Serum uric acid, protein intake and mortality in hemodialysis patients

Christina Park, Yoshitsugu Obi, Elani Streja, Connie M. Rhee, Christina J. Catabay, Nosratola D. Vaziri, Csaba Kovesdy, Kamyar Kalantar-Zadeh

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background The association between serum uric acid (SUA) and mortality has been conflicting among studies using hemodialysis (HD) patients. Given the close link between purine and protein in foods, we hypothesized that normalized protein catabolic rate (nPCR), a dietary protein intake surrogate, modifies the SUA-mortality association in the HD population. Methods We identified 4298 patients who initiated HD and had one or more SUA measurement in a contemporary cohort of HD patients over 5 years (1 January 2007-31 December 2011), and examined survival probability according to the first uric acid measurement, adjusting for dialysis vintage, case-mix and malnutrition-inflammation complex-related variables. Results Mean SUA concentration was 6.6 ± 1.8 mg/dL. There was a consistent association of higher SUA with better nutritional status and lower all-cause mortality irrespective of adjusted models (P trend < 0.001). In the case-mix adjusted model, the highest SUA category (≥8.0 mg/dL) compared with the reference group (>6.0-7.0 mg/dL) showed no significant mortality risk [hazard ratio (HR) 0.90, 95% confidence interval (CI) 0.72-1.13], while the lowest category (<5.0 mg/dL) was associated with higher mortality (HR 1.42, 95% CI 1.16-1.72). The hypouricemia-mortality association was significantly modified by nPCR (P interaction = 0.001). Mortality risk of low SUA (<5.0 mg/dL) persisted among patients with low nPCR (<0.9 g/kg/day; HR 1.73, 95% CI 1.42-2.10) but not with high nPCR (≥0.9 g/kg/day; HR 0.99, 95% CI 0.74-1.33). Conclusions SUA may be a nutritional marker in HD patients. Contrary to the general population, low but not high SUA is associated with higher all-cause mortality in HD patients, especially in those with low protein intake. Nutritional features of SUA warrant additional studies.

Original languageEnglish (US)
Pages (from-to)1750-1757
Number of pages8
JournalNephrology Dialysis Transplantation
Volume32
Issue number10
DOIs
StatePublished - Oct 1 2017

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Uric Acid
Renal Dialysis
Mortality
Serum
Proteins
Confidence Intervals
Dietary Proteins
Diagnosis-Related Groups
Nutritional Status
Malnutrition
Population
Dialysis
Odds Ratio
Inflammation
Food
Survival

All Science Journal Classification (ASJC) codes

  • Nephrology
  • Transplantation

Cite this

Park, C., Obi, Y., Streja, E., Rhee, C. M., Catabay, C. J., Vaziri, N. D., ... Kalantar-Zadeh, K. (2017). Serum uric acid, protein intake and mortality in hemodialysis patients. Nephrology Dialysis Transplantation, 32(10), 1750-1757. https://doi.org/10.1093/ndt/gfw419

Serum uric acid, protein intake and mortality in hemodialysis patients. / Park, Christina; Obi, Yoshitsugu; Streja, Elani; Rhee, Connie M.; Catabay, Christina J.; Vaziri, Nosratola D.; Kovesdy, Csaba; Kalantar-Zadeh, Kamyar.

In: Nephrology Dialysis Transplantation, Vol. 32, No. 10, 01.10.2017, p. 1750-1757.

Research output: Contribution to journalArticle

Park, C, Obi, Y, Streja, E, Rhee, CM, Catabay, CJ, Vaziri, ND, Kovesdy, C & Kalantar-Zadeh, K 2017, 'Serum uric acid, protein intake and mortality in hemodialysis patients', Nephrology Dialysis Transplantation, vol. 32, no. 10, pp. 1750-1757. https://doi.org/10.1093/ndt/gfw419
Park C, Obi Y, Streja E, Rhee CM, Catabay CJ, Vaziri ND et al. Serum uric acid, protein intake and mortality in hemodialysis patients. Nephrology Dialysis Transplantation. 2017 Oct 1;32(10):1750-1757. https://doi.org/10.1093/ndt/gfw419
Park, Christina ; Obi, Yoshitsugu ; Streja, Elani ; Rhee, Connie M. ; Catabay, Christina J. ; Vaziri, Nosratola D. ; Kovesdy, Csaba ; Kalantar-Zadeh, Kamyar. / Serum uric acid, protein intake and mortality in hemodialysis patients. In: Nephrology Dialysis Transplantation. 2017 ; Vol. 32, No. 10. pp. 1750-1757.
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abstract = "Background The association between serum uric acid (SUA) and mortality has been conflicting among studies using hemodialysis (HD) patients. Given the close link between purine and protein in foods, we hypothesized that normalized protein catabolic rate (nPCR), a dietary protein intake surrogate, modifies the SUA-mortality association in the HD population. Methods We identified 4298 patients who initiated HD and had one or more SUA measurement in a contemporary cohort of HD patients over 5 years (1 January 2007-31 December 2011), and examined survival probability according to the first uric acid measurement, adjusting for dialysis vintage, case-mix and malnutrition-inflammation complex-related variables. Results Mean SUA concentration was 6.6 ± 1.8 mg/dL. There was a consistent association of higher SUA with better nutritional status and lower all-cause mortality irrespective of adjusted models (P trend < 0.001). In the case-mix adjusted model, the highest SUA category (≥8.0 mg/dL) compared with the reference group (>6.0-7.0 mg/dL) showed no significant mortality risk [hazard ratio (HR) 0.90, 95{\%} confidence interval (CI) 0.72-1.13], while the lowest category (<5.0 mg/dL) was associated with higher mortality (HR 1.42, 95{\%} CI 1.16-1.72). The hypouricemia-mortality association was significantly modified by nPCR (P interaction = 0.001). Mortality risk of low SUA (<5.0 mg/dL) persisted among patients with low nPCR (<0.9 g/kg/day; HR 1.73, 95{\%} CI 1.42-2.10) but not with high nPCR (≥0.9 g/kg/day; HR 0.99, 95{\%} CI 0.74-1.33). Conclusions SUA may be a nutritional marker in HD patients. Contrary to the general population, low but not high SUA is associated with higher all-cause mortality in HD patients, especially in those with low protein intake. Nutritional features of SUA warrant additional studies.",
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AU - Obi, Yoshitsugu

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AU - Rhee, Connie M.

AU - Catabay, Christina J.

AU - Vaziri, Nosratola D.

AU - Kovesdy, Csaba

AU - Kalantar-Zadeh, Kamyar

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N2 - Background The association between serum uric acid (SUA) and mortality has been conflicting among studies using hemodialysis (HD) patients. Given the close link between purine and protein in foods, we hypothesized that normalized protein catabolic rate (nPCR), a dietary protein intake surrogate, modifies the SUA-mortality association in the HD population. Methods We identified 4298 patients who initiated HD and had one or more SUA measurement in a contemporary cohort of HD patients over 5 years (1 January 2007-31 December 2011), and examined survival probability according to the first uric acid measurement, adjusting for dialysis vintage, case-mix and malnutrition-inflammation complex-related variables. Results Mean SUA concentration was 6.6 ± 1.8 mg/dL. There was a consistent association of higher SUA with better nutritional status and lower all-cause mortality irrespective of adjusted models (P trend < 0.001). In the case-mix adjusted model, the highest SUA category (≥8.0 mg/dL) compared with the reference group (>6.0-7.0 mg/dL) showed no significant mortality risk [hazard ratio (HR) 0.90, 95% confidence interval (CI) 0.72-1.13], while the lowest category (<5.0 mg/dL) was associated with higher mortality (HR 1.42, 95% CI 1.16-1.72). The hypouricemia-mortality association was significantly modified by nPCR (P interaction = 0.001). Mortality risk of low SUA (<5.0 mg/dL) persisted among patients with low nPCR (<0.9 g/kg/day; HR 1.73, 95% CI 1.42-2.10) but not with high nPCR (≥0.9 g/kg/day; HR 0.99, 95% CI 0.74-1.33). Conclusions SUA may be a nutritional marker in HD patients. Contrary to the general population, low but not high SUA is associated with higher all-cause mortality in HD patients, especially in those with low protein intake. Nutritional features of SUA warrant additional studies.

AB - Background The association between serum uric acid (SUA) and mortality has been conflicting among studies using hemodialysis (HD) patients. Given the close link between purine and protein in foods, we hypothesized that normalized protein catabolic rate (nPCR), a dietary protein intake surrogate, modifies the SUA-mortality association in the HD population. Methods We identified 4298 patients who initiated HD and had one or more SUA measurement in a contemporary cohort of HD patients over 5 years (1 January 2007-31 December 2011), and examined survival probability according to the first uric acid measurement, adjusting for dialysis vintage, case-mix and malnutrition-inflammation complex-related variables. Results Mean SUA concentration was 6.6 ± 1.8 mg/dL. There was a consistent association of higher SUA with better nutritional status and lower all-cause mortality irrespective of adjusted models (P trend < 0.001). In the case-mix adjusted model, the highest SUA category (≥8.0 mg/dL) compared with the reference group (>6.0-7.0 mg/dL) showed no significant mortality risk [hazard ratio (HR) 0.90, 95% confidence interval (CI) 0.72-1.13], while the lowest category (<5.0 mg/dL) was associated with higher mortality (HR 1.42, 95% CI 1.16-1.72). The hypouricemia-mortality association was significantly modified by nPCR (P interaction = 0.001). Mortality risk of low SUA (<5.0 mg/dL) persisted among patients with low nPCR (<0.9 g/kg/day; HR 1.73, 95% CI 1.42-2.10) but not with high nPCR (≥0.9 g/kg/day; HR 0.99, 95% CI 0.74-1.33). Conclusions SUA may be a nutritional marker in HD patients. Contrary to the general population, low but not high SUA is associated with higher all-cause mortality in HD patients, especially in those with low protein intake. Nutritional features of SUA warrant additional studies.

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