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Asymptomatic hyperuricemia and cardiovascular mortality in patients with chronic kidney disease who progress to hemodialysis

  • Nephrology - Original Paper
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Abstract

Purpose

Hyperuricemia has been associated with higher mortality in the general population, but less is known about CKD patients. The aim of our study was to determine the impact of elevated serum uric acid on cardiovascular mortality of CKD patients who later progress to hemodialysis.

Methods

In this retrospective study, 120 CKD patients (entire population of patients with ESKD on January 1st, 2012) were observed from their first visit at the Nephrology outpatient clinic, while transitioning to hemodialysis, and until their death or January 1, 2016. After non-cardiovascular death exclusion, 83 CKD patients (33 female, 50 male) were left for further analysis. The average time of observation was 8.8 ± 4.2 years. Serum uric acid was measured regularly (every 3 months). No patients were treated for hyperuricemia. Mean uric acid of 420 µmol/L was set as a cut-off between normouricemic and hyperuricemic patients as per the laboratory’s reference values. Survival rates were analyzed using Kaplan–Meier survival curves. Three Cox regression models were used to assess the influence of uric acid on survival.

Results

Mean uric acid was 379.8 ± 71.6 µmol/L (range 220–574). Sixty-three (75.9%) patients were normouricemic and 20 (24.1%) were hyperuricemic. Cholesterol was the only variable to show statistically significant difference (p = 0.004) between the groups. Bivariate analysis revealed an association between death and age, hyperuricemia, arterial hypertension, and history of cardiovascular disease. Kaplan–Meier survival analysis showed higher risk of cardiovascular death for hyperuricemic patients (log rank test; p < 0.0005). In Cox regression models, hyperuricemia remained a predictor of cardiovascular mortality (SE = 0.500, Exp(B) = 14.120, 95% CI 5.297–37.640) in our patients next to age and arterial hypertension.

Conclusion

The results indicate an association between hyperuricemia and cardiovascular mortality in CKD patients who transition to hemodialysis.

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Acknowledgements

We would like to acknowledge and thank our colleagues at the Dept. of Nephrology and Dept. of Dialysis for their devoted work.

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Authors and Affiliations

  1. Department of Nephrology, Clinic for Internal Medicine, University Medical Centre Maribor, Ljubljanska ulica 5, 2000, Maribor, Slovenia

    Tadej Petreski, Radovan Hojs & Sebastjan Bevc

  2. Department of Dialysis, Clinic for Internal Medicine, University Medical Centre Maribor, Ljubljanska ulica 5, 2000, Maribor, Slovenia

    Robert Ekart

  3. Faculty of Medicine, University of Maribor, Taborska ulica 8, 2000, Maribor, Slovenia

    Robert Ekart, Radovan Hojs & Sebastjan Bevc

Authors
  1. Tadej Petreski
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  2. Robert Ekart
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  4. Sebastjan Bevc
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Corresponding author

Correspondence to Tadej Petreski.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in the study were in accordance with the ethical standards of the Slovenian National Medical Ethics Committee, which approved the protocols in this study (Approval No. 41/12/12), and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Petreski, T., Ekart, R., Hojs, R. et al. Asymptomatic hyperuricemia and cardiovascular mortality in patients with chronic kidney disease who progress to hemodialysis. Int Urol Nephrol 51, 1013–1018 (2019). https://doi.org/10.1007/s11255-019-02154-w

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  • DOI: https://doi.org/10.1007/s11255-019-02154-w

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