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Kidney Week

Abstract: PO1039

Impact of Age on the Association of Pre-ESRD Uric Acid with Post-Transition Mortality Among US Veterans

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Cuvelier, Nicholas, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
  • Wenziger, Cachet, VA Long Beach Healthcare System, Long Beach, California, United States
  • Hsiung, Jui-Ting, VA Long Beach Healthcare System, Long Beach, California, United States
  • Hanna, Ramy Magdy, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
  • Tantisattamo, Ekamol, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
  • Rhee, Connie, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
  • Kovesdy, Csaba P., Memphis VA Medical Center, Memphis, Tennessee, United States
  • Kalantar-Zadeh, Kamyar, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
  • Streja, Elani, VA Long Beach Healthcare System, Long Beach, California, United States
Background

Elevated uric acid is a marker for gout and higher mortality in kidney disease patients. In a prior analysis we demonstrated that higher pre-dialysis uric acid was associated with higher post-transition outcomes. As higher uric acid is more commonly found in older patients, we examined the differences in the association between pre-dialysis uric acid and mortality post-transition to dialysis across age groups.

Methods

From US veterans who transitioned to dialysis between 10/2007-03/2015, we identified 9,110 patients with a uric acid measured 3 months before transitioning to ESRD. We examined the association of pre-ESRD uric acid category with all-cause mortality post-transition using Cox proportional hazards models adjusted for case-mix covariates, and additional adjustments for laboratory values and eGFR, separately in patients less than 65 or >= 65 years.

Results

The mean age of the cohort was 66±11 years old, 2% female, and 36% African American. The 3-month prelude uric acid average was 8.13 ± 2.29 mg/dL. 4,521 patients died during follow-up (median follow up time of 25 months). Compared to the reference group (7-<8mg/dL) in the fully adjusted model, lower uric acid led to a lower risk and the highest category of uric acid had an 18% higher risk of mortality in those 65 years or older. There was no significant association between uric acid and mortality among patient younger than 65. Wald Test for interaction showed a significant difference in association (p value: 0.0029). [Figure]

Conclusion

Elevated uric acid pre-transition is associated with a higher risk of mortality post-transition among older Veteran patients. In older patients, prelude uric acid can be informative of post-transition outcomes. Further study of this relationship is warranted to determine if uric acid should be more closely monitored in patients transitioning to dialysis and to further understand why age modifies the clinical impact of uric acid.