title: Low serum uric acid level is a risk factor for death in incident hemodialysis patients.
abstract: BACKGROUND
  A reverse epidemiology of classic cardiovascular risk factors was observed in hemodialysis patients with a high comorbidity burden. We hypothesized that uric acid, a novel cardiovascular risk factor, also has an altered association with survival in these patients.
  
  
  METHODS
  A retrospective study was conducted on 168 consecutive outpatient hemodialysis patients over a 6-year period. Serum uric acid, albumin levels and relevant laboratory information were recorded monthly. The disease severity was assessed using Comorbidity Index (CoI) scores. Patients were stratified into 3 groups according to their serum uric acid concentrations: group I was the lowest quintile, group II was the middle 3 quintiles and group III was the highest quintile. The risks of death were calculated utilizing a Cox regression model.
  
  
  RESULTS
  Using group II as a reference group, the hazard ratio of group I was 2.23 [95% confidence interval (CI) 1.21-4.11, p = 0.01] and group III was 0.89 (95% CI 0.47-1.71, p = 0.74). The serum uric acid levels correlated inversely with CoI scores (r = -0.31, 95% CI -0.44 to -0.17, p < 0.0001) and positively with serum albumin levels (r = 0.35, 95% CI 0.21-0.48, p < 0.0001).
  
  
  CONCLUSIONS
  Low serum uric acid is a mortality risk factor in incident hemodialysis patients with a high comorbidity burden and hypoalbuminemia.
authors.affiliation: Biotronics Kidney Center, 2755 Liberty Avenue, Beaumont, TX 77702, USA. Kurt4915@sbcglobal.net
authors.forename: S M Kurt
authors.initials: SM
authors.lastname: Lee
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Lee
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Winters
authors.forename: Emily
authors.initials: E
authors.lastname: Tam
authors.forename: Mohammed
authors.initials: M
authors.lastname: Jaleel
authors.forename: Peter
authors.initials: P
authors.lastname: Stenvinkel
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Johnson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D015897:Comorbidity; D005260:Female; D006801:Humans; D034141:Hypoalbuminemia / Q000097:blood / Q000401:mortality; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012189:Retrospective Studies; D012307:Risk Factors; D014527:Uric Acid / Q000097:blood*; D055815:Young Adult
chemical_list: D014527:Uric Acid