Mortality Predictive Role of Serum Uric Acid in Diabetic Hemodialysis Patients

Objectives: It is controversial to what extent serum uric acid (SUA) is associated with mortality in patients with chronic kidney disease undergoing hemodialysis (HD). We analyzed the predictive role of SUA in the mortality of diabetic and nondiabetic chronic kidney disease patients starting on maintenance HD therapy. Design and Subjects: SUA was measured at the initiation of HD therapy in 319 patients (137 females and 193 diabetic patients) with mean age of 60 +/- 14 years and mean estimated glomerular filtration rate of 7.5 +/- 3.8 mL/min/1.73 m(2). The patients were divided into 2 groups, hyperuricemia (HUA; n=165) and non-HUA (n=154) groups based on laboratory limit for normal SUA. Mortality was recorded during 31.5 +/- 24.8 months. Results: Among the 193 diabetic patients, but not among the whole group of 319 patients, survival was significantly lower in HUA than in non-HUA patients. Among diabetic patients 2-year patient survival was worse in patients with HUA and cardiovascular disease (CVD; 52.3%; n=30) than in non-HUA patients with CVD (81.1%; n=36), HUA without CVD (88.6%; n=62), and non-HUA without CVD (93.9%; n=65). Cox analysis in all 319 patients showed that, old age, CVD, other comorbidity, and low serum albumin but not high SUA predicted mortality. Among diabetic patients, predictors of increased mortality risk were old age, CVD, other comorbidity but also high SUA with adjusted hazard ratio of 1.12 (95% confidence interval 1.02-1.22) per 1 mg/dL increase in SUA. In diabetic patients with HUA and CVD, adjusted hazard ratio for mortality was 5.98 times that of diabetic non-HUA patients without CVD. Conclusions: High SUA is associated with poor survival in diabetic patients undergoing HD but not in nondiabetic patients undergoing HD. High SUA was found to be a risk marker especially in diabetic HD patients with concurrent CVD. (C) 2014 by the National Kidney Foundation, Inc. All rights reserved.