title: Serum uric acid as a clinically useful nutritional marker and predictor of outcome in maintenance hemodialysis patients.
abstract: OBJECTIVE
  The importance of serum uric acid (SUA) for the maintenance of a hemodialysis (MHD) population has not been well established. The aim of this study was to determine if SUA levels are associated with nutritional risk and consequently with adverse clinical outcomes in MHD patients.
  
  
  METHODS
  This was a 2-y prospective observational study, performed on 261 MHD outpatients (38.7% women) with a mean age of 68.6 ± 13.6 y. We measured prospective all-cause and cardiovascular (CV) hospitalization and mortality, nutritional scores (malnutrition-inflammation score [MIS) and geriatric nutritional risk index (GNRI), handgrip strength (HGS), and short-form 36 (SF36) quality-of-life (QoL) scores.
  
  
  RESULTS
  SUA positively correlated with laboratory nutritional markers (albumin, creatinine), body composition parameters, HGS (r = 0.26; P < 0.001) and GNRI (r = 0.34; P < 0.001). SUA negatively correlated with MIS (r = -0.33; P < 0.001) and interleukin-6 (r = -0.13; P = 0.04). Patients in the highest SUA tertile had higher total SF-36 scores (P = 0.04), higher physical functioning (P = 0.003), and role-physical (P = 0.006) SF-36 scales. For each 1 mg/dL increase in baseline SUA levels, the first hospitalization hazard ratio (HR) was 0.79 (95% confidence interval [CI], 0.68-0.91) and first CV event HR was 0.60 (95% CI, 0.44-0.82); all-cause death HR was 0.55 (95% CI, 0.43-0.72) and CV death HR was 0.55 (95% CI, 0.35-0.80). Associations between SUA and mortality risk continued to be significant after adjustments for various confounders including MIS and interleukin-6. Cubic spline survival models confirmed the linear trends.
  
  
  CONCLUSIONS
  In MHD patients, SUA is a good nutritional marker and associates with body composition, muscle function, inflammation, and health-related QoL, upcoming hospitalizations, as well as independently predicting all-cause and CV death risk.
authors.affiliation: Nephrology Division, Assaf Harofeh Medical Center, Zerifin, affiliated with the Sackler Faculty of Medicine Tel Aviv University, Israel. Electronic address: Iliab@asaf.health.gov.il.
authors.forename: Ilia
authors.initials: I
authors.lastname: Beberashvili
authors.affiliation: Pathology Department, Assaf Harofeh Medical Center, Zerifin, affiliated with the Sackler Faculty of Medicine Tel Aviv University, Israel.
authors.forename: Inna
authors.initials: I
authors.lastname: Sinuani
authors.affiliation: Nutrition Department, Assaf Harofeh Medical Center, Zerifin, affiliated with the Sackler Faculty of Medicine Tel Aviv University, Israel.
authors.forename: Ada
authors.initials: A
authors.lastname: Azar
authors.affiliation: Nephrology Division, Assaf Harofeh Medical Center, Zerifin, affiliated with the Sackler Faculty of Medicine Tel Aviv University, Israel.
authors.forename: Gregory
authors.initials: G
authors.lastname: Shapiro
authors.affiliation: Nephrology Division, Assaf Harofeh Medical Center, Zerifin, affiliated with the Sackler Faculty of Medicine Tel Aviv University, Israel.
authors.forename: Leonid
authors.initials: L
authors.lastname: Feldman
authors.affiliation: Urology Department, Assaf Harofeh Medical Center, Zerifin, affiliated with the Sackler Faculty of Medicine Tel Aviv University, Israel.
authors.forename: Kobi
authors.initials: K
authors.lastname: Stav
authors.affiliation: Nutrition Department, Assaf Harofeh Medical Center, Zerifin, affiliated with the Sackler Faculty of Medicine Tel Aviv University, Israel.
authors.forename: Judith
authors.initials: J
authors.lastname: Sandbank
authors.affiliation: Nephrology Division, Assaf Harofeh Medical Center, Zerifin, affiliated with the Sackler Faculty of Medicine Tel Aviv University, Israel.
authors.forename: Zhan
authors.initials: Z
authors.lastname: Averbukh
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood*; D001823:Body Composition; D015992:Body Mass Index; D003404:Creatinine / Q000097:blood; D002149:Energy Intake; D005260:Female; D018737:Hand Strength; D006760:Hospitalization; D006801:Humans; D007249:Inflammation / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D011446:Prospective Studies; D011788:Quality of Life; D006435:Renal Dialysis; D012307:Risk Factors; D012709:Serum Albumin / Q000378:metabolism; D012885:Skinfold Thickness; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000097:blood; D014527:Uric Acid / Q000097:blood*
chemical_list: D015415:Biomarkers; C508600:IL6 protein, human; D015850:Interleukin-6; D012709:Serum Albumin; D014409:Tumor Necrosis Factor-alpha; D014527:Uric Acid; D003404:Creatinine
keywords: Handgrip strength; Hemodialysis; Malnutrition-inflammation score; Quality of life; Survival; Uric acid