Abstract: FR-PO863

Low Serum Uric Acid-Mortality Association in Incident Hemodialysis Patients

Session Information

Category: Dialysis

  • 607 Dialysis: Epidemiology, Outcomes, Clinical Trials - Non-Cardiovascular

Authors

  • Nishizawa, Yoshiko, Division of Nephrology, Ichiyokai Harada Hospital, Hiroshima, Japan
  • Mizuiri, Sonoo, Division of Nephrology, Ichiyokai Harada Hospital, Hiroshima, Japan
  • Asai, Mariko, Division of Nephrology, Ichiyokai Harada Hospital, Hiroshima, Japan
  • Ono, Kyoka, Division of Nephrology, Ichiyokai Harada Hospital, Hiroshima, Japan
  • Shigemoto, Kenichiro, Division of Nephrology, Ichiyokai Harada Hospital, Hiroshima, Japan
  • Usui, Kohji, Ichiyokai Ichiyokai Clinic, Hiroshima, Japan
  • Yamashita, Kazuomi, Ichiyokai Yokogawa Clinic, Hiroshima, Japan
  • Arita, Michiko, Ichiyokai East Clinic, Hiroshima, Japan
  • Masaki, Takao, Nephrology, Hiroshima University Hospital, Hiroshima, Japan
Background

The association between serum uric acid (SUA) and mortality is contradictory in studies of hemodialysis (HD) patients. We hypothesized that nutritional status modifies the SUA-mortality association in the HD population.

Methods

We identified 462 patients who had HD treatment over 12 years (2004–2016) and had SUA measurements at HD initiation. Patients were followed-up until death. Kaplan-Meier survival analysis was assessed in each baseline SUA quartile (Q). Univariate Cox regression analyses of 1-year death were performed using data from HD initiation [variables: age, sex, presence of diabetes, hemoglobin, SUA (<5.0 mg/dl or Q4), creatinine, potassium, phosphate, C-reactive protein, geriatric nutritional risk index (GNRI), normalized protein catabolic rate (nPCR), and beta-2 microglobulin]. Multivariate Cox models were performed using significant variables from the univariate analyses. Regression analyses (RA) and multiple RA for SUA were performed using the same independent variables as univariate Cox models.

Results

The cumulative 1-year survival rate of patients belonging to the lowest UA Q1 (<6.2 mg/dl) was 81.1%, and was significantly lower (P<0.05) than patients in Q2 (92.7%, 6.2–7.2 mg/dl), Q3 (94.8%, 7.3–8.3 mg/dl), and Q4 (90.6%, ≥8.4 mg/dl). The cumulative 3 and 5 year survival rates of UA Q1 group were significantly (P<0.05) lower than those of the UA Q4 group (81.4% vs. 93.4%, and 80.7% vs. 89.6%, respectively). One-year all-cause mortality was found to be significantly associated with sex [hazard ratio (HR) 22.3, 95% confidence interval (CI) 2.56–338.6, P<0.01], serum creatinine (HR 0.26, 95% CI 0.10–0.52, P<0.01), serum phosphate (HR 3.22, 95% CI 1.40–8.20, P<0.01), SUA<5.0 mg/dl (HR 8.42, 95% CI, P<0.01), but not UA Q1. The HR of patients with SUA<5.0 mg/dl was 8.4 (P<0.05). In RA, SUA level was significantly associated with age, sex, hemoglobin, creatinine, potassium, phosphate, C-reactive protein, GNRI and nPCR (P<0.05). In multiple RA, SUA level was only associated with serum phosphate (β 0.20, P<0.01), creatinine(β 0.14, P<0.05), and GNRI (β 0.19, P<0.01).

Conclusion

Low SUA level but not high SUA level is associated with 1, 3, and 5-year mortality in incident HD patients, and a link between low SUA concentration and malnutrition status was present in this population.