透析前血尿酸水平与腹膜透析患者全因死亡的相关性分析

Correlation of serum uric acid before dialysis and all-cause mortality in peritoneal dialysis patients

目的:探讨透析前尿酸(uric acid,UA)水平与慢性肾衰竭(chronic renal failure,CRF)腹膜透析(peritoneal dialysis,PD)患者全因死亡的相关性。方法:回顾性分析2001年1月1日至2017年12月31日厦门大学附属第一医院收治的以PD作为首选肾脏替代治疗的140例终末期肾病阶段(end stage renal disease,ESRD)患者的病例资料。根据UA水平的三分位间距将所有患者分为3组:低UA组(<387μmol/L,n=46)、中UA组(387~519μmol/L,n=44)和高UA组(≥519μmol/L,n=50)。比较3组全因死亡的风险比并采用Kaplan-Meier法绘制生存曲线。结果:UA每增加20μmol/L,全因死亡风险增加0.3%(HR=1.003,95%CI 1.00~1.005,P=0.019)。高UA组较低UA组的全因死亡率高,HR为2.3(95%CI 1.06~5.01,P=0.035),且透析3年内UA对死亡风险预测价值更高。结论:UA水平与PD患者全因死亡率正相关,透析前UA升高是全因死亡的独立危险因素,提示控制UA水平有助于延长PD患者生存时限。

Objective:To explore the correlation of serum uric acid(UA)level before dialysis and mortality in patients undergoing peritoneal dialysis.Methods:The clinical data of 140 patients with end-stage renal disease(ESRD)treated with PD as the first choice of renal replacement therapy in the First Affiliated Hospital of Xiamen University from January 1,2001 to December 31,2017 were retrospectively analyzed.The patients were divided into three groups based on the tertile of uric acid level:low UA group(<387μmol/L,n=46),middle UA group(387-519μmol/L,n=44)and high UA group(≥519μmol/L,n=50).The risk ratio of all-cause death was compared among the three groups,and the survival curve was drawn by the Kaplan-Meier method.Results:For every 20μmol/L increased in UA,the risk of all-cause death increased by 0.3%(HR=1.003,95%CI 1.00-1.005,P=0.019).The all-cause mortality in the high UA group was higher than that in the low UA group,HR was 2.3(95%CI 1.06-5.01,P=0.035),and the value of UA in predicting death risk within 3 years after dialysis was higher.Conclusions:UA may be positively correlated with all-cause mortality in patients undergoing maintenance peritoneal dialysis.The increase of baseline UA may be an independent risk factor for all-cause mortality in those patients indicating that control of the UA level may be helpful to prolong the survival time of patients undergoing peritoneal dialysis.