title: Uric acid levels and all-cause and cardiovascular mortality in the hemodialysis population.
abstract: OBJECTIVE
  Hyperuricemia is associated with hypertension, coronary artery disease, and chronic kidney disease. However, there are no specific data on the relationship of uric acid to cardiovascular disease in the chronic hemodialysis setting.
  
  
  METHODS
  Data from 5827 patients on chronic hemodialysis from six countries affiliated with the Dialysis Outcomes and Practice Patterns Study (DOPPS) were analyzed. All laboratory data were based upon the initial cross-section of patients in DOPPS I and II. Cox regression was used to calculate the hazard ratio (HR) of all-cause and cardiovascular (CV) mortality with adjustments for case-mix including 14 classes of comorbidity.
  
  
  RESULTS
  There were no clinically significant differences in baseline characteristics between those who had measured uric acid (n = 4637) and those who did not (n = 1190). Uric acid level was associated with lower all-cause mortality (HR: 0.95, 95% confidence interval [CI]: 0.90 to 1.00 per 1 mg/dl higher uric acid level) and CV mortality (HR: 0.92, 95% CI: 0.86 to 0.99). When analyzed as a dichotomous variable, the adjusted HR at uric acid ≤8.2 mg/dl compared with >8.2 mg/dl was 1.24 (95% CI: 1.03 to 1.49) for all-cause mortality and 1.54 (95% CI: 1.15 to 2.07) for CV mortality.
  
  
  CONCLUSIONS
  Higher uric acid levels were associated with lower risk of all-cause and CV mortality in the hemodialysis population. These results are in contrast to the association of hyperuricemia with higher cardiovascular risk in the general population and should be the subject of further research.
authors.affiliation: Beth Israel Medical Center, Albert Einstein College of Medicine, New York, New York, USA.
authors.forename: Walead
authors.initials: W
authors.lastname: Latif
authors.forename: Angelo
authors.initials: A
authors.lastname: Karaboyas
authors.forename: Lin
authors.initials: L
authors.lastname: Tong
authors.forename: James F
authors.initials: JF
authors.lastname: Winchester
authors.forename: Charlotte J
authors.initials: CJ
authors.lastname: Arrington
authors.forename: Ronald L
authors.initials: RL
authors.lastname: Pisoni
authors.forename: Mark R
authors.initials: MR
authors.lastname: Marshall
authors.forename: Werner
authors.initials: W
authors.lastname: Kleophas
authors.forename: Nathan W
authors.initials: NW
authors.lastname: Levin
authors.forename: Ananda
authors.initials: A
authors.lastname: Sen
authors.forename: Bruce M
authors.initials: BM
authors.lastname: Robinson
authors.forename: Rajiv
authors.initials: R
authors.lastname: Saran
mesh_terms: D000328:Adult; D000368:Aged; D001315:Australia; D015415:Biomarkers / Q000097:blood; D002170:Canada; D002318:Cardiovascular Diseases / Q000401:mortality*; D002908:Chronic Disease; D016000:Cluster Analysis; D005060:Europe; D005260:Female; D006801:Humans; D033461:Hyperuricemia / Q000097:blood / Q000401:mortality*; D007564:Japan; D007674:Kidney Diseases / Q000401:mortality* / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D016016:Proportional Hazards Models; D011446:Prospective Studies; D006435:Renal Dialysis / Q000401:mortality*; D018570:Risk Assessment; D012307:Risk Factors; D014481:United States; D014527:Uric Acid / Q000097:blood*
chemical_list: D015415:Biomarkers; D014527:Uric Acid