Effects Of Serum Uric Acid Level On All-cause Death And Cardiovascular Death In Patients Of Maintaining Peritoneal Dialysis

Objective:To retrospectively analyze the relationship between serum uric acid level and all-cause mortality and cardiovascular mortality in peritoneal dialysis patients at different stages(0-24 months),as well as the risk factors affecting the prognosis of PD patients,and to explore the optimal level of SUA in different stages of PD.Methods:Retrospective analysis maintenance PD patients in the First Affiliated Hospital of Medical College of Zhejiang University were included in the study.SUA?420?mol/L was defined as high uric acid(HUA)group and SUA<420?mol/L was defined as normal uric acid(UA)group.To analyze the trend of SUA during PD at different time,the effects of different SUA levels on all-cause mortality and cardiovascular mortality.Univariate and multivariate COX regression analysis and Sample mean-standard deviation classification was used.Results:1.In totle,1402 maintenance PD patients were enrolled.The median follow-up time of PD patients was 31(18,49)months.During the follow-up period,173(12.34%)patients occurred all-cause deaths,of which 68(4.85%)were cardiovascular deaths.2.The SUA level of patients during PD showed a downward trend overall,which decreased significantly in the first six months and then slowly.There was the statistically significant difference between the SUA level and baseline in the sixth month,and between the 24-month SUA and the 6-month SUA.COX regression analysis showed that HUA(HR=1.440)was an independent risk factor for all-cause mortality at 6 months of PD,and HUA(HR=0.565)was a protective factor for all-cause mortality at 24 months of PD.There was no statistically significant correlation between HUA and all-cause mortality at the rest of time.At 6 months of PD,HUA(HR=1.672)was an independent risk factor for cardiovascular mortality.There was no significant correlation between HUA and cardiovascular mortality in the rest of the time.3.The all-cause mortality in HUA group after 6 months of PD were higher than those in normal UA group,and there was statistically significant difference(P=0.023).The cardiovascular mortality in HUA group after 6 months of PD were higher than those in normal UA group,and there was no statistically significant difference(P=0.054).HUA(HR=1.440),elder(HR=1.058),hyperglycemia(HR=1.128)and high Charlson Comorbidity Index(HR=1.249)were independent risk factors for all-cause mortality.High albumin(HR=0.958)and high residual renal creatinine clearance rate(Ccr)at 6 months of PD(HR=0.991)were protective factors for all-cause mortality.HUA at 6 months of PD(HR=1.672),elder(HR=1.035),hyperglycemia(HR=1.163)and high Charlson's Complication Index(HR=1.323)were independent risk factors for cardiovascular mortality in patients.High residual renal creatinine clearance rate(HR=0.983)at 6 months of PD was the protective factor for cardiovascular disease.4.SUA in Grade 2(336?mol/L<SUA<424?mol/L)at 6 months after PD had the highest cumulative survival rate,which was significantly different from Grade 3(424?mol/L<SUA<512?mol/L)(x2=7.095,P=0.008)and Grade 4(SUA>512 pmol/L)(x2=9.105,P=0.003)when analysising the all-cause mortality.SUA in Grade 2(336 ?mol/L<SUA<424 ?mol/L)at 6 months after PD had the highest cumulative survival rate,which was significantly different from Grade3(424?mol/L?SUA?512?mol/L)(x2=7.547,P=0.006)when analysising cardiovascular mortality.5.SUA in Grade 3(413 ?mol/L<SUA<488 ?unol/L)at 6 months after PD had the highest cumulative survival rate,which was significantly different from Grade 2(338 ?mol/L<SUA<413 ?mol/L)(x2=6.700,P=0.010)and Grade4(SUA>488?mol/L)(x2=4.978,P=0.026)when analysising the all-cause mortality.There was no significant difference in the cumulative survival rate of cardiovascular mortality among the groups classified by SUA at 6 months after PD.Conclusion:The SUA level in the patients showed a downward trend during PD.HU A at 6 months of PD was an independent risk factor for all-cause mortality and cardiovascular mortality.HUA at 24 months of PD was a protective factor for the patients.Excessive or low uric acid level during PD was not conducive to reducing mortality.The optimal target value of uric acid level should be determined by comprehensive evaluation of PD time and nutritional status.