Serum Uric Acid Levels And All-cause Mortality In Maintenance Hemodialysis Patients:a Systematic Review And Meta-analysis

Background: It shown that inconsistent results about the association between serum uric acid levels and all-cause mortality in maintenance hemodialysis patients.Therefore,this study explored the relationship between serum uric acid levels and all-cause mortality in maintenance hemodialysis patients.Methods: A systematic search was performed on published articles in pubmed,Embase,Cochrane Library,Web of Science,China National Knowledge Infrastructure,Wanfang Database,and Weipu Chinese Science and Technology Journal Database to identify studies investigating the association between serum uric acid and all-cause mortality in maintenance hemodialysis patients.The meta-analysis was performed using STATA 16.0 software.According to the heterogeneity test results,the pooled hazard ratios of all-cause mortality and corresponding 95%confidence intervals were calculated using random effects models.Subgroup analysis was conducted to explore the source of heterogeneity and sensitivity analysis was conducted to evaluate the stability of the meta-analysis results.Results: A total of 1379 articles that might meet the criteria were identified through a systematic search,and 14 studies with a total of269702 maintenance hemodialysis patients were eventually included based on the inclusion and exclusion criteria.In the studies that used serum uric acid as a categorical variable,a meta-analysis showed that patients with the lowest serum uric acid level were associated with a higher risk for all-cause mortality(9 studies;HR=1.21;95%CI 1.03-1.43,P< 0.001)compared with patients with the highest serum uric acid level.In the studies that analyzed serum uric acid as a continuous variable,a meta-analysis showed that an increase of 1 mg/d L in serum uric acid level was associated with an 10% decreased risk of mortality(8 studies;HR=0.90,95%CI 0.85-0.95,P< 0.001).There was heterogeneity in all the above results,and subgroup analysis showed that adjusted albumin and renal function might be the sources of heterogeneity.Conclusions: Lower serum uric acid level is significantly related to the risk of all-cause mortality in maintenance hemodialysis patients.We should pay more attention to serum uric acid levels in maintenance hemodialysis patients.However,limited by the current type and number of studies,more high-quality studies,especially randomized controlled trials,should be conducted to determine whether low uric acid level is a potentially variable risk factor for all-cause mortality in maintenance hemodialysis patients and to guide the management of uric acid in these patients.