1
|
Yang Y, Qin X, Li Y, Yang S, Chen J, He Y, Huang Y, Lin Z, Li Y, Kong Y, Lu Y, Zhao Y, Wan Q, Wang Q, Huang S, Liu Y, Liu A, Liu F, Hou FF, Liang M. Relationship between Serum Uric Acid and Mortality Risk in Hemodialysis Patients: A Multicenter Prospective Cohort Study. Am J Nephrol 2020; 51:823-832. [PMID: 33070128 DOI: 10.1159/000509258] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 06/08/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Several studies have reported that low serum uric acid (SUA) levels are related to increased risk of mortality in maintenance hemodialysis (MHD) patients. However, the possible detrimental effects of high SUA on the mortality risk have not been well examined. Moreover, the possible effect modifiers for the SUA-mortality association have not been fully investigated. To address the aforementioned gap, we aimed to explore the nonlinear relationship between SUA levels and all-cause and cardiovascular disease (CVD) mortality risk, and to examine any possible effect modifiers in MHD patients. METHODS We conducted a multicenter, prospective cohort study among 1,018 MHD patients from 8 hemodialysis centers. The primary outcome was all-cause mortality, and the secondary outcomes were CVD mortality and non-CVD mortality. RESULTS The mean value for SUA in the total population was 8.5 ± 1.9 mg/dL. The lowest and highest quintiles of SUA were <7.0 and >10.1 mg/dL, respectively. Over a median follow-up of 45.6 months, 343 deaths were recorded, of which 202 (58.9%) were due to CVD. When SUA was assessed as quintiles, a significantly higher risk of all-cause mortality was found in patients in quintile 1 (<7.0 mg/dL; hazard ratio [HR], 1.33; 95% confidence interval [CI]: 1.02-1.73) or quintile 5 (≥10.1 mg/dL; HR, 1.47; 95% CI: 1.09-2.00), compared to those in quintiles 2-4 (7-10.1 mg/dL). Moreover, the U-shaped SUA-mortality association was mainly found in those with lower C-reactive protein levels (<3 compared with ≥3 mg/L; p for interaction = 0.018). Similar trends were found for CVD mortality and non-CVD mortality. CONCLUSION There was a U-shaped relationship between SUA levels and the risk of all-cause mortality, CVD mortality, and non-CVD mortality in MHD patients.
Collapse
Affiliation(s)
- Yaya Yang
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xianhui Qin
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yumin Li
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Shenglin Yang
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Junzhi Chen
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yanhuan He
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yan Huang
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zizhen Lin
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Youbao Li
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yaozhong Kong
- The First People's Hospital of Foshan, Foshan, China
| | - Yongxin Lu
- People's Hospital of Yuxi City, Yuxi, China
| | | | - Qijun Wan
- Shenzhen Second People's Hospital, Shenzhen, China
| | - Qi Wang
- Huadu District People's Hospital of Guangzhou, Guangzhou, China
| | - Sheng Huang
- Southern Medical University Affiliated Nanhai Hospital, Foshan, China
| | - Yan Liu
- Nephrology Department, Guangzhou Red Cross Hospital, Medical College of Jinan University, Guangzhou, China
| | - Aiqun Liu
- The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Fanna Liu
- Jinan University First Affiliated Hospital, Guangzhou, China
| | - Fan Fan Hou
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Min Liang
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China,
| |
Collapse
|
2
|
Wu L, Cai K, Luo Q, Wang L, Hong Y. Baseline Serum Magnesium Level and Its Variability in Maintenance Hemodialysis Patients: Associations with Mortality. Kidney Blood Press Res 2019; 44:222-232. [PMID: 30921805 DOI: 10.1159/000498957] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 01/04/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS The study aimed at investigating the impact of serum magnesium (Mg) baseline level and its variability on mortality in maintenance hemodialysis (MHD) patients. METHODS Eligible patients receiving regular MHD at Ningbo No. 2 Hospital between January 2009 and August 2016 were enrolled and follow-ups were conducted afterwards until death or transplantation. General information, laboratory results, and outcomes of subjects were collected. The relationship between baseline serum Mg level, its coefficient of variation (CV), and all-cause mortality and cardiovascular disease mortality were assessed, respectively. Subjects were divided into groups in 2 manners: by serum Mg level (lower Mg group: serum Mg <1.00 mmol/L, higher Mg group: serum Mg ≥1.00 mmol/L) and by serum Mg CV (high variation group: CV ≥0.149 mmol/L, middle variation group: 0.114 mmol/L ≤ CV < 0.149 mmol/L, and low variation group: CV <0.114 mmol/L). RESULTS 169 MHD patients were recruited in the study, with mean serum Mg 1.00 ± 0.18 mmol/L, average age 60.20 ± 15.64 years, and median dialysis duration 37.00 (18.30, 77.97) months. During the follow-up, 69 (40.83%) patients died, 24 (34.78%) of which died due to cardiovascular disease. Comparing the two groups, patients in the lower Mg group had a higher all-cause mortality (50.00 vs. 29.33%, p = 0.007). The multivariate Cox regression analysis suggested that lower Mg level was an independent factor for all-cause mortality as well as cardiovascular mortality (HR = 13.268, 95% CI 6.234-28.237, p < 0.001; HR = 12.702, 95% CI 3.737-43.174, p < 0.001, respectively). However, there were no significant statistical differences of all-cause and cardiovascular mortality among these three groups concerning Mg variation. And in the univariate and multivariate Cox regression analysis, serum magnesium CV was not the independent factor for all-cause mortality and cardiovascular mortality. CONCLUSIONS The lower baseline serum magnesium level was associated with all-cause and cardiovascular mortality in MHD patients. However, the variability of magnesium level was not independently associated with the risk of death and further studies need to be conducted.
Collapse
Affiliation(s)
- Lingping Wu
- Department of Nephrology, Ningbo No. 2 Hospital, School of Medicine, Ningbo University, Ningbo, China
| | - Kedan Cai
- Department of Nephrology, Ningbo No. 2 Hospital, School of Medicine, Ningbo University, Ningbo, China
| | - Qun Luo
- Department of Nephrology, Ningbo No. 2 Hospital, School of Medicine, Ningbo University, Ningbo, China,
| | - Lailiang Wang
- Department of Nephrology, Ningbo No. 2 Hospital, School of Medicine, Ningbo University, Ningbo, China
| | - Yue Hong
- Department of Nephrology, Ningbo No. 2 Hospital, School of Medicine, Ningbo University, Ningbo, China
| |
Collapse
|
3
|
Jeong JH, Wu PT, Kistler BM, Fitschen PJ, Biruete AG, Phillips SA, Ali MM, Fernhall B, Wilund KR. The presence and impact of diastolic dysfunction on physical function and body composition in hemodialysis patients. J Nephrol 2015; 28:739-47. [PMID: 25753450 PMCID: PMC10413439 DOI: 10.1007/s40620-015-0188-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 02/27/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Cardiovascular (CV) diseases are the main cause of death in maintenance hemodialysis (MHD) patients. Muscle wasting and physical function decline are common in MHD patients, and significantly impair their quality of life. These can result from abnormalities in cardiac function, which can be further worsened by physical deconditioning. Left ventricular diastolic function parameters were recently shown to be a better predictor of exercise capacity than systolic measures in patients with CV complications. But little is known about the relationship between cardiac function and physical function in MHD patients. METHODS In 82 MHD patients, left ventricular systolic dysfunction (LVSD) was assessed by ejection fraction and fractional shortening with echocardiography, and left ventricular diastolic dysfunction (LVDD) was assessed by pulse wave and tissue Doppler indices. Physical function was assessed by gait speed, performance on a shuttle walk test, and leg muscle strength. Dual-emission X-ray absorptiometry (DXA) was used to measure whole body lean mass (WBLM). RESULTS The prevalence of LVDD and LVSD was 48.8 and 12.2%, respectively. Gait speed, shuttle walk time, leg strength, and WBLM% were significantly higher in the group without LVDD than with LVDD (p < 0.05 for all). However, there was no significant difference in any measure of physical function or body composition between patients with and without LVSD. CONCLUSION These data suggest that LVDD is more closely related to physical function and body composition than LVSD in MHD patients, and hence that LVDD may be an important therapeutic target.
Collapse
Affiliation(s)
- Jin Hee Jeong
- University of Illinois at Urbana-Champaign, Kinesiology and Community Health, Urbana, IL, USA.
| | - Pei-Tzu Wu
- School of Nursing, University of California, Los Angeles, Los-Angeles, CA, USA
| | - Brandon Michael Kistler
- University of Illinois at Urbana-Champaign, Kinesiology and Community Health, Urbana, IL, USA
| | - Peter John Fitschen
- Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Annabel Guzman Biruete
- Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Shane Aaron Phillips
- University of Illinois at Chicago, Kinesiology, Nutrition, and Rehabilitation, Chicago, IL, USA
| | - Mohamed M Ali
- University of Illinois at Chicago, Kinesiology, Nutrition, and Rehabilitation, Chicago, IL, USA
| | - Bo Fernhall
- University of Illinois at Chicago, Kinesiology, Nutrition, and Rehabilitation, Chicago, IL, USA
| | - Kenneth Robert Wilund
- University of Illinois at Urbana-Champaign, Kinesiology and Community Health, Urbana, IL, USA
| |
Collapse
|