.10-3.77]}. High circulating ANGPTL2 levels were also strongly associated with an increased mortality risk, particularly in patients with a relatively benign prognostic profile [HR 3.06 (95% CI 1.86-5.03)]. Furthermore, the relationship between circulating ANGPTL2 levels and mortality risk was particularly strong in patients showing few aging-related phenotypes, such as younger patients [HR 7.99 (95% CI 3.55-18.01)], patients with a short hemodialysis vintage [HR 3.99 (95% CI 2.85-5.58)] and nondiabetic patients [HR 5.15 (95% CI 3.19-8.32)]. CONCLUSION We conclude that circulating ANGPTL2 levels are positively associated with mortality risk in patients receiving maintenance hemodialysis and that ANGPTL2 could be a unique marker for the progression of premature aging and subsequent mortality risk in uremic patients, except those with significant aging-related phenotypes.
Collapse
Affiliation(s)
- Jun Morinaga
- Department of Nephrology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.,Department of Molecular Genetics, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.,Department of Clinical Investigation, Kumamoto University Hospital, Kumamoto, Japan.,Biostatistics Center, Kurume University, Fukuoka, Japan
| | | | - Hirotaka Fukami
- Department of Nephrology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.,Department of Molecular Genetics, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Manabu Hayata
- Department of Nephrology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Kohei Uchimura
- Third Department of Internal Medicine, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Teruhiko Mizumoto
- Department of Nephrology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Yutaka Kakizoe
- Department of Nephrology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Taku Miyoshi
- Department of Nephrology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Naoki Shiraishi
- Department of Nephrology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Masataka Adachi
- Department of Nephrology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Yuichiro Izumi
- Department of Nephrology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Takashige Kuwabara
- Department of Nephrology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Yusuke Okadome
- Department of Molecular Genetics, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Michio Sato
- Department of Molecular Genetics, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Haruki Horiguchi
- Department of Molecular Genetics, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Taichi Sugizaki
- Department of Molecular Genetics, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Tsuyoshi Kadomatsu
- Department of Molecular Genetics, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Keishi Miyata
- Department of Molecular Genetics, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | | | | | - Kimio Tomita
- Department of Nephrology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Kenichiro Kitamura
- Third Department of Internal Medicine, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Yuichi Oike
- Department of Molecular Genetics, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Masashi Mukoyama
- Department of Nephrology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| |
Collapse
|
21
|
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.
Collapse
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,
| |
Collapse
|
22
|
Lee CL, Tsai SF. Association between mortality and serum uric acid levels in non-diabetes-related chronic kidney disease: An analysis of the National Health and Nutrition Examination Survey, USA, 1999-2010. Sci Rep 2020; 10:17585. [PMID: 33067501 PMCID: PMC7568534 DOI: 10.1038/s41598-020-74747-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 10/06/2020] [Indexed: 12/17/2022] Open
Abstract
The relationship between serum uric acid (SUA) and cardiovascular (CV) mortality in patients with chronic kidney disease (CKD) has been described as either a J- or U-shaped function. However, its effect in non-diabetic CKD (and varying severities of CKD) remains unclear. We analyzed the database of the National Health and Nutrition Examination Survey, USA, from the years 1999 to 2010. We then grouped the subjects into 4 categories according to their SUA levels: (a) < 5 mg/dl, (b) 5-7 mg/dl, (c) 7-9 mg/dl and (d) ≥ 9 mg/dl. For mortality comparison purposes (CV related, cancer related and all-cause mortality), we set the SUA group of 5-7 mg/dl as the reference. We also separated this population into moderate (stage 3) and severe (stages 4 and 5) CKD. A total of 1860 participants were included in this study. Results showed that the group with the lowest SUA levels (< 5 mg/dl), were the least male gender (19.25%), had the lowest body mass index (26.41(95% CI = 25.66-27.16) kg/m2), highest systolic blood pressure (139.02 (95% CI 135.72-142.32) mmHg), highest high-density cholesterol (59.55 (95% CI 57.37-61.74) mg/dl), lowest blood glucose (95.46 (95% CI 93.16-97.76) mg/dl), highest total cholesterol (210.31 (95% CI 203.36-217.25) mg/dl), lowest serum albumin (4.09 (95% CI 4.04-4.14) g/dl), highest estimated glomerular filtration rate (eGFR) (47.91 (95% CI 45.45-50.49) ml/min/1.732m2), least history of hypertension (54.4%), and least total energy intake (1643.7 (95% CI 1536.13-1751.27) kcal/day). In the group with SUA ≥ 9 mg/dl, patients had higher all-cause mortality (HR = 2.15) whatever their baseline CVD status. In non-DM CKD patients with a CVD history, the group with SUA ≥ 9 mg/dl had the highest all-cause mortality (HR = 5.39), CVD mortality (HR = 8.18) and CVD or cancer (HR = 8.25) related mortality. In non-DM patients with severe CKD (eGFR < 30 ml/min/1.732m2), the group with SUA < 5 had a significantly increased all-cause mortality. On the contrary, in non-DM patients with moderate CKD (eGFR = 30-60 ml/min/1.832m2), the group with SUA ≥ 9 had a significantly increased all-cause mortality. In moderate non-DM CKD, SUA ≥ 9 mg/dl is associated with higher all-cause mortality. However, once progressing to severe non-DM CKD, SUA < 5 mg/dl is associated with higher all-cause mortality (even though it has the least risk factors for metabolic syndrome).
Collapse
Affiliation(s)
- Chia-Lin Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shang-Feng Tsai
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, 160, Sec. 3, Taiwan Boulevard, Taichung, 407, Taiwan.
- Department of Life Science, Tunghai University, Taichung, Taiwan.
| |
Collapse
|
23
|
Association between Serum Uric Acid Levels, Nutritional and Antioxidant Status in Patients on Hemodialysis. Nutrients 2020; 12:nu12092600. [PMID: 32867018 PMCID: PMC7551179 DOI: 10.3390/nu12092600] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/02/2020] [Accepted: 08/03/2020] [Indexed: 12/22/2022] Open
Abstract
Purpose: To determine the relationship between uric acid (UA) and nutritional and antioxidant status in hemodialysis (HD) patients, given that hyperuricemia could be an indicator of good nutritional status possibly because of the antioxidant properties of UA. Methods: Cross-sectional study with 93 patients on HD. Hyperuricemia was considered as UA ≥6.0 mg/dL in females and ≥7.0 mg/dL in males. Nutritional variables were registered. Blood samples were taken before the dialysis session to determine oxidative damage as plasma malondialdehyde (MDA) content, and antioxidant capacity measuring 2,2-diphenyl-piclrylhidrazil radical (DPPH●) scavenging activity and oxygen radical absorbance capacity (ORAC) value. Results: Patients with hyperuricemia had higher creatinine (11.9 vs. 10.5 mg/dL; p = 0.004), potassium (5.5 vs. 5.0 mg/dL; p = 0.014) levels; phase angle (5.8 vs. 4.9; p = 0.005), protein consumption (normalized protein nitrogen appearance, nPNA, 1.03 vs. 0.83; p = 0.013) than normouricemic patients. DPPH● scavenging activity was higher in hyperuricemic subjects (1.139 vs. 1.049 mM Trolox equivalents; p = 0.007); likewise, hyperuricemic subjects had less oxidant damage measured by MDA (10.6 vs. 12.7 nmol/mL; p = 0.020). Subjects with normouricemia were at higher risk of having a reactance to height (Xc/H) ratio less than 35 (OR 2.79; 95% CI, 1.1–7.017, p = 0.028); nPNA < 1.0 (OR 3.78; 95% CI, 1.4–10.2, p = 0.007), diagnosis of cachexia (OR 2.95; 95% CI, 1156–7.518, p = 0.021), potassium levels <5 (OR 2.97; 95% CI, 1.136–7.772, p = 0.023) and PA < 5.5° (OR 3.38; 95% CI, 1.309–8.749, p = 0.012.) Conclusions: Patients with hyperuricemia had higher antioxidant capacity and better nutritional status. Purines and protein restrictions in HD patients with hyperuricemia need to be reviewed individually for each patient. More studies are needed to stablish a cut point of UA levels in renal population.
Collapse
|
24
|
Zawada AM, Carrero JJ, Wolf M, Feuersenger A, Stuard S, Gauly A, Winter AC, Ramos R, Fouque D, Canaud B. Serum Uric Acid and Mortality Risk Among Hemodialysis Patients. Kidney Int Rep 2020; 5:1196-1206. [PMID: 32775819 PMCID: PMC7403560 DOI: 10.1016/j.ekir.2020.05.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 04/29/2020] [Accepted: 05/18/2020] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Although high serum uric acid (SUA) has been consistently associated with an increased risk of death in the general population and in persons with nondialysis chronic kidney disease (CKD), studies in patients undergoing dialysis are conflicting. It has been postulated that low SUA simply reflects poor nutritional status in dialysis patients. We here characterize the association between SUA and the risk of death in a large dialysis cohort and explore effect modification by underlying nutritional status as reflected by body composition. METHODS In this retrospective cohort study, we included 16,057 hemodialysis (HD) patients treated during 2007 to 2016 in NephroCare centers as recorded in the European Clinical Database (EuCliD). The association between SUA, all-cause, and cardiovascular (CV)-related mortality was evaluated with competing risk models and characterized with splines. Effect modification was explored by lean tissue index (LTI) and fat tissue index (FTI). RESULTS During a mean of 1.8 years of follow-up, 2791 patients (17.4%) died. We found a multivariable-adjusted U-shaped pattern between SUA and all-cause mortality. Patients with SUA levels of 6.5 mg/dl (387 μmol/l) were at the lowest risk of death (subdistribution hazard ratio = 0.94 [confidence interval {CI} 0.91; 0.96]). The form of association was not meaningfully affected by underlying LTI and FTI. CONCLUSION We found a U-shaped pattern between SUA levels and all-cause mortality among HD patients, which was independent of the patients' body composition.
Collapse
Affiliation(s)
- Adam M. Zawada
- Fresenius Medical Care Deutschland GmbH, EMEA Medical Office, Bad Homburg, Germany
| | - Juan Jesus Carrero
- European Renal Nutrition (ERN) Working Group of the European Renal Association–European Dialysis Transplant Association (ERA-EDTA), London, United Kingdom
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Melanie Wolf
- Fresenius Medical Care Deutschland GmbH, EMEA Medical Office, Bad Homburg, Germany
| | - Astrid Feuersenger
- Fresenius Medical Care Deutschland GmbH, EMEA Medical Office, Bad Homburg, Germany
| | - Stefano Stuard
- Fresenius Medical Care Deutschland GmbH, Global Medical Office—Clinical & Therapeutic Governance EMEA, Bad Homburg, Germany
| | - Adelheid Gauly
- Fresenius Medical Care Deutschland GmbH, EMEA Medical Office, Bad Homburg, Germany
| | - Anke C. Winter
- Fresenius Medical Care Deutschland GmbH, EMEA Medical Office, Bad Homburg, Germany
| | - Rosa Ramos
- Fresenius Medical Care España, S.A., Departamento Dirección Médica, Tres Cantos, Spain
| | - Denis Fouque
- European Renal Nutrition (ERN) Working Group of the European Renal Association–European Dialysis Transplant Association (ERA-EDTA), London, United Kingdom
- Department of Nephrology, Université de Lyon, UCBL, Carmen, Centre Hospitalier Lyon-Sud, Pierre Bénite, France
| | - Bernard Canaud
- Fresenius Medical Care Deutschland GmbH, Global Medical Office, Bad Homburg, Germany
- University of Montpellier, School of Medicine, Montpellier, France
| |
Collapse
|
25
|
Yoshida H, Inaguma D, Koshi-Ito E, Ogata S, Kitagawa A, Takahashi K, Koide S, Hayashi H, Hasegawa M, Yuzawa Y, Tsuboi N. Extreme hyperuricemia is a risk factor for infection-related deaths in incident dialysis patients: a multicenter prospective cohort study. Ren Fail 2020; 42:646-655. [PMID: 32662307 PMCID: PMC7470168 DOI: 10.1080/0886022x.2020.1788582] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Introduction There are few studies on the association between serum uric acid (UA) level and mortality in incident dialysis patients. We aimed to clarify whether the serum UA level at dialysis initiation is associated with mortality during maintenance dialysis. Methods We enrolled 1486 incident dialysis patients who participated in a previous multicenter prospective cohort study in Japan. We classified the patients into the following five groups according to their serum UA levels at dialysis initiation: G1 with a serum UA level <6 mg/dL; G2, 6.0–8.0 mg/dL; G3, 8.0–10.0 mg/dL; G4, 10.0–12.0 mg/dL; and G5, ≥12.0 mg/dL. We created three models (Model 1: adjusted for age and sex, Model 2: adjusted for Model 1 + 12 variables, and Model 3: stepwise regression adjusted for Model 2 + 13 variables) and performed a multivariate Cox proportional hazard regression analysis to examine the association between the serum UA level and outcomes, including infection-related mortality. Results Hazard ratios (HRs) were calculated relative to the G2, because the all-cause mortality rate was the lowest in G2. For Models 1 and 2, the all-cause mortality rate was significantly higher in G5 than in G2 (HR: 1.63, 95% confidence interval [CI]: 1.14–2.33 and HR: 1.78, 95% CI: 1.19–2.68, respectively). For Models 1, 2, and 3, the infection-related mortality rate was significantly higher in G5 than in G2 (HR: 2.75, 95% CI: 1.37–5.54, HR: 3.09, 95% CI: 1.45–6.59, HR: 3.37, and 95% CI: 1.24–9.15, respectively). Conclusions Extreme hyperuricemia (serum UA level ≥12.0 mg/dL) at dialysis initiation is a risk factor for infection-related deaths.
Collapse
Affiliation(s)
- Hiroyuki Yoshida
- Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Daijo Inaguma
- Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Eri Koshi-Ito
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Soshiro Ogata
- Faculty of Nursing, School of Health Sciences, Fujita Health University, Toyoake, Japan.,Department of Preventive Medicine & Epidemiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Akimitsu Kitagawa
- Department of Nephrology, Fujita Health University, Bantane Hospital, Nagoya, Japan
| | - Kazuo Takahashi
- Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Shigehisa Koide
- Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Hiroki Hayashi
- Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Midori Hasegawa
- Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Yukio Yuzawa
- Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Naotake Tsuboi
- Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Japan
| |
Collapse
|
26
|
Noh J, Yoo KD, Bae W, Lee JS, Kim K, Cho JH, Lee H, Kim DK, Lim CS, Kang SW, Kim YL, Kim YS, Kim G, Lee JP. Prediction of the Mortality Risk in Peritoneal Dialysis Patients using Machine Learning Models: A Nation-wide Prospective Cohort in Korea. Sci Rep 2020; 10:7470. [PMID: 32366838 PMCID: PMC7198502 DOI: 10.1038/s41598-020-64184-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 04/07/2020] [Indexed: 02/06/2023] Open
Abstract
Herein, we aim to assess mortality risk prediction in peritoneal dialysis patients using machine-learning algorithms for proper prognosis prediction. A total of 1,730 peritoneal dialysis patients in the CRC for ESRD prospective cohort from 2008 to 2014 were enrolled in this study. Classification algorithms were used for prediction of N-year mortality including neural network. The survival hazard ratio was presented by machine-learning algorithms using survival statistics and was compared to conventional algorithms. A survival-tree algorithm presented the most accurate prediction model and outperformed a conventional method such as Cox regression (concordance index 0.769 vs 0.745). Among various survival decision-tree models, the modified Charlson Comorbidity index (mCCI) was selected as the best predictor of mortality. If peritoneal dialysis patients with high mCCI (>4) were aged ≥70.5 years old, the survival hazard ratio was predicted as 4.61 compared to the overall study population. Among the various algorithm using longitudinal data, the AUC value of logistic regression was augmented at 0.804. In addition, the deep neural network significantly improved performance to 0.841. We propose machine learning-based final model, mCCI and age were interrelated as notable risk factors for mortality in Korean peritoneal dialysis patients.
Collapse
Affiliation(s)
- Junhyug Noh
- Department of Computer Science and Engineering, College of Engineering, Seoul National University, Seoul, South Korea
| | - Kyung Don Yoo
- Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Wonho Bae
- College of Information and Computer Sciences, University of Massachusetts Amherst, Massachusetts, United States
| | - Jong Soo Lee
- Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Kangil Kim
- School of Electrical Engineering and Computer Science, Gwangju Institute of Science and Technology (GIST), Gwangju, South Korea
| | - Jang-Hee Cho
- Department of Internal Medicine, Kyungpook National University College of Medicine, Daegu, South Korea
| | - Hajeong Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
- Department of Internal Medicine Seoul National University College of Medicine, Seoul, South Korea
| | - Chun Soo Lim
- Department of Internal Medicine Seoul National University College of Medicine, Seoul, South Korea
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Shin-Wook Kang
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Yong-Lim Kim
- Department of Internal Medicine, Kyungpook National University College of Medicine, Daegu, South Korea
| | - Yon Su Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
- Department of Internal Medicine Seoul National University College of Medicine, Seoul, South Korea
| | - Gunhee Kim
- Department of Computer Science and Engineering, College of Engineering, Seoul National University, Seoul, South Korea.
| | - Jung Pyo Lee
- Department of Internal Medicine Seoul National University College of Medicine, Seoul, South Korea.
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, South Korea.
| |
Collapse
|
27
|
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.
Collapse
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.
| |
Collapse
|
28
|
Nakashima A, Ichida K, Ohkido I, Yokoyama K, Matsuo H, Ohashi Y, Takada T, Nakayama A, Suzuki H, Shinomiya N, Urashima M, Yokoo T. Dysfunctional ABCG2 gene polymorphisms are associated with serum uric acid levels and all-cause mortality in hemodialysis patients. Hum Cell 2020; 33:559-568. [PMID: 32180207 PMCID: PMC7324430 DOI: 10.1007/s13577-020-00342-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 02/27/2020] [Indexed: 02/07/2023]
Abstract
Dysfunctional variants of ATP-binding cassette transporter subfamily G member 2 (ABCG2), a urate transporter in the kidney and intestine, are the major causes of hyperuricemia and gout. A recent study found that ABCG2 is a major transporter of uremic toxins; however, few studies have investigated the relationship between ABCG2 gene polymorphisms and mortality. This prospective cohort study of 1214 hemodialysis patients investigated the association between serum uric acid levels and ABCG2 genotype and mortality. Genotyping of dysfunctional ABCG2 variants, Q126X (rs72552713) and Q141K (rs2231142), was performed using the patients’ DNA. During the study period, 220 patients died. Lower serum uric acid levels were associated with higher mortality (hazard ratio [HR] 1.89, 95% confidence interval [CI] 1.14–3.10, P ≤ 0.001). ABCG2 dysfunction, estimated by genetic variants, had a significant positive association with serum uric acid levels (full function: 7.4 ± 1.2 mg/dl, 3/4 function: 7.9 ± 1.3 mg/dl, 1/2 function: 8.2 ± 1.4 mg/dl, ≤ 1/4 function: 8.7 ± 1.3 mg/dl, P ≤ 0.001). This association remained significant on multiple regression analysis. The Cox proportional hazard analysis indicated that the ABCG2 ≤ 1/4 function type was significantly associated with higher mortality (HR 6.66, 95% CI 2.49 to 17.8, P ≤ 0.001) than the other function types. These results showed that ABCG2 plays a physiologically important role in uric acid excretion, and that ABCG2 dysfunction is a risk factor for mortality in hemodialysis patients.
Collapse
Affiliation(s)
- Akio Nakashima
- Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
| | - Kimiyoshi Ichida
- Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan. .,Department of Pathophysiology, Tokyo University of Pharmacy and Life Sciences, 1432-1 Horinouchi, Hachioji, Tokyo, 192-0392, Japan.
| | - Ichiro Ohkido
- Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
| | - Keitaro Yokoyama
- Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
| | - Hirotaka Matsuo
- Department of Integrative Physiology and Bio-Nano Medicine, National Defense Medical College, Tokorozawa, Japan
| | - Yuki Ohashi
- Department of Pathophysiology, Tokyo University of Pharmacy and Life Sciences, 1432-1 Horinouchi, Hachioji, Tokyo, 192-0392, Japan
| | - Tappei Takada
- Department of Pharmacy, The University of Tokyo Hospital, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akiyoshi Nakayama
- Department of Integrative Physiology and Bio-Nano Medicine, National Defense Medical College, Tokorozawa, Japan
| | - Hiroshi Suzuki
- Department of Pharmacy, The University of Tokyo Hospital, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Nariyoshi Shinomiya
- Department of Integrative Physiology and Bio-Nano Medicine, National Defense Medical College, Tokorozawa, Japan
| | - Mitsuyoshi Urashima
- Division of Molecular Epidemiology, Jikei University School of Medicine, Tokyo, Japan
| | - Takashi Yokoo
- Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
| |
Collapse
|
29
|
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.
Collapse
|
30
|
Selim G, Stojceva-Taneva O, Tozija L, Zafirova-Ivanovska B, Spasovski G, Gerasimovska V, Petronijevic Z, Trajceska L, Dzekova-Vidimliski P, Gjorgjievski N, Pavleska-Kuzmanovska S, Kabova A, Georgievska-Ismail L. Uric acid and left ventricular hypertrophy: another relationship in hemodialysis patients. Clin Kidney J 2019; 14:578-585. [PMID: 33623682 PMCID: PMC7886584 DOI: 10.1093/ckj/sfz172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 11/12/2019] [Indexed: 12/28/2022] Open
Abstract
Background The impact of serum uric acid (UA) on morbidity and mortality in hemodialysis (HD) patients is quite controversial in relation to the general population. The aim of this study was to evaluate the association of serum UA with both mortality and left ventricular hypertrophy (LVH) in HD patients. Methods This longitudinal study enrolled 225 prevalent HD patients who were classified into three groups according to their follow-up-averaged UA (FA-UA) levels: low FA-UA (FA-UA <400 µmol/L), intermediate/reference FA-UA (FA-UA between 400 and 450 µmol/L) and high FA-UA (FA-UA >450 µmol/L). Echocardiography was performed on a nondialysis day and the presence of LVH was defined based on a left ventricular mass index (LVMI) >131 and >100 g/m2 for men and women, respectively. The patients were followed during a 60-month period. Results The mean FA-UA level was 425 ± 59 µmol/L (range 294–620). There was a consistent association of higher FA-UA with better nutritional status (higher body mass index, normalized protein catabolic rate, creatinine, albumin and phosphorus), higher hemoglobin, but lower C-reactive protein and LVMI. During the 5-year follow-up, 81 patients died (36%) and the main causes of death were cardiovascular (CV) related (70%). When compared with the reference group, the hazard ratio for all-cause mortality was 1.75 [95% confidence interval (CI) 1.02–2.98; P = 0.041] in the low FA-UA group, but there was no significant association with the high FA-UA group. In contrast, FA-UA did not show an association with CV mortality neither with the lower nor with the high FA-UA group. The unadjusted odds ratio (OR) of LVH risk in the low FA-UA compared with the reference FA-UA group was 3.11 (95% CI 1.38–7.05; P = 0.006), and after adjustment for age, gender, diabetes and CV disease, ORs for LVH persisted significantly only in the low FA-UA group [OR 2.82 (95% CI 1.16–6.88,); P = 0.002]. Conclusions Low serum UA is a mortality risk factor and is associated with LVH in HD patients. These results are in contrast with the association of UA in the general population and should be the subject of further research.
Collapse
Affiliation(s)
- Gjulsen Selim
- University Clinic of Nephrology, Ss. Cyril and Methodius University Skopje, Republic of North Macedonia
| | - Olivera Stojceva-Taneva
- University Clinic of Nephrology, Ss. Cyril and Methodius University Skopje, Republic of North Macedonia
| | - Liljana Tozija
- University Clinic of Nephrology, Ss. Cyril and Methodius University Skopje, Republic of North Macedonia
| | - Beti Zafirova-Ivanovska
- Institute of Epidemiology and Biostatistics, Ss. Cyril and Methodius University Skopje, Republic of North Macedonia
| | - Goce Spasovski
- University Clinic of Nephrology, Ss. Cyril and Methodius University Skopje, Republic of North Macedonia
| | - Vesna Gerasimovska
- University Clinic of Nephrology, Ss. Cyril and Methodius University Skopje, Republic of North Macedonia
| | - Zvezdana Petronijevic
- University Clinic of Nephrology, Ss. Cyril and Methodius University Skopje, Republic of North Macedonia
| | - Lada Trajceska
- University Clinic of Nephrology, Ss. Cyril and Methodius University Skopje, Republic of North Macedonia
| | | | - Nikola Gjorgjievski
- University Clinic of Nephrology, Ss. Cyril and Methodius University Skopje, Republic of North Macedonia
| | | | - Angela Kabova
- University Clinic of Nephrology, Ss. Cyril and Methodius University Skopje, Republic of North Macedonia
| | - Ljubica Georgievska-Ismail
- University Institute for Heart Diseases, Ss. Cyril and Methodius University Skopje, Republic of North Macedonia
| |
Collapse
|
31
|
Impact of Percent Body Fat on All-Cause Mortality among Adequate Dialysis Patients with and without Insulin Resistance: A Multi-Center Prospective Cohort Study. Nutrients 2019; 11:nu11061304. [PMID: 31181824 PMCID: PMC6627844 DOI: 10.3390/nu11061304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 06/04/2019] [Accepted: 06/04/2019] [Indexed: 12/24/2022] Open
Abstract
The association between body fat and mortality in hemodialysis patients remains controversial. We examined the effect of percent body fat (PBF) on all-cause mortality among adequate hemodialysis patients with and without insulin resistance (IR). A prospective cohort study was conducted on 365 adequate hemodialysis patients (equilibrated Kt/V ≥ 1.2) from seven hospitals. Patients’ characteristics and clinical and biochemical parameters were assessed at baseline between September 2013 and April 2017. Patients were followed up for all-cause mortality until April 2018. The median value of homeostatic model assessment (HOMA-IR) was used to classify IR. Cox proportional hazard models were utilized to examine predictors of all-cause mortality. During 1.4 (1.0–3.2) years of follow-up, 46 patients died. In patients with IR (HOMA-IR ≥ 5.18), PBF was significantly higher in the survival group than in the death group (31.3 ± 9.0 vs. 25.4 ± 8.2, p = 0.005). After controlling for confounding factors, PBF was significantly associated with lower risk for all-cause mortality in patients with IR (hazard ratio, 0.94; 95% confidence interval, 0.89–1.00; p = 0.033). The association was not observed in patients without IR. In conclusion, percent body fat shows a protective effect on survival in hemodialysis patients with IR.
Collapse
|
32
|
Asymptomatic hyperuricemia and cardiovascular mortality in patients with chronic kidney disease who progress to hemodialysis. Int Urol Nephrol 2019; 51:1013-1018. [PMID: 31020628 DOI: 10.1007/s11255-019-02154-w] [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: 10/22/2018] [Accepted: 04/16/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE Hyperuricemia has been associated with higher mortality in the general population, but less is known about CKD patients. The aim of our study was to determine the impact of elevated serum uric acid on cardiovascular mortality of CKD patients who later progress to hemodialysis. METHODS In this retrospective study, 120 CKD patients (entire population of patients with ESKD on January 1st, 2012) were observed from their first visit at the Nephrology outpatient clinic, while transitioning to hemodialysis, and until their death or January 1, 2016. After non-cardiovascular death exclusion, 83 CKD patients (33 female, 50 male) were left for further analysis. The average time of observation was 8.8 ± 4.2 years. Serum uric acid was measured regularly (every 3 months). No patients were treated for hyperuricemia. Mean uric acid of 420 µmol/L was set as a cut-off between normouricemic and hyperuricemic patients as per the laboratory's reference values. Survival rates were analyzed using Kaplan-Meier survival curves. Three Cox regression models were used to assess the influence of uric acid on survival. RESULTS Mean uric acid was 379.8 ± 71.6 µmol/L (range 220-574). Sixty-three (75.9%) patients were normouricemic and 20 (24.1%) were hyperuricemic. Cholesterol was the only variable to show statistically significant difference (p = 0.004) between the groups. Bivariate analysis revealed an association between death and age, hyperuricemia, arterial hypertension, and history of cardiovascular disease. Kaplan-Meier survival analysis showed higher risk of cardiovascular death for hyperuricemic patients (log rank test; p < 0.0005). In Cox regression models, hyperuricemia remained a predictor of cardiovascular mortality (SE = 0.500, Exp(B) = 14.120, 95% CI 5.297-37.640) in our patients next to age and arterial hypertension. CONCLUSION The results indicate an association between hyperuricemia and cardiovascular mortality in CKD patients who transition to hemodialysis.
Collapse
|
33
|
Duong TV, Wu PY, Wong TC, Chen HH, Chen TH, Hsu YH, Peng SJ, Kuo KL, Liu HC, Lin ET, Feng YW, Yang SH. Mid-arm circumference, body fat, nutritional and inflammatory biomarkers, blood glucose, dialysis adequacy influence all-cause mortality in hemodialysis patients: A prospective cohort study. Medicine (Baltimore) 2019; 98:e14930. [PMID: 30896655 PMCID: PMC6708842 DOI: 10.1097/md.0000000000014930] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Hemodialysis patients are at the high risk for morbidity and mortality. Evaluation and management of body composition and biochemical values are important to improve dialysis outcomes. We aimed to examine the effects of the mid-arm circumference, body fat, nutritional and inflammatory biomarkers, blood glucose, and dialysis adequacy on the mortality.A prospective cohort study was conducted on 375 patients from 7 hospital-based dialysis centers. At baseline between September 2013 and April 2017, we assessed patients' characteristics using chart review, body composition using the bioelectrical impedance analysis, and biochemical parameters using available laboratory tests. Patients were followed-up for all-cause mortality until April 2018. Kaplan-Meier Curves with Log-rank test, and Cox proportional hazards models were used to analyze the effects of assessed factors on the mortality.During the median of follow-up time of 1.4 (1.0-3.2) years, 47 (12.5%) patients died. In the multivariate analysis, mid-arm circumference (hazard ratio, HR, 0.90; 95% confidence interval, 95%CI, 0.82-0.99; P = .036), body fat mass (HR, 0.95; 95%CI, 0.91-1.00; P = .031), percent body fat (HR, 0.96; 95%CI, 0.92-0.99; P = .024), serum creatinine (HR, 0.81; 95%CI, 0.68-0.96; P = .015), and eKt/V (HR, 0.07; 95%CI, 0.01-0.33; P = .001) reduced the mortality risk. Inflammation (HR, 2.90; 95%CI, 1.59-5.27; P < .001), hyperglycemia (HR, 2.16; 95%CI, 1.06-4.40; P = .033), and low serum uric acid (HR, 2.22; 95%CI, 1.15-4.31; P = .018) increased the death risk.In hemodialysis patients, the higher values of the mid-arm circumference, body fat, serum creatinine, uric acid, and dialysis adequacy were associated with lower mortality, whereas, inflammation and hyperglycemia associated with higher mortality.
Collapse
Affiliation(s)
- Tuyen Van Duong
- School of Nutrition and Health Sciences, Taipei Medical University
| | - Pei-Yu Wu
- School of Nutrition and Health Sciences, Taipei Medical University
| | - Te-Chih Wong
- Department of Nutrition and Health Sciences, Chinese Culture University
| | - Hsi-Hsien Chen
- School of Medicine, Taipei Medical University
- Department of Nephrology, Taipei Medical University Hospital
| | - Tso-Hsiao Chen
- School of Medicine, Taipei Medical University
- Department of Nephrology, Taipei Medical University-Wan Fang Hospital
| | - Yung-Ho Hsu
- School of Medicine, Taipei Medical University
- Division of Nephrology, Department of Internal Medicine, Taipei Medical University- Shuang Ho Hospital
| | | | - Ko-Lin Kuo
- Division of Nephrology, Taipei Tzu-Chi Hospital, New Taipei 231
| | - Hsiang-Chung Liu
- Department of Nephrology, Wei Gong Memorial Hospital, Miaoli 351
| | - En-Tzu Lin
- Department of Nephrology, Lotung Poh-Ai Hospital, Yilan 265
| | - Yi-Wei Feng
- School of Nutrition and Health Sciences, Taipei Medical University
| | - Shwu-Huey Yang
- School of Nutrition and Health Sciences, Taipei Medical University
- Research Center of Geriatric Nutrition, Taipei Medical University
- Nutrition Research Center, Taipei Medical University Hospital, Taipei 110, Taiwan
| |
Collapse
|
34
|
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
| |
Collapse
|
35
|
Cho SK, Chang Y, Kim I, Ryu S. U-Shaped Association Between Serum Uric Acid Level and Risk of Mortality: A Cohort Study. Arthritis Rheumatol 2018; 70:1122-1132. [PMID: 29694719 DOI: 10.1002/art.40472] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Accepted: 02/22/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVE In addition to the controversy regarding the association of hyperuricemia with cardiovascular disease (CVD) mortality, few studies have examined the impact of a low uric acid level on mortality. We undertook the present study to evaluate the relationship between both low and high uric acid levels and the risk of all-cause and cause-specific mortality in a large sample of Korean adults over a full range of uric acid levels. METHODS A cohort study was performed in 375,163 South Korean men and women who underwent health check-ups from 2002 to 2012. Vital status and cause of death were ascertained from the national death records. Hazard ratios (HRs) and 95% confidence intervals (95% CIs) for mortality outcomes were estimated using Cox proportional hazards regression analysis. RESULTS During a total of 2,060,721.9 person-years of follow-up, 2,020 participants died, with 287 CVD deaths and 963 cancer deaths. Low and high uric acid levels were associated with increased all-cause, CVD, and cancer mortality. The multivariable-adjusted HRs for all-cause mortality in the lowest uric acid categories (<3.5 mg/dl for men and <2.5 mg/dl for women) compared with the sex-specific reference category were 1.58 (95% CI 1.18-2.10) and 1.80 (95% CI 1.10-2.93), respectively. Corresponding HRs in the highest uric acid categories (≥9.5 mg/dl for men and ≥8.5 mg/dl for women) were 2.39 (95% CI 1.57-3.66) and 3.77 (95% CI 1.17-12.17), respectively. CONCLUSION In this large cohort study of men and women, both low and high uric acid levels were predictive of increased mortality, supporting a U-shaped association between serum uric acid levels and adverse health outcomes.
Collapse
Affiliation(s)
| | - Yoosoo Chang
- Sungkyunkwan University School of Medicine and Kangbuk Samsung Hospital, Seoul, Republic of Korea
| | - Inah Kim
- Hanyang University, Seoul, Republic of Korea
| | - Seungho Ryu
- Sungkyunkwan University School of Medicine and Kangbuk Samsung Hospital, Seoul, Republic of Korea
| |
Collapse
|
36
|
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.
Collapse
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
| |
Collapse
|
37
|
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.
Collapse
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
| |
Collapse
|
38
|
Ishii T, Taguri M, Tamura K, Oyama K. Evaluation of the Effectiveness of Xanthine Oxidoreductase Inhibitors on Haemodialysis Patients using a Marginal Structural Model. Sci Rep 2017; 7:14004. [PMID: 29070821 PMCID: PMC5656650 DOI: 10.1038/s41598-017-13970-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 10/03/2017] [Indexed: 02/07/2023] Open
Abstract
A lower serum uric acid (UA) level has been associated with a higher mortality rate in haemodialysis patients. We investigated the long-term confounding factors of UA and mortality, and fitted a marginal structural model (MSM) based on the causal effect of xanthine oxidoreductase inhibitors (XORi). In total, 2429 patients on regular dialysis from April 2013 to March 2016 were included, and divided into quintiles by serum UA with Kaplan Meier (KM) curves and log rank analysis. Baseline characteristics were evaluated for relationships with all-cause mortality and cardiovascular disease (CVD) using the Cox hazard model. The MSM was used to control for time-dependent confounders of the XORi treatment effect. KM curves indicated that patients in the highest UA quintile had better outcomes than those in the lowest UA quintile. UA was not correlated with all-cause mortality or CVD events in the Cox model; however, the hazard ratio (HR) for mortality was 0.96 for the baseline administration of XORi. The MSM analysis for the effect of XORi treatment on all-cause mortality revealed a HR of 0.24 (95% confidence interval: 0.15-0.38) in all cohorts. These results suggest that XORi improved all-cause mortality in end-stage renal disease, irrespective of the serum UA level.
Collapse
Affiliation(s)
- Takeo Ishii
- Department of Internal Medicine, Yokohama City, Yokohama-Daiichi Hospital, Yokohama, 220-0011, Japan. .,Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, 236-0004, Japan.
| | - Masataka Taguri
- Department of Biostatistics, Yokohama City University Graduate School of Medicine, Yokohama, 236-0004, Japan
| | - Kouichi Tamura
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, 236-0004, Japan.
| | - Kunio Oyama
- Department of Internal Medicine, Yokohama City, Yokohama-Daiichi Hospital, Yokohama, 220-0011, Japan
| |
Collapse
|
39
|
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.
Collapse
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.
| |
Collapse
|
40
|
Abstract
[This corrects the article DOI: 10.1097/MD.0000000000003291.][This corrects the article DOI: 10.1097/MD.0000000000003731.][This corrects the article DOI: 10.1097/MD.0000000000003791.][This corrects the article DOI: 10.1097/MD.0000000000003805.][This corrects the article DOI: 10.1097/MD.0000000000003827.][This corrects the article DOI: 10.1097/MD.0000000000003863.][This corrects the article DOI: 10.1097/MD.0000000000003878.][This corrects the article DOI: 10.1097/MD.0000000000003879.][This corrects the article DOI: 10.1097/MD.0000000000003884.][This corrects the article DOI: 10.1097/MD.0000000000003900.][This corrects the article DOI: 10.1097/MD.0000000000003513.][This corrects the article DOI: 10.1097/MD.0000000000003631.][This corrects the article DOI: 10.1097/MD.0000000000003644.][This corrects the article DOI: 10.1097/MD.0000000000003692.][This corrects the article DOI: 10.1097/MD.0000000000003701.][This corrects the article DOI: 10.1097/MD.0000000000003706.][This corrects the article DOI: 10.1097/MD.0000000000003712.][This corrects the article DOI: 10.1097/MD.0000000000003767.][This corrects the article DOI: 10.1097/MD.0000000000003781.][This corrects the article DOI: 10.1097/MD.0000000000003808.][This corrects the article DOI: 10.1097/MD.0000000000003831.][This corrects the article DOI: 10.1097/MD.0000000000003837.][This corrects the article DOI: 10.1097/MD.0000000000003839.][This corrects the article DOI: 10.1097/MD.0000000000003842.][This corrects the article DOI: 10.1097/MD.0000000000003843.][This corrects the article DOI: 10.1097/MD.0000000000003847.][This corrects the article DOI: 10.1097/MD.0000000000003848.][This corrects the article DOI: 10.1097/MD.0000000000003850.][This corrects the article DOI: 10.1097/MD.0000000000003861.][This corrects the article DOI: 10.1097/MD.0000000000003862.][This corrects the article DOI: 10.1097/MD.0000000000003864.][This corrects the article DOI: 10.1097/MD.0000000000003866.][This corrects the article DOI: 10.1097/MD.0000000000003871.][This corrects the article DOI: 10.1097/MD.0000000000003872.][This corrects the article DOI: 10.1097/MD.0000000000003880.][This corrects the article DOI: 10.1097/MD.0000000000003878.][This corrects the article DOI: 10.1097/MD.0000000000003873.][This corrects the article DOI: 10.1097/MD.0000000000003876.][This corrects the article DOI: 10.1097/MD.0000000000003879.][This corrects the article DOI: 10.1097/MD.0000000000003881.][This corrects the article DOI: 10.1097/MD.0000000000003884.][This corrects the article DOI: 10.1097/MD.0000000000003885.][This corrects the article DOI: 10.1097/MD.0000000000003888.][This corrects the article DOI: 10.1097/MD.0000000000003889.][This corrects the article DOI: 10.1097/MD.0000000000003891.][This corrects the article DOI: 10.1097/MD.0000000000003893.][This corrects the article DOI: 10.1097/MD.0000000000003894.][This corrects the article DOI: 10.1097/MD.0000000000003897.][This corrects the article DOI: 10.1097/MD.0000000000003899.][This corrects the article DOI: 10.1097/MD.0000000000003900.][This corrects the article DOI: 10.1097/MD.0000000000003901.][This corrects the article DOI: 10.1097/MD.0000000000003902.][This corrects the article DOI: 10.1097/MD.0000000000003903.][This corrects the article DOI: 10.1097/MD.0000000000003904.][This corrects the article DOI: 10.1097/MD.0000000000003908.][This corrects the article DOI: 10.1097/MD.0000000000003910.][This corrects the article DOI: 10.1097/MD.0000000000003912.][This corrects the article DOI: 10.1097/MD.0000000000003916.][This corrects the article DOI: 10.1097/MD.0000000000003917.][This corrects the article DOI: 10.1097/MD.0000000000003918.][This corrects the article DOI: 10.1097/MD.0000000000003920.][This corrects the article DOI: 10.1097/MD.0000000000003921.][This corrects the article DOI: 10.1097/MD.0000000000003923.][This corrects the article DOI: 10.1097/MD.0000000000003924.][This corrects the article DOI: 10.1097/MD.0000000000003925.][This corrects the article DOI: 10.1097/MD.0000000000003934.][This corrects the article DOI: 10.1097/MD.0000000000003941.][This corrects the article DOI: 10.1097/MD.0000000000003944.][This corrects the article DOI: 10.1097/MD.0000000000003970.].
Collapse
|