Uric Acid Levels and All-Cause and Cardiovascular Mortality in the Hemodialysis Population
Uric Acid Levels and All-Cause and Cardiovascular Mortality in the Hemodialysis Population
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DOI：
10.2215/cjn.00670111
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发表时间：
2011-10-01
影响因子：
9.8
通讯作者：
Saran, Rajiv
中科院分区：
文献类型：
--
作者：
Latif, Walead;Karaboyas, Angelo;Saran, Rajiv
背景和目的高尿酸血症与高血压、冠状动脉疾病和慢性肾脏疾病有关。然而，在慢性血液透析环境中，尿酸与心血管疾病的关系没有具体的数据。我们分析了来自6个国家的5827名慢性血液透析患者的设计、设置、参与者和测量数据，这些数据与透析结果和实践模式研究(DOPPS)有关。所有实验室数据均基于DOPPS I和II患者的初始横断面。采用COX回归方法计算全因死亡率和心血管(CV)死亡率的风险比(HR)，并调整病例组合，包括14类合并症。结果有尿酸检测的患者(n=4637)和未检测尿酸的患者(n=1190)的基线特征在临床上没有显著差异。尿酸水平与较低的全因死亡率(HR：0.95，95%可信区间[CI]：0.90~1.00/1 mg/dl高尿酸水平)和CV死亡率(HR：0.92，95%CI：0.86~0.99)相关。将尿酸浓度定为8.2 mg/dl时，调整后的全因死亡率为1.24(95%CI：1.03~1.49)，心血管死亡率为1.54(95%CI：1.15~2.07)。结论在血液透析人群中，尿酸水平越高，全因死亡率和心血管死亡率越低。这些结果与普通人群中高尿酸血症与更高的心血管风险之间的关联形成对比，应该是进一步研究的主题。临床J am Soc肾病6：2470-2477,2011。DOI：10.2215/CJN.00670111
Background and objectives Hyperuricemia is associated with hypertension, coronary artery disease, and chronic kidney disease. However, there are no specific data on the relationship of uric acid to cardiovascular disease in the chronic hemodialysis setting.Design, setting, participants, & measurements Data from 5827 patients on chronic hemodialysis from six countries affiliated with the Dialysis Outcomes and Practice Patterns Study (DOPPS) were analyzed. All laboratory data were based upon the initial cross-section of patients in DOPPS I and II. Cox regression was used to calculate the hazard ratio (HR) of all-cause and cardiovascular (CV) mortality with adjustments for case-mix including 14 classes of comorbidity.Results There were no clinically significant differences in baseline characteristics between those who had measured uric acid (n = 4637) and those who did not (n = 1190). Uric acid level was associated with lower all-cause mortality (HR: 0.95, 95% confidence interval [CI]: 0.90 to 1.00 per 1 mg/dl higher uric acid level) and CV mortality (HR: 0.92, 95% Cl: 0.86 to 0.99). When analyzed as a dichotomous variable, the adjusted HR at uric acid 8.2 mg/dl was 1.24 (95% Cl: 1.03 to 1.49) for all-cause mortality and 1.54 (95% Cl: 1.15 to 2.07) for CV mortality.Conclusions Higher uric acid levels were associated with lower risk of all-cause and CV mortality in the hemodialysis population. These results are in contrast to the association of hyperuricemia with higher cardiovascular risk in the general population and should be the subject of further research. Clin J Am Soc Nephrol 6: 2470-2477, 2011. doi: 10.2215/CJN.00670111