Nephrol Dial Transplant (2004) 19: 457-462
© ERA–EDTA 2004; all rights reserved
Preliminary Communication
Serum uric acid levels show a ‘J-shaped’ association with all-cause mortality in haemodialysis patients
Department of Internal Medicine, 1Far Eastern Memorial Hospital and 2National Taiwan University Hospital, Taipei, Taiwan, Republic of China
Correspondence and offprint requests to: Dr Kuan-Yu Hung, Department of Internal Medicine, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, Taiwan, Republic of China. Email: d820612{at}ha.mc.ntu.edu.tw
Background. Although elevated serum levels of uric acid are common in patients with kidney disease or in those receiving maintenance dialysis therapy, the clinical impact of uric acid on mortality in haemodialysis (HD) patients remains unclear. This work was designed to explore the predictive value of serum uric acid levels on all-cause mortality of HD patients.
Methods. We retrospectively analysed mortality rates in 146 chronic HD patients that were treated with HD three times per week at our HD unit for a period of one full year. The analysed parameters included demographic characteristics, aetiology of end-stage renal disease, co-morbid conditions, duration (at least 1 year) and delivered dose of HD, normalized protein catabolic rate, serum albumin concentration, haematocrit, serum uric acid (UA) levels and other laboratory parameters. A multivariate Cox proportional hazards model, which included adjustment for the above factors, was applied to identify the predictive value of UA levels on patient mortality.
Results. A Cox proportional hazards model revealed that decreased serum albumin, underlying diabetic nephropathy (DMN) and UA groups (
20th, 20–80th and 
80th percentiles; P = 0.016) were all significant, independent predictors of all-cause mortality in HD patients. The hazard ratios of death were: serum albumin (per 0.5 g/dl decrease), 3.10 [95% confidence interval (95% CI), 1.80–5.34, P < 0.001]; DMN (vs non-DMN), 3.47 (95% CI, 1.25–9.59, P = 0.017); and UA groups (vs 20th to 80th percentile): 20th percentile, 2.98 (95% CI, 0.82–10.90, P = 0.099); 80th percentile, 5.67 (95% CI, 1.71–18.78, P = 0.004).
Conclusions. These preliminary observations suggest that HD patients in the lowest and highest quintiles of UA levels would face higher risk of mortality. Further studies with larger sample sizes will be needed to confirm these findings.
Keywords: albumin; diabetes mellitus; haemodialysis; mortality rate; serum uric acid
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