The relationship between uric acid concentration and cardiovascular risk: Retrospective analysis of patients on hemodialysis

Abstract

Literature data indicate that increased uric acid (UA) levels are an important risk factor for cardiovascular disease. The aim of this study was to examine the association of UA with cardiovascular risk factors in patients with hemodialysis using retrospective analysis. In 110 patients, we studied the values of basic renal function parameters, bone metabolism and cardiovascular risk factors in the period from 2010 to 2017. The results indicate a significant increase in urea (P=0.004), creatinine (P=0.028) and inorganic phosphate (P=0.001), as well as significant differences in gender (P=0.013), in risk categories defined on the basis of the UA decision limit (cut off <350 μmol/L). After controlling the effects of most parameters, statistically significant correlation coefficients were obtained for UA and urea (r=0.361; P=0.0013), creatinine (r=0.388; P=0.0005) and inorganic phosphate (r=0.366; P=0.0011). Significant regression coefficients were obtained for UA and male gender (β=-0.227, P=0.004), age (β=-0.298, P˂0.001), urea (β=0.271, P=0.005) and inorganic phosphate (β=0.232, P=0.009). The predictive value of independent parameters in relation to UA was confirmed for male gender (OR=3.595; 95% CI: 1.421-9.094; P=0.007) and inorganic phosphate (OR=14.842; 2.518-87.472, P=0.003). By Cox regression analysis of proportional hazard ratio, we obtained the most significant combined effect of the body mass index, dialysis and diastolic pressure on UA concentration in relation to the duration of hemodialysis (P <0.0001). The results of this long-term study suggest that UA can not be considered an independent cardiovascular risk factor, but that HD patients need to strategically control the level of MK in order to reduce the resulting complications, morbidity and mortality.

Literaturni podaci ukazuju da povećana koncentracija mokraćne kiseline (MK) predstavlja značajan faktor rizika za kardiovaskularne bolesti. Cilj ove studije bio je da se retrospektivnom analizom ispita povezanost MK sa faktorima rizika za kardiovaskularne bolesti kod bolesnika na hemodijalizi. Za 110 bolesnika analizirane su vrednosti osnovnih parametara funkcije bubrega, metabolizma kostiju i faktora rizika za kardiovaskularne bolesti u periodu od 2010. do 2017. godine. Rezultati ukazuju na značajno povećanje koncentracije uree (P=0,004), kreatinina (P=0,028) i neorganskog fosfata (P˂0,001), kao i značajne razlike u zavisnosti od pola (P=0,013) u kategorijama rizika definisanim na osnovu granične koncentracije MK (cut off <350 μmol/L). Nakon kontrolisanja efekta većine parametara, statistički značajne vrednosti koeficijenata korelacije dobijene su za MK i ureu (r=0,361; P=0,0013), kreatinin (r=0,388; P=0,0005) i neorganski fosfat (r=0,366; P=0,0011). Značajni regresioni koeficijenti su dobijeni za MK i muški pol (β=-0,227, P=0,004), godine starosti (β=-0,298, P˂0,001), ureu (β=0,271, P=0,005) i neorganski fosfat (β=0,232, P=0,009). Prediktivna vrednost nezavisnih parametara u odnosu na MK je potvrđena za muški pol (OR=3,595; 95% CI: 1,421-9,094; P=0,007) i neorganski fosfat (OR=14,842; 95% CI: 2,518-87,472, P=0,003). Cox-ovom regresijom proporcionalnih nepoželjnih ishoda dobijen je najznačajniji udruženi efekat indeksa telesne mase i adekvatnosti dijalize na koncentraciju MK u odnosu na dužinu trajanja hemodijalize (P<0,0001). Rezultati ove dugoročne studije ukazuju da se MK ne može smatrati nezavisnim faktorom rizika za kardiovaskularne bolesti, ali da je kod bolesnika na HD, potrebno strateški kontrolisati nivo MK u cilju smanjenja posledičnih komplikacija, morbiditeta i mortaliteta.