Correlation Between Serum Uric Acid Level And All-cause Death In Patients With Maintenance Hemodialysis

Objective: To explore the correlation between serum uric acid levels and prognostic outcomes in patients with maintenance hemodialysis(MHD)and its influencing factors,so as to provide a theoretical basis for the management of SUA in MHD patients.Methods: A retrospective analysis of 112 patients who were diagnosed with end-stage renal disease(ESRD)from January 1,2016 to January 1,2020 and received MHD treatment in the Dialysis Center of Yan’an University Affiliated Hospital for the first time and met the selection criteria,followed up and observed for 1 year the above.According to the "Expert Consensus on the Diagnosis and Treatment of Chronic Kidney Disease with Hyperuricemia in China",the patients were divided into 2 groups:(1)Hyperuric acid group: male > 420 mmol / L,female > 360 mmol / L;(2)Non-hyperuric acid group: male ≤ 420 mmol / L,female ≤ 360mmol/L.All patients received HD treatment 3 times a week for 4 hours each time.Collecting patient’s general information:personal history(name,gender,age,height,weight),history of primary disease,past medical history(history of diabetes,hypertension),dialysis mode,dialysis age,vascular access,dialysis treatment status;Biochemical indicators: Hb,Ca,P,i PTH,ALP,Alb,PA,SUA,Scr,BUN,TG,TC,LDL-C,HDL-C,and CRP;Cardiac indicators: EF value,left ventricular hypertrophy,cardiac valve calcification;Hospitalizations and deaths: the number of hospitalizations and deaths.SPSS22.0 statistical software for data processing and Pearson or Spearman correlation test was used to analyze the correlation between SUA and various clinical indicators in MHD patients.Kaplan-Meier method was used to analyze the relationship between SUA and all-cause death.COX regression analysis of independent influencing factors of all-cause mortality in MHD patients.Result:1.A total of 112 subjects meet the selection criteria,with an average age of(51.49±14.69)years,of which there are 64 male patients(57.1%)and 48 female patients(49.2%),mainly middle-aged and elderly male patients.The main choice of vascular access was autogenous arteriovenous fistula,accounting for 64.3%.The primary disease was 54 cases(48.2%)with chronic nephritis syndrome and 40 cases(35.7%)with diabetic nephropathy.2.There were 59 cases(52.7%)in the hyperuric acid group and 53 cases(47.3%)in the non-hyperuric acid group.The baseline data showed that the body mass index(BMI)of patients with non-hyperuricemia was lower,while the proportion of male patients was higher(P < 0.05);The comparison of cardiac indexes showed that the EF value of patients with high uric acid group was morely lower than that of non-hyperuric acid group;About biochemical indicators: Hb,ALP,BUN,PA and TC were higher,TG and CRP were lower in high uric acid group.The difference is meaningful(P<0.05).3.Correlation analysis showed that SUA was positively correlated with BUN,Scr,TC,BMI,and dialysis age,but negatively correlated with age and CRP(all P<0.05).4.With all-cause death as the clinical outcome,the 1-year,3-year,and 5-year survival rates of MHD patients were 89.3%,74.1%,and 59.8%.The Kaplan-Meier survival curve showed that the patients in the hyperuric acid group had better survival benefits than the non-hyperuricemia group during the observation period,and the difference was significant(P<0.05).5.There were statistical differences between the death group and the survival group in age,BMI,dialysis age,EF value,left ventricular hypertrophy,cardiac valve calcification,SUA、Hb、Alb、TC and CRP.Compared with the surviving group,patients in the death group are older,lighter,and shorter on dialysis;and the death group had lower EF values,left ventricular hypertrophy and heart valve calcification were more likely to occur.The death group has lower levels of SUA,Hb,Alb,and TC,and higher levels of CRP than the survival group.Hint of multivariate COX regression analysis showed that left ventricular hypertrophy(HR= 2.999,95%CI= 1.207-7.452,P=0.018)and heart valve calcification(HR=3.143,95%CI=1.226-8.059,P=0.012)were all-cause mortality’s independent risk factors;cardiac EF value(HR=0.848,95%CI= 0.768-0.937,P=0.001),serum uric acid(HR=0.178,95%CI=0.036-0.881,P=0.034),serum albumin(HR=0.899,95%CI= 0.809-0.999,P=0.047)were protective factor for all-cause deaths.Conclusions:1.In patients with MHD,SUA is a good nutritional marker,and it is positively correlated with BUN,Scr,TC,and body mass index.2.With all-cause death as the clinical outcome event,the 1-year,3-year,and 5-year survival rates of MHD patients in this study were 89.3%,74.1%,and 59.8%.3.Left ventricular hypertrophy and cardiac valve calcification increases,the risk of all-cause death in MHD patients increases.EF value,serum uric acid,and serum albumin are the protective factors for all-cause death.