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ORIGINAL RESEARCH article

Front. Nutr.
Sec. Clinical Nutrition
Volume 11 - 2024 | doi: 10.3389/fnut.2024.1499438

Association between serum uric acid and all-cause and cardiovascular-related mortality in hemodialysis patients

Provisionally accepted
Wenyuan Gan Wenyuan Gan Fan Zhu Fan Zhu *Xun Fang Xun Fang *Wenzhe Wang Wenzhe Wang *Danni Shao Danni Shao *Huihui Mao Huihui Mao *Wei Xiao Wei Xiao *Wenli Chen Wenli Chen *Fang Xu Fang Xu *Xingruo Zeng Xingruo Zeng *
  • Central Hospital of Wuhan, Huazhong University of Science and Technology, Wuhan, China

The final, formatted version of the article will be published soon.

    The association between serum uric acid (UA) and all-cause and cardiovascular-related mortality in hemodialysis (HD) patients are conflicting. We investigated this association and explored the effect moderation of underlying nutritional status as reflected in the Lean Tissue Index (LTI) and the Geriatric Nutritional Risk Index (GNRI), which are surrogate of muscle mass and nutritional risk in HD patients.Methods: A retrospective cohort study was conducted from January 2019 to December 2023. We investigate the association between serum UA and outcomes by using the Cox proportional hazards regression and restricted cubic spline function. Subgroup analyses based on LTI and GNRI were conducted to explore possible effect modifications.Results: During a mean of 32.9 months of follow-up, 876 patients treated with HD were included. The association between serum UA and all-cause mortality showed a non-linear U-shaped pattern (P = 0.007), with a survival benefit for serum UA levels between 3.4 and 6.8 mg/dl. In the multivariable-adjusted model, the low and high UA group was associated with greater risk of all-cause mortality compared to the reference UA group (HR=1.24, CI 1.03-2.12, P=0.027; HR=1.09; CI 1.05-2.08. P=0.012). In low UA group, the greater risk of mortality was observed with low LTI (<12.3; HR 1.56, 95% CI 1.22-1.82) and GNRI (<102.1; HR 1.43, 95% CI 1.12-1.76), but not with high LTI and GNRI. There seems no significant association between serum UA and cardiovascular disease-related mortality.Our study shows that lower or higher serum UA levels increase the risk of all-cause mortality in HD patients. Among patients with lower UA levels, low LTI and GNRI showed a greater risk of mortality. It suggested that a better nutritional status and not elevated UA levels is likely to improve long-term survival in HD patients.

    Keywords: Uric Acid, hemodialysis, Mortality, Cardiovascular-related death, GNRI (Geriatric Nutritional Risk Index)

    Received: 20 Sep 2024; Accepted: 14 Nov 2024.

    Copyright: © 2024 Gan, Zhu, Fang, Wang, Shao, Mao, Xiao, Chen, Xu and Zeng. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence:
    Fan Zhu, Central Hospital of Wuhan, Huazhong University of Science and Technology, Wuhan, China
    Xun Fang, Central Hospital of Wuhan, Huazhong University of Science and Technology, Wuhan, China
    Wenzhe Wang, Central Hospital of Wuhan, Huazhong University of Science and Technology, Wuhan, China
    Danni Shao, Central Hospital of Wuhan, Huazhong University of Science and Technology, Wuhan, China
    Huihui Mao, Central Hospital of Wuhan, Huazhong University of Science and Technology, Wuhan, China
    Wei Xiao, Central Hospital of Wuhan, Huazhong University of Science and Technology, Wuhan, China
    Wenli Chen, Central Hospital of Wuhan, Huazhong University of Science and Technology, Wuhan, China
    Fang Xu, Central Hospital of Wuhan, Huazhong University of Science and Technology, Wuhan, China
    Xingruo Zeng, Central Hospital of Wuhan, Huazhong University of Science and Technology, Wuhan, China

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