Serum uric acid as a clinically useful nutritional marker and predictor of outcome in maintenance hemodialysis patients
Serum uric acid as a clinically useful nutritional marker and predictor of outcome in maintenance hemodialysis patients
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DOI：
10.1016/j.nut.2014.06.012
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发表时间：
2015-01-01
期刊：
影响因子：
4.4
通讯作者：
Averbukh, Zhan
中科院分区：
文献类型：
--
作者：
Beberashvili, Ilia;Sinuani, Inna;Averbukh, Zhan
目的：血清尿酸（SUA）对维持血液透析（MHD）人群的重要性尚未得到很好的证实。本研究的目的是确定SUA水平是否与营养风险相关，并因此与MHD patients.Methods的不良临床结局相关：这是一项为期2年的前瞻性观察研究，对261名MHD门诊患者（38.7%女性）进行，平均年龄为68.6 +/- 13.6 y。我们测量了前瞻性全因和心血管（CV）住院和死亡率，营养评分结果：SUA与实验室营养指标呈正相关（P < 0. 05），与老年营养风险指数（GNRI）、握力（HGS）、生活质量量表（SF 36）评分呈正相关（P < 0. 05（白蛋白、肌酐）、体成分、HGS（r = 0.26; P < 0.001）和GNRI（r = 0.34; P < 0.001）。SUA与MIS（r = -0.33; P < 0.001）和IL-6（r = -0.13; P = 0.04）呈负相关。SUA最高三分位数的患者具有较高的SF-36总评分（P = 0.04）、较高的身体功能（P = 0.003）和角色-身体（P = 0.006）SF-36量表。基线SUA水平每升高1 mg/dL，首次住院风险比（HR）为0.79（95%置信区间[CI]，0.68-0.91），首次CV事件HR为0.60（95% CI，0.44-0.82）;全因死亡HR为0.55（95% CI，0.43-0.72），CV死亡HR为0.55（95% CI，0.35-0.80）。在调整包括MIS和白细胞介素-6在内的各种混杂因素后，SUA和死亡风险之间的相关性仍然显著。三次样条生存模型证实了线性trends.Conclusions：在MHD患者中，SUA是一个很好的营养指标，与身体成分，肌肉功能，炎症，健康相关的生活质量，即将住院，以及独立预测全因和CV死亡风险。(C)2015 Elsevier Inc. All rights reserved.
Objective: The importance of serum uric acid (SUA) for the maintenance of a hemodialysis (MHD) population has not been well established. The aim of this study was to determine if SUA levels are associated with nutritional risk and consequently with adverse clinical outcomes in MHD patients.Methods: This was a 2-y prospective observational study, performed on 261 MHD outpatients (38.7% women) with a mean age of 68.6 +/- 13.6 y. We measured prospective all-cause and cardiovascular (CV) hospitalization and mortality, nutritional scores (malnutrition-inflammation score [MIS) and geriatric nutritional risk index (GNRI), handgrip strength (HGS), and short-form 36 (SF36) quality-of-life (QoL) scores.Results: SUA positively correlated with laboratory nutritional markers (albumin, creatinine), body composition parameters, HGS (r = 0.26; P < 0.001) and GNRI (r = 0.34; P < 0.001). SUA negatively correlated with MIS (r = -0.33; P < 0.001) and interleukin-6 (r = -0.13; P = 0.04). Patients in the highest SUA tertile had higher total SF-36 scores (P = 0.04), higher physical functioning (P = 0.003), and role-physical (P = 0.006) SF-36 scales. For each 1 mg/dL increase in baseline SUA levels, the first hospitalization hazard ratio (HR) was 0.79 (95% confidence interval [CI], 0.68-0.91) and first CV event HR was 0.60 (95% CI, 0.44-0.82); all-cause death HR was 0.55 (95% CI, 0.43-0.72) and CV death HR was 0.55 (95% CI, 0.35-0.80). Associations between SUA and mortality risk continued to be significant after adjustments for various confounders including MIS and interleukin-6. Cubic spline survival models confirmed the linear trends.Conclusions: In MHD patients, SUA is a good nutritional marker and associates with body composition, muscle function, inflammation, and health-related QoL, upcoming hospitalizations, as well as independently predicting all-cause and CV death risk. (C) 2015 Elsevier Inc. All rights reserved.