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Abstract: TH-PO425

Association of Hyperuricemia and Serum Uric Acid Lowering Medication with Mortality in Hemodialysis Patients

Session Information

Category: Hypertension and CVD

  • 1401 Hypertension and CVD: Epidemiology, Risk Factors, and Prevention

Authors

  • Rohn, Benjamin, Marien Hospital Herne, Herne, Germany
  • Seibert, Felix S., University Hospital Marien Hospital Herne, Herne, Germany
  • Babel, Nina, Ruhr University Bochum, Herne, Germany
  • Bauer, Frederic, Ruhr-University Bochum, Herne, Germany
  • Westhoff, Timm H., Ruhr-University Bochum, Germany, Herne, Germany
Background

In the general population hyperuricemia is associated with increased cardiovascular risk and mortality. It is unknown whether this association exists in hemodialysis patients as well and whether this population benefits from serum uric acid (SUA) lowering medication.

Methods

We performed a retrospective analysis of 601 patients on chronic hemodialysis therapy in five dialysis outpatient centers for a maximum follow-up of 100 months (mean follow-up 41 months). Death was defined as primary endpoint. Hyper- and normouricemic subjects differed in age. Therefore a Cox regression analysis adjusted for age was performed in addition to Kaplan Meier survival analyses.

Results

Kaplan Meier survival curves showed a higher cumulative survival rate for those subjects with a higher than median SUA concentration both based on mean annual SUA concentrations and baseline SUA concentrations (three months after the initiation of dialysis, p<0.05 each). Groups showed no significant difference in survival anymore after adjustment for age in Cox regression analyses (p>0.05 each). SUA lowering therapy (allopurinol or febuxostat) revealed no effect on cumulative survival, neither in Kaplan Meier nor in Cox regression analysis (p>0.05 each). Body mass index had no impact on survival rates. There were 22 symptomatic gout attacks during the follow-up corresponding to an incidence of 1/93.3 patient years. Among those with prior symptomatic hyperuricemia (10.1% of overall population) 47.5% continued on medication, 52.5% discontinued. Only 6 subjects with prior symptomatic hyperuricemia developed additional gout attacks after the initiation of hemodialysis (1/342.2 patient years), all of them despite medication.

Conclusion

The present analysis shows that – in contrast to the general population – hyperuricemia is not associated with increased mortality in patients undergoing hemodialysis. A “reversed epidemiology phenomenon” of better survival with higher SUA concentrations disappears after adjustment for age. SUA lowering therapy is neither associated with a survival benefit nor a significant reduction of gout free patient years. These data indicate that SUA lowering medication might be dispensable after the initiation of dialysis.