Plasma creatine kinase and all-cause mortality in patients on peritoneal dialysis: a multi-center retrospective study

Abstract Background: Higher plasma creatine kinase (CK) values are associated with the failure of antihypertensive treatment. However, an association between CK and all-cause mortality in peritoneal dialysis (PD) patients has received little attention.Methods: In this retrospective multicenter study, 2224 incident PD patients with baseline CK values were enrolled from November 1, 2005, to February 28, 2017. All patients with oral statins were excluded and then were divided into four groups [Quartile 1 (<60 U/L), Quartile 2 (60-100 U/L), Quartile 3 (101-179 U/L), and Quartile 4 (>179 U/L)]. The primary endpoint was all-cause mortality. The association between plasma CK values and all-cause mortality was assessed with Cox regression and the Fine and Gray models.Results: Of eligible 1382 patients, 298 (21.6%) patients died during a median 35-month (interquartile range=19-54 months) follow-up period. Patients in Quartile 4 were older (P<0.001), more likely to be male (P<0.001), had a higher prevalence of diabetes (P=0.002), and a history of cardiovascular disease (P=0.005), and higher values of Charlson comorbidity index (P=0.031). All-cause mortality incidence had a significant difference among the four Quartiles (Quartile 1, 16.2%; Quartile 2, 22.2%; Quartile 3, 23.8%; Quartile 4, 24.1%; P=0.043). Quartile 4 had a higher all-cause mortality compared to other groups (Log Rank=10.55, P=0.015). After adjusting for confounding factors, the highest CK quartile had a hazard ratio (HR) for all-cause mortality of 1.72 [95% confidence interval (CI) 1.31-3.26, P=0.042]. With kidney transplantation or hemodialysis as a competing risk, the Quartile 4 had an HR for all-cause mortality of 1.64 (95%CI 1.25-3.48, P=0.046), after adjusting for confounding factors. Conclusions: Higher plasma CK levels at the commencement of PD may be a valuable biomarker for predicting the development of all-cause mortality in PD patients.

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Plasma creatine kinase and all-cause mortality in patients on peritoneal dialysis: a multi-center retrospective study

10.21203/rs.2.20630/v1 ◽

2020 ◽

Author(s):

Yueqiang Wen ◽

FenFen Peng ◽

Xiaoran Feng ◽

Niansong Wang ◽

Xiaojiang Zhan ◽

...

Keyword(s):

Creatine Kinase ◽

Peritoneal Dialysis ◽

Cox Regression ◽

Significant Difference ◽

All Cause Mortality ◽

Mortality Incidence ◽

History Of ◽

Comorbidity Index ◽

Plasma Creatine Kinase

Abstract Background Higher plasma creatine kinase (CK) values are associated with the failure of antihypertensive treatment. However, an association between CK and all-cause mortality in peritoneal dialysis (PD) patients has received little attention.Methods In this retrospective multicenter study, 1382 incident PD patients with baseline CK values were enrolled from November 1, 2005, to February 28, 2017. All patients with oral statins were excluded and then were divided into four groups according to quartile range [Quartile 1 (<60 U/L), Quartile 2 (60-100 U/L), Quartile 3 (101-179 U/L), and Quartile 4 (>179 U/L)]. The primary endpoint was all-cause mortality. The association between plasma CK values and all-cause mortality was assessed with Cox regression and the Fine and Gray models.Results Of 1382 patients 298 (21.6%) patients died during a median 35-month (interquartile range=19-54 months) follow-up period. Patients in Quartile 4 were older (P<0.001), likely to be male (P<0.001), had a higher prevalence of diabetes (P=0.002), and a history of cardiovascular disease (P=0.005), and higher values of Charlson comorbidity index (P=0.031). All-cause mortality incidence was a significant difference among the four Quartiles (Quartile 1, 16.2%; Quartile 2, 22.2%; Quartile 3, 23.8%; Quartile 4, 24.1%; P=0.043). Cumulative all-cause mortality in the Quartile 4 was significantly higher compared with other groups (Log Rank=10.55, P=0.015). After adjusting for confounding factors, the highest CK quartile had a hazard ratio (HR) for all-cause mortality of 1.75 [95% confidence interval (CI) 1.34-3.20, P=0.041]. With kidney transplantation or hemodialysis as a competing risk, the Quartile 4 had an HR for all-cause mortality of 1.66 (95%CI 1.30-3.41, P=0.044), after adjusting for confounding factors.Conclusions Higher plasma CK levels at the commencement of PD may be a valuable biomarker for predicting the development of all-cause mortality in PD patients.

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Improved renal allograft survival for pre-emptive paediatric renal transplant recipients in the UK

Archives of Disease in Childhood ◽

10.1136/archdischild-2020-321277 ◽

2021 ◽

pp. archdischild-2020-321277

Author(s):

Matko Marlais ◽

Kate Martin ◽

Stephen D Marks

Keyword(s):

Peritoneal Dialysis ◽

Renal Transplant ◽

Renal Allograft ◽

Cox Regression ◽

Renal Transplant Recipients ◽

Transplant Recipients ◽

Allograft Survival ◽

Significant Difference ◽

Donor Type ◽

The Uk

BackgroundThe aim of this study was to investigate whether being on dialysis at the time of renal transplantation affected renal allograft survival in paediatric renal transplant recipients (pRTRs).MethodsRetrospective study of UK Transplant Registry (National Health Service Blood and Transplant) data on all children (aged <18 years) receiving a kidney-only transplant from 1 January 2000 to 31 December 2015. Kaplan-Meier estimates of patient and renal allograft survival calculated and Cox regression modelling accounting for donor type. The relationship between time on dialysis and renal allograft survival was examined.Results2038 pRTRs were analysed: 607 (30%) were pre-emptively transplanted, 789 (39%) and 642 (32%) on peritoneal dialysis and haemodialysis, respectively, at the time of transplantation. Five-year renal allograft survival was significantly better in the pre-emptively transplanted group (90.6%) compared with those on peritoneal dialysis and haemodialysis (86.4% and 85.7%, respectively; p=0.02). After accounting for donor type, there was a significantly lower hazard of 5-year renal allograft failure in pre-emptively transplanted children (HR 0.742, p=0.05). Time spent on dialysis pre-transplant negatively correlated with renal allograft survival (p=0.002). There was no significant difference in 5-year renal allograft survival between children who were on dialysis for less than 6 months and children transplanted pre-emptively (87.5% vs 90.5%, p=0.25).ConclusionsPre-emptively transplanted children have improved 5-year renal allograft survival, compared with children on dialysis at the time of transplantation. Although increased time spent on dialysis correlated with poorer renal allograft survival, there was no evidence that short periods of dialysis pre-transplant affected renal allograft survival.

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Factors affecting progression to permanent atrial fibrillation in an unselected population of patients with non-permanent form of atrial fibrillation

European Heart Journal ◽

10.1093/ehjci/ehaa946.0481 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

V.L Malavasi ◽

E Fantecchi ◽

V Tordoni ◽

L Melara ◽

A Barbieri ◽

...

Keyword(s):

Atrial Fibrillation ◽

Cox Regression ◽

Area Under The Curve ◽

Roc Curves ◽

Factors Affecting ◽

Cox Proportional Hazard ◽

Significant Difference ◽

History Of ◽

Unselected Population ◽

Cox Proportional Hazard Regression

Abstract Background Natural history of atrial fibrillation (AF) shows a progression of arrhythmia from non-permanent to permanent AF. Permanent AF was found associated with a worse prognosis than non-permanent one. Aim To assess the factors associated with progression to permanent AF in an unselected population of AF patients with non-permanent AF. Methods In this prospective study we enrolled in- as well as out-patients with non-permanent AF and age ≥18 years, with at least one episode of ECG-documented AF within 1 year. The patients were followed-up at 1 month and every 6 months thereafter. Results Out of 523 patients, 314 (60%) were in non-permanent AF (80 [25.5%] paroxysmal AF, 165 [52.5%] persistent AF, 69 [2%] first diagnosed AF), mostly male (188, 59.9%), median age 71 years (IQ range 62–77), median CHA2DS2VASc 3 (1–4), median HATCH score 1 (1–2). After a median follow-up of 701 (IQ range 437–902) days, 66 patients (21%) showed permanent AF. CHA2DS2VASc and HATCH scores were incrementally associated to progression to permanent AF (CHA2DS2VASc χ2 p=0.001; HATCH χ2 p=0.017; p for trend CHA2DS2VASc <0.001, HATCH p=0.001). At multivariable Cox proportional hazard regression the following variables were significantly associated with AF progression: age (hazard ratio [HR] 1.041; 95% CI: 1.004–1.079; p=0.028), at least moderate left atrial (LA) enlargement (>42 ml/m2) (HR 2.092; 95% CI: 1.132–3.866; p=0.018), antiarrhythmics drugs after the enrollment (HR 0.087; 95% CI: 0.011–0.662; p=0.018), EHRA score >2 (HR 0.351; 95% CI: 0.158–0.779; p=0.010) and Valvular HD (HR 2.161; 95% CI: 1.057–4.420; p=0.035). Adding LA dilation to HATCH score (HATCH-LA) and assigning 2 points based on multivariable Cox regression, HATCH-LA was statistically better in ROC curves in prediction of AF progression vs HATCH score (area under the curve 0.695 vs 0.636; DeLong p=0.0225). Survival-free curves on freedom from permanent AF using as discriminator HATCH-LA score ≤2 vs >2 led to a statistically significant difference (χ2=16.080 p<0.001), but the same was not found for HATCH score (χ2 =3.099; p=0.078). Conclusions In patients without permanent AF, progression of AF was independentely related to age, LA dilation, AF symptoms severity, antiarrhythmic drugs and Valvular HD. HATCH score predicted AF progression and adding to it LA dilation (at least moderate) improved patients stratification for the risk of evolution to permanent AF. Funding Acknowledgement Type of funding source: None

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Creatine kinase is associated with bleeding after myocardial infarction

Open Heart ◽

10.1136/openhrt-2020-001261 ◽

2020 ◽

Vol 7 (2) ◽

pp. e001261 ◽

Cited By ~ 4

Author(s):

Lizzy Maritza Brewster ◽

Jim Fernand

Keyword(s):

Myocardial Infarction ◽

Creatine Kinase ◽

Regression Analysis ◽

Platelet Activation ◽

Peak Plasma ◽

Tissue Type ◽

Type Plasminogen Activator ◽

Fatal Bleeding ◽

All Cause Mortality ◽

History Of

BackgroundThe ADP-scavenging enzyme creatine kinase (CK) is reported to reduce ADP-dependent platelet activation. Therefore, we studied whether highly elevated CK after ST-elevation myocardial infarction (STEMI) is associated with bleeding.MethodsData of the Thrombolysis in Myocardial Infarction Study Group phase II trial on the efficacy of angioplasty, following intravenous recombinant tissue-type plasminogen activator (rt-PA), are used to assess whether peak plasma CK (CKmax) is independently associated with adjudicated fatal or non-fatal bleeding (primary) and combined bleeding/all-cause mortality (secondary) in multivariable binomial logistic regression analysis, adjusting for baseline and treatment allocation covariates.ResultsThe included patients (n=3339, 82% men, 88% white, mean age 57 years, SE 0.2) had a history of angina pectoris (55%), hypertension (38%) and/or diabetes mellitus (13%). CKmax ranged from 16 to 55 890 IU/L (mean 2389 IU/L, SE 41), reached within 8 hours in 51% of the patients (93% within 24 hours). Adjudicated fatal/non-fatal bleeding occurred in 30% of the patients (respectively 26% in the low vs 34% in the high CK tertile), and bleeding/all-cause mortality in 35% (29% in the low vs 40% in the high CK tertile). In multivariable regression analysis, the adjusted OR for fatal/non-fatal bleeding (vs not bleeding and survival) was 2.6 (95% CI 1.8 to 3.7)/log CKmax increase, and 3.1 (2.2 to 4.4) for bleeding/all-cause mortality.ConclusionHighly elevated plasma CK after myocardial infarction might be an independent predictor of bleeding and haemorrhagic death. This biologically plausible association warrants further prospective study of the potential role of extracellular CK in ADP-dependent platelet activation and bleeding.

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P4792Dabigatran versus vitamin K antagonists in patients with atrial fibrillation and valvular heart disease

European Heart Journal ◽

10.1093/eurheartj/ehz745.1168 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

J E Strange ◽

C Sindet-Pedersen ◽

L Staerk ◽

E L Grove ◽

T A Gerds ◽

...

Keyword(s):

Atrial Fibrillation ◽

Heart Disease ◽

Vitamin K ◽

Valvular Heart Disease ◽

Cox Regression ◽

Absolute Risk ◽

Risk Difference ◽

Increased Risk ◽

Significant Difference ◽

All Cause Mortality

Abstract Background Atrial fibrillation (AF) and valvular heart disease (VHD) are both associated with an increased risk of stroke. Outside post-hoc analyses of randomized controlled trials, knowledge on the effectiveness and safety of dabigatran in patients with AF and VHD is scarce. Objectives To compare the risk of all-cause mortality, stroke, and bleeding in patients with AF and VHD treated with dabigatran or a vitamin K antagonist (VKA). Methods All Danish residents are provided a unique personal identification number enabling cross-linking of data from Danish nationwide registries. We identified all patients with AF and VHD initiating treatment with dabigatran or VKA between the 22nd of August 2011 and the 31st of December 2014. We defined VHD as aortic stenosis/regurgitation, mitral regurgitation, bioprosthetic heart valves, mitral-, and aortic valve repair. Outcomes were all-cause mortality, stroke, and bleeding. 2-year standardized absolute risks were calculated from cause-specific Cox regression models with death as competing risk. Results In total, 599 (27.3%) and 1,596 (72.7%) patients initiated treatment with dabigatran and VKA. The 2-year standardized absolute risk of all-cause mortality (95% CI) for VKA was 27.6% (25.1% to 30.1%) and 25.4% (21.8% to 29.0%) for dabigatran with a corresponding absolute risk difference of −2.2% (−6.3% to 1.9%) (Figure 1). The 2-year standardized absolute risk of stroke for VKA was 3.4% (2.3% to 4.5%) and 3.9% (2.2% to 5.5%) for dabigatran with a corresponding absolute risk difference of 0.5% (−1.6% to 2.5%). Lastly, the 2-year standardized absolute risk of bleeding for VKA was 8.2% (6.6% to 9.7%) and 7.6% (5.1% to 10.1%) for dabigatran with a corresponding absolute risk difference of −0.5% (−3.4% to 2.4%). Figure 1 Conclusions In this nationwide cohort study, we found no significant difference in the risk of all-cause mortality, stroke, or bleeding in patients with AF and VHD when comparing VKA to dabigatran.

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Serum magnesium and cardiovascular mortality in peritoneal dialysis patients: a 5-year prospective cohort study

British Journal Of Nutrition ◽

10.1017/s0007114518001599 ◽

2018 ◽

Vol 120 (4) ◽

pp. 415-423 ◽

Cited By ~ 4

Author(s):

Hongjian Ye ◽

Peiyi Cao ◽

Xiaodan Zhang ◽

Jianxiong Lin ◽

Qunying Guo ◽

...

Keyword(s):

Cohort Study ◽

Peritoneal Dialysis ◽

Prospective Cohort Study ◽

Cardiovascular Mortality ◽

Prospective Cohort ◽

Cox Regression ◽

Serum Magnesium ◽

Study Endpoint ◽

Lower Serum ◽

All Cause Mortality

AbstractThe aim of this study was to explore the association between serum Mg and cardiovascular mortality in the peritoneal dialysis (PD) population. This prospective cohort study included prevalent PD patients from a single centre. The primary outcome of this study was cardiovascular mortality. Serum Mg was assessed at baseline. A total of 402 patients (57 % male; mean age 49·3±14·9 years) were included. After a median of 49·9 months (interquartile range: 25·9–68·3) of follow-up, sixty-two patients (25·4 %) died of CVD. After adjustment for conventional confounders in multivariate Cox regression models, being in the lower quartile for serum Mg level was independently associated with a higher risk of cardiovascular mortality, with hazards ratios of 2·28 (95 % CI 1·04, 5·01), 1·41 (95 % CI 0·63, 3·16) and 1·62 (95 % CI 0·75, 3·51) for the lowest, second and third quartiles, respectively. A similar trend was observed when all-cause mortality was used as the study endpoint. Further analysis showed that the relationships between lower serum Mg and higher risk of cardiovascular and all-cause mortality were present only in the female subgroup, and not among male patients. The test for interaction indicated that the associations between lower serum Mg and cardiovascular and all-cause mortality differed by sex (P=0·008 andP=0·011, respectively). In conclusion, lower serum Mg was associated with a higher risk of cardiovascular and all-cause mortality in the PD population, especially among female patients.

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Readmissions for Depression and Suicide Attempt following Stroke and Myocardial Infarction

Cerebrovascular Diseases Extra ◽

10.1159/000509454 ◽

2020 ◽

Vol 10 (2) ◽

pp. 94-104

Author(s):

Laura K. Stein ◽

Alana Kornspun ◽

John Erdman ◽

Mandip S. Dhamoon

Keyword(s):

Myocardial Infarction ◽

Suicide Attempt ◽

Cox Regression ◽

Vascular Events ◽

Discharge Home ◽

Increased Risk ◽

Significant Difference ◽

History Of ◽

Nationally Representative ◽

History Of Depression

Background and Purpose: Rates of depression after ischemic stroke (IS) and myocardial infarction (MI) are significantly higher than in the general population and associated with morbidity and mortality. There is a lack of nationally representative data comparing depression and suicide attempt (SA) after these distinct ischemic vascular events. Methods: The 2013 Nationwide Readmissions Database contains >14 million US admissions for all payers and the uninsured. Using International Classification of Disease, 9th Revision, Clinical Modification Codes, we identified index admission with IS (n = 434,495) or MI (n = 539,550) and readmission for depression or SA. We calculated weighted frequencies of readmission. We performed adjusted Cox regression to calculate hazard ratio (HR) for readmission for depression and SA up to 1 year following IS versus MI. Analyses were stratified by discharge home versus elsewhere. Results: Weighted depression readmission rates were higher at 30, 60, and 90 days in patients with IS versus MI (0.04%, 0.09%, 0.12% vs. 0.03%, 0.05%, 0.07%, respectively). There was no significant difference in SA readmissions between groups. The adjusted HR for readmission due to depression was 1.49 for IS versus MI (95% CI 1.25–1.79, p < 0.0001). History of depression (HR 3.70 [3.07–4.46]), alcoholism (2.04 [1.34–3.09]), and smoking (1.38 [1.15–1.64]) were associated with increased risk of depression readmission. Age >70 years (0.46 [0.37–0.56]) and discharge home (0.69 [0.57–0.83]) were associated with reduced hazards of readmission due to depression. Conclusions: IS was associated with greater hazard of readmission due to depression compared to MI. Patients with a history of depression, smoking, and alcoholism were more likely to be readmitted with depression, while advanced age and discharge home were protective. It is unclear to what extent differences in type of ischemic tissue damage and disability contribute, and further investigation is warranted.

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Distribution and association of cancer with mortality in end-stage renal disease patients receiving dialysis

Journal of Nephrology ◽

10.1007/s40620-019-00649-4 ◽

2019 ◽

Vol 32 (6) ◽

pp. 1003-1009

Author(s):

Rajkumar Chinnadurai ◽

Emma Flanagan ◽

Philip A. Kalra

Keyword(s):

Cox Regression ◽

Matched Sample ◽

Cancer History ◽

Cancer Group ◽

All Cause Mortality ◽

History Of ◽

Stage Renal Disease ◽

End Stage ◽

Esrd Patients

Abstract Background and aims Cancer in end-stage renal disease (ESRD) patients is an important comorbidity to be taken into consideration while planning for renal replacement therapy (RRT) options due to its associated increased mortality. This study aims to investigate the natural history and association of cancer with all-cause mortality in an ESRD population receiving dialysis. Method The study was conducted on 1271 ESRD patients receiving dialysis between January 2012 and December 2017. A comparative analysis was carried out between 119 patients with and 1152 without cancer history at entry into this study (baseline). A 1:2 (119 cancer: 238 no cancer) propensity score matched sample of 357 patients was also used for analysis. Cox-regression analysis was used to study the strength of the association between cancer and all-cause mortality. Kaplan–Meier (KM) analysis was used to demonstrate the difference in cumulative survival between the groups. A competing risk analysis was also carried out to calculate the probability of competing events (death, transplant and incident cancer). Results At baseline, 10.1% of the cohort had a history of cancer (current and past) with the annual incident rate being 1.3%. Urological cancers were the leading site of cancer. The median age of our cohort was 63 years with a predominance of males (63%) and Caucasians (79%). The majority (69%) of the cohort were receiving haemodialysis. 47% had a history of diabetes with 88% being hypertensive. During a median follow-up of 28 months, the proportion of deaths observed was similar between the groups in the matched sample (cancer 49.6 versus no-cancer 52.1%, p value 0.77). In a univariable Cox-regression model, there was no significant association between cancer and all-cause mortality (HR 1.28; 95% CI 0.97–1.67; p = 0.07). The KM estimates showed similar observations in the cumulative survival between the groups (matched sample log-rank, p value 0.85). In competing risk analysis, the cumulative probability of death at 5 years was non-significantly higher in the cancer group (cancer group 64% vs no cancer group 51%, p value 0.16). Conclusions In our real-world multi-morbid dialysis cohort of 119 cancer patients, baseline cancer history did not prove to be an independent risk factor for all-cause mortality in the first 5 years of follow-up, suggesting the need for a case-by-case approach in provision of RRT options, including transplantation.

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Comparison of lean mass indices as predictors of mortality in incident peritoneal dialysis patients

PLoS ONE ◽

10.1371/journal.pone.0254942 ◽

2021 ◽

Vol 16 (7) ◽

pp. e0254942

Author(s):

Seok Hui Kang ◽

A. Young Kim ◽

Jun Young Do

Keyword(s):

Peritoneal Dialysis ◽

Lean Mass ◽

Operating Characteristic ◽

Cox Regression ◽

Statistical Significance ◽

Characteristic Curve ◽

Lower Extremities ◽

Reactive Protein ◽

All Cause Mortality ◽

Upper And Lower Extremities

Background Few studies have considered optimal adjusted lean mass indices for prediction of clinical outcomes in peritoneal dialysis (PD) patients. We aimed to evaluate clinical variables using various adjusted indices in PD patients. Methods Total 528 incident PD patients were included. Lean mass was measured using dual energy X-ray absorptiometry. Appendicular lean mass (ALM) was calculated using the sum for both upper and lower extremities. Each ALM index was calculated using ALM per body weight (ALM/BW), height squared (ALM/Ht2), or body mass index (ALM/BMI). Limb/trunk lean mass (LTLM) ratio was defined as the sum for both upper and lower extremities divided by trunk lean mass. Results A total of 528 patients were analyzed men: 286, women: 242. In area under the receiver operating characteristic curve analyses, LTLM alone was associated with 1 year mortality. In the LTLM ratio, the cut-off value for 1-year mortality was ≤ 0.829 in men and ≤ 0.717 in women, respectively. In both sexes, LTLM ratio alone showed statistical significance in all-cause mortality in both univariate and multivariate Cox-regression analyses. Compared with other indices, the LTLM ratio was independent of edema and fat in both sexes. Edema- and C-reactive protein-adjusted correlation analysis showed that LTLM ratio alone was associated with serum albumin in men. Although statistical significance was not obtained for women, the correlation coefficient was highest for the LTLM ratio compared with other indices. Conclusion Among various indices using lean mass, LTLM ratio was independent of volume status and fat mass and was associated with mortality in incident PD patients.

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The Significance of Follow-Up Serum Uric Acid Levels in Predicting All-Cause Mortality and Cardiovascular Mortality in Peritoneal Dialysis Patients

10.21203/rs.3.rs-146953/v1 ◽

2021 ◽

Author(s):

Pingping Ren ◽

Qilong Zhang ◽

Yixuan Pan ◽

Yi Liu ◽

Chenglin Li ◽

...

Keyword(s):

Uric Acid ◽

Peritoneal Dialysis ◽

Serum Uric Acid ◽

Cardiovascular Mortality ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Kaplan Meier ◽

Significant Difference ◽

All Cause Mortality

Abstract Background: Studies on the correlation between serum uric acid (SUA) and all-cause mortality in peritoneal dialysis (PD) patients were mainly based on the results of baseline SUA. We aimed to analyze the change of SUA level post PD, and the correlation between follow-up SUA and prognosis in PD patients. Methods: All patients who received PD catheterization and maintaining PD in our center from March 2, 2001 to March 8, 2017 were screened. Kaplan-Meier and Cox proportional-hazards regression models were used to analyze the effect of SUA levels on the risks of death. We graded SUA levels at baseline, 6 months, 12 months, 18 months and 24 months post PD by mean of SUA plus or minus a standard deviation as cut-off values, and compared all-cause and cardiovascular mortality among patients with different SUA grades. Results: A total of 1402 patients were included, 763 males (54.42%) and 639 females (45.58%). Their average age at PD start was 49.50±14.20 years. The SUA levels were 7.97±1.79mg/dl at baseline, 7.12±1.48mg/dl at 6 months, 7.05±1.33mg/dl at 12 months, 7.01±1.30mg/dl at 18 months, and 6.93±1.26mg/dl at 24 months. During median follow-up time of 31 (18, 49) months, 173 (12.34%) all-cause deaths occurred, including 68 (4.85%) cardiovascular deaths. There were no significant differences on all-cause mortality among groups with graded SUA levels at baseline, 12 months, 18 months and 24 months during follow-up or on cardiovascular mortality among groups with graded SUA levels at baseline, 6 months, 12 months, 18 months and 24 months during follow-up. At 6 months post PD，Kaplan Meier analysis showed there was significant difference on all-cause mortality among graded SUA levels (c2=11.315, P=0.010), and the all-cause mortality was lowest in grade of 5.65mg/dl≤SUA<7.13mg/dl. Conclusion: SUA level decreased during follow up post PD. At 6 months post PD, a grade of 5.65mg/dl≤SUA<7.13mg/dl was appropriate for better patients’ survival.

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