接受腹膜透析治疗患者的血清尿酸与全因死亡和心血管死亡之间的关系

Background Although serum uric acid level appears to be associated with mortality in individuals treated with hemodialysis, the relationship between serum uric acid level and death is uncertain in patients treated with peritoneal dialysis (PD). Study Design Cohort study. Setting & Participants 985 patients from a single PD center in South China followed up for a median of 25.3 months. Predictor Serum uric acid level. Outcomes & Measurements The association of baseline sex-specific uric acid level with all-cause and cardiovascular mortality was evaluated. Models were adjusted for age, body mass index, comorbidity score, residual kidney function, total Kt/V, allopurinol and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker use, and laboratory test results, including hemoglobin, serum albumin, creatinine, calcium, phosphorus, triglycerides, low-density lipoprotein cholesterol, and high-sensitivity C-reactive protein. Results Mean age was 48.3 ± 15.4 (SD) years, and 23% had diabetes. Mean uric acid level was 7.0 ± 1.3 (range, 3.8-19.8) mg/dL. During follow-up, 144 deaths were recorded, of which 64 were due to cardiovascular events. In multivariable models, the highest sex-specific tertile of uric acid level was associated with increased risk of all-cause mortality (HR, 1.93; 95% CI, 1.27-2.93; P = 0.004) and cardiovascular mortality (HR, 3.31; 95% CI, 1.70-6.41; P < 0.001) compared to the lowest tertile. Adjusted Cox regression models showed that the HRs per 1-mg/dL higher uric acid level for all-cause and cardiovascular mortality were 1.33 (95% CI, 1.14-1.56; P < 0.001) and 1.44 (95% CI, 1.17-1.77; P = 0.001) for men and 1.03 (95% CI, 0.86-1.24; P = 0.8) and 1.16 (95% CI, 0.97-1.38; P = 0.1) for women, respectively. A formal test for interaction indicated that the association of uric acid level with all-cause and cardiovascular mortality differed by sex (β = -0.06 [P = 0.02] and β = -0.10 [P = 0.02], respectively). Limitations Single measurement of uric acid at baseline. Cause of death determined by death certificates and expert consensus. Conclusions Elevated serum uric acid level is an independent risk factor for all-cause and cardiovascular mortality in men treated with PD. © 2014 by the National Kidney Foundation, Inc.