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

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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Claudication, in contrast to angina pectoris, independently predicts mortality risk in the general population

VASA ◽

10.1024/0301-1526/a000172 ◽

2012 ◽

Vol 41 (2) ◽

pp. 105-113 ◽

Cited By ~ 5

Author(s):

G. Kieback ◽

Lorbeer ◽

Wallaschofski ◽

Ittermann ◽

Völzke ◽

...

Keyword(s):

Angina Pectoris ◽

Mortality Rate ◽

Cardiovascular Mortality ◽

Proportional Hazards ◽

Population Based ◽

Cox Proportional Hazards ◽

Kaplan Meier ◽

All Cause Mortality ◽

Study Population

Background: The aim of our analyses was to investigate whether claudication and angina pectoris, each defined and based on the answer to a single question, are predictive of future mortality. Probands and methods: The study population consisted of 3995 subjects selected from the population-based Study of Health In Pomerania (SHIP). Kaplan-Meier analysis and multivariable Cox proportional hazards regression analysis were used to analyze the association of angina pectoris and claudication with all-cause and cardiovascular mortality adjusted for major cardiovascular risk factors. Results: At baseline, 417 individuals had symptoms of angina pectoris, and 323 had symptoms of claudication. During a median follow-up of 8.5 years, 277 individuals died. Individuals with claudication had a higher fully-adjusted all-cause mortality rate (Hazard Ratio (HR) 1.79; 95 % CI 1.34, 2.39, p < 0.001) and a higher sex- and age-adjusted cardiovascular mortality rate (HR 1.76; 95 % CI 1.03, 2.99, p = 0.038) compared to subjects without claudication. In contrast, subjects with angina pectoris had neither an elevated fully-adjusted all-cause mortality rate (HR 1.15; 95 % CI 0.82, 1.61, p = 0.413) nor sex- and age-adjusted cardiovascular mortality rate (HR 0.71; 95 % CI 0.34, 1.48, p = 0.363) compared to those without this symptom. Conclusions: Claudication, in contrast to angina pectoris, is a strong, independent predictor of all-cause mortality.

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The Efficacy of Etoposide-Based Therapy in Adult Secondary Hemophagocytic Lymphohistiocytosis

Acta Haematologica ◽

10.1159/000514920 ◽

2021 ◽

pp. 1-9

Author(s):

Leonard Naymagon ◽

Douglas Tremblay ◽

John Mascarenhas

Keyword(s):

Hemophagocytic Lymphohistiocytosis ◽

Proportional Hazards ◽

Multivariable Analysis ◽

Cox Proportional Hazards ◽

Rank Test ◽

Kaplan Meier ◽

Hazard Ratios ◽

Significant Difference ◽

The Impact

Data supporting the use of etoposide-based therapy in hemophagocytic lymphohistiocytosis (HLH) arise largely from pediatric studies. There is a lack of comparable data among adult patients with secondary HLH. We conducted a retrospective study to assess the impact of etoposide-based therapy on outcomes in adult secondary HLH. The primary outcome was overall survival. The log-rank test was used to compare Kaplan-Meier distributions of time-to-event outcomes. Multivariable Cox proportional hazards modeling was used to estimate adjusted hazard ratios (HRs) with 95% confidence intervals (CIs). Ninety adults with secondary HLH seen between January 1, 2009, and January 6, 2020, were included. Forty-two patients (47%) received etoposide-based therapy, while 48 (53%) received treatment only for their inciting proinflammatory condition. Thirty-three patients in the etoposide group (72%) and 32 in the no-etoposide group (67%) died during follow-up. Median survival in the etoposide and no-etoposide groups was 1.04 and 1.39 months, respectively. There was no significant difference in survival between the etoposide and no-etoposide groups (log-rank <i>p</i> = 0.4146). On multivariable analysis, there was no association between treatment with etoposide and survival (HR for death with etoposide = 1.067, 95% CI: 0.633–1.799, <i>p</i> = 0.8084). Use of etoposide-based therapy was not associated with improvement in outcomes in this large cohort of adult secondary HLH patients.

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Association of mean arterial pressure with all-cause and cardiovascular mortality in young adults

Postgraduate Medical Journal ◽

10.1136/postgradmedj-2019-137354 ◽

2020 ◽

Vol 96 (1138) ◽

pp. 455-460 ◽

Cited By ~ 1

Author(s):

Shuo Sun ◽

Kenneth Lo ◽

Lin Liu ◽

Jiayi Huang ◽

Ying Qing Feng ◽

...

Keyword(s):

Young Adults ◽

Mean Arterial Pressure ◽

Arterial Pressure ◽

Cardiovascular Mortality ◽

Proportional Hazards ◽

Continuous Variable ◽

Cox Proportional Hazards ◽

Significant Difference ◽

Cvd Mortality

BackgroundMean arterial pressure (MAP) is a predictor of all-cause and cardiovascular disease (CVD) mortality in middle-aged population and elderly, but less evidence has been shown in young adults.ObjectivesWe examined the associations of MAP with all-cause and CVD mortality in young adults aged between 18 and 40 years.MethodsData were from the National Health and Nutrition Examination Survey (1999–2006) and participants were followed up to 31 December 2015. MAP was categorised by quartiles. Multivariable Cox proportional hazards models and Kaplan-Meier survival curves were performed to estimate the association between MAP, all-cause and CVD mortality.ResultsThere were a total of 8356 (4598 women (55.03%)) participants with the mean age of 26.63±7.01 years, of which 265 (3.17%) and 10 (0.12%) cases of all-cause and cardiovascular mortality occurred during a median follow-up duration of 152.96±30.45 months, respectively. There was no significant difference in the survival rate by MAP quartiles (p=0.058). When MAP was treated as a continuous variable, the multivariable adjusted HRs for all-cause and CVD mortality were 1.00 (95% CI 0.96 to 1.04; p=0.910) and 0.94 (95% CI 0.77 to 1.14; p=0.529), respectively. When using the lowest quartile (Q1) as referent, the adjusted HRs for all-cause mortality from Q2 to Q4 were 1.16 (95% CI 0.56 to 2.42), 1.06 (95% CI 0.48 to 2.32) and 0.91 (95% CI 0.37 to 2.24; p for tend was 0.749) after adjusting for potential confounders.ConclusionThere was no significant association of MAP with all-cause and CVD mortality in young adults with a relatively short follow-up time.

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P1463EARLY VASCULAR ACCESS CREATION IS NOT ASSOCIATED WITH BETTER OUTCOME IN PATIENTS AFTER CHRONIC DIALYSIS INITIATION

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1463 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Yukimasa Iwata ◽

Hiroki Okushima ◽

Taisuke Takatsuka ◽

Daisuke Yoshimura ◽

Tomohiro Kawamura ◽

...

Keyword(s):

Vascular Access ◽

Cardiovascular Mortality ◽

Proportional Hazards ◽

Medical Center ◽

Clinical Status ◽

Cox Proportional Hazards ◽

Chronic Hemodialysis ◽

Dialysis Initiation ◽

Significant Difference ◽

All Cause Mortality

Abstract Background and Aims Although initiation of chronic hemodialysis with central venous catheters are associated with higher mortality compared to that with arteriovenous fistula, the association between the timing of vascular access (VA) creation and outcome after dialysis initiation is not fully investigated. Thus, we conducted single center retrospective cohort study on incident hemodialysis patients to investigate the effect of VA types and timing of VA creation on all-cause and cardiovascular mortality after dialysis initiation. Method A total of 1052 patients with accurate clinical data and outcomes was extracted from 1069 patients who started chronic hemodialysis treatment at Osaka General Medical Center between 2006 and 2015. Clinical status at dialysis initiation, all-cause and cardiovascular mortality were compared by three patient groups categorized by VA types and timing of VA creation: temporary catheter (TC) group, dialysis initiation with TC; early VA (EVA) group, dialysis was initiated more than one month after VA creation; late VA (LVA) group, dialysis was initiated within one month after VA creation. Cox proportional hazards analysis was used to examine predictive factors for outcomes. Results Median age was 70 years and 64% of patients were male. Patient number of each group was 285 (27%), 441 (42%), and 326 (31%) for TC, EVA, and LVA groups, respectively. Although there was no significant difference in eGFR at dialysis initiation among three groups ([median] 5.4 vs. 5.4 vs. 5.4 mL/min/1.73m2, respectively, P=0.881), hemoglobin and albumin were lower in TC group compared to EVA and LVA groups (hemoglobin [median] 8.3 vs. 9.5 vs. 8.9 g/dL, respectively, P<0.001; albumin [median], 3.0 vs. 3.5 vs. 3.2 g/dL, respectively, P<0.001). Kaplan-Meier curves revealed significant difference among three groups for all-cause (P<0.001) and cardiovascular mortality (P<0.001). On multivariate Cox proportional hazards analysis, timing of VA creation was not associated with all-cause and cardiovascular mortality. Although temporary catheter usage at dialysis initiation was significantly associated with all-cause mortality (HR, 1.91; 95%CI, 1.30-2.83; P=0.001), it was not associated with cardiovascular mortality (HR, 1.64; 95%CI, 0.79-3.43; P=0.186). Conclusion Timing of VA creation was not associated with all-cause and cardiovascular mortality, whereas hemodialysis initiation with TC was significantly associated with increased all-cause mortality.

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Maintained Folic Acid Supplementation Reduces the Risk of Mortality in Continuous Ambulatory Peritoneal Dialysis Patients

Blood Purification ◽

10.1159/000480222 ◽

2017 ◽

Vol 45 (1-3) ◽

pp. 28-35

Author(s):

Rong Rong ◽

Qian Zhou ◽

Jianxiong Lin ◽

Naya Huang ◽

Wei Li ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Folic Acid ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Cardiovascular Mortality ◽

Proportional Hazards ◽

Folic Acid Supplementation ◽

Cox Proportional Hazards ◽

Cutoff Value ◽

Cox Proportional Hazards Models

Background: The association between folic acid (FA) supplementation and mortality in continuous ambulatory peritoneal dialysis (CAPD) patients is unclear. Methods: FA exposure was calculated as a percentage of cumulative duration of drug usage to total follow-up duration (FA%). A total of 1,358 patients were classified by a cutoff value of FA%. The association of FA with mortality was evaluated using Cox proportional hazards models. Results: The cutoff value of FA% for predicting mortality was <34% at a median follow-up of 40.7 months. FA ≥34% was associated with decreased risk for all-cause (adjusted hazard ratios [HRs] 95% CI 0.64 [0.48-0.85] and cardiovascular mortality 0.67 (95% CI 0.47-0.97). Moreover, the adjusted HRs per 10% higher FA for all-cause and cardiovascular mortality were 0.925 (95% CI 0.879-0.973) and 0.926 (95% CI 0.869-0.988), respectively. Conclusions: Longer period of FA supplementation led to a reduction in risk of both all-cause and cardiovascular mortality in CAPD patients.

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Association between Serum Uric Acid and Renal Outcome in Patients with Biopsy-confirmed Diabetic Nephropathy

Endocrine Connections ◽

10.1530/ec-21-0307 ◽

2021 ◽

Author(s):

Yutong Zou ◽

Lijun Zhao ◽

Junlin Zhang ◽

Yiting Wang ◽

Yucheng Wu ◽

...

Keyword(s):

Uric Acid ◽

Diabetic Nephropathy ◽

Survival Analysis ◽

Serum Uric Acid ◽

Chinese Patients ◽

Renal Outcome ◽

Lowering Therapy ◽

Kaplan Meier ◽

Significant Difference

Objective: To investigate the relationship between serum uric acid (SUA) level and renal outcome in patients with type 2 diabetes mellitus (T2DM) and diabetic nephropathy(DN). Methods: A total of 393 Chinese patients with T2DM and biopsy-proven DN and followed at least one year were enrolled in this study. Patients were stratified by the quartiles of baseline level of SUA: Q1 group286.02± 46.66 μmol/L (n=98); Q2 group: 358.23±14.03μmol/L (n=99); Q3 group: 405.50±14.59μmol/L (n=98) and Q4 group: 499.14±56.97μmol/L (n=98).Renal outcome was defined by progression to end stage renal disease (ESRD). Kaplan-Meier survival analysis and Cox proportional hazards model were used to analyze the association between SUA quartiles and the renal outcomes. Results: During the median 3-year follow-up period, there were 173 ESRD outcome events (44.02%) during follow-up. No significant difference among SUA level the risk of progression of DN (P=0.747) was shown in the Kaplan-Meier survival analysis. In multivariable-adjusted model, HRs for developing ESRD were 1.364(0.621-2.992; p=0.439), 1.518(0.768-3.002; p=0.230) and 1.411(0.706-2.821; p=0.330) for the Q2, Q3 and Q4, respectively, in comparison with the Q1 (P=0.652). Conclusions: No significant association between SUA level and renal outcome of ESRD in Chinese patients with T2DM and DN was found in our study. Besides, the role of uric acid-lowering therapy in delaying DN progression and improve ESRD outcome had not yet been proven. Further study was needed to clarify the renal benefit of the uric acid-lowering therapy in the treatment of DN.

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Geriatric Nutritional Risk Index Is a Simple Predictor of Mortality in Chronic Hemodialysis Patients

Blood Purification ◽

10.1159/000381798 ◽

2015 ◽

Vol 39 (4) ◽

pp. 281-287 ◽

Cited By ~ 19

Author(s):

Mizuki Komatsu ◽

Masayuki Okazaki ◽

Ken Tsuchiya ◽

Hiroshi Kawaguchi ◽

Kosaku Nitta

Keyword(s):

Proportional Hazards ◽

Risk Index ◽

Cox Proportional Hazards ◽

Nutritional Risk ◽

Geriatric Nutritional Risk Index ◽

Kaplan Meier ◽

Nutritional Risk Index ◽

All Cause Mortality ◽

Overall Mortality

Background: Malnutrition is common in hemodialysis (HD) patients, and it is associated with increasing risk of mortality. The geriatric nutritional risk index (GNRI) has been developed as a tool to assess the nutritional risk. The aim of this study was to examine the reliability of the GNRI as a mortality predictor in a Japanese HD cohort. Methods: We prospectively examined the GNRI of 332 maintenance HD patients aged 65.4 ± 13.2, 213 males, and followed up on them for 36 months. The patients were divided into quartiles (Q) according to GNRI values (Q1: <91.6, Q2: 91.7-97.0, Q3: 97.1-102.2, Q4: >102.3). Predictors for all-cause mortality were examined using Kaplan-Meier and Cox proportional-hazards analyses. Results: The GNRI presented a normal distribution. During the follow-up period of 36 months, 76 patients died. The overall mortality at the end of the 3-year observational period was 22.3%. At the 3-year follow-up period, Kaplan-Meier survival rates for all-cause mortality were 72.3, 79.3, 84.9 and 92.6% in Q1, Q2, Q3, and Q4, respectively (p = 0.0067). Multivariate Cox proportional-hazards analysis demonstrated that the GNRI was a significant predictor of adjusted all-cause mortality (HR 0.958; 95% CI 0.929-0.989, p = 0.0073). Conclusions: The results of the present study demonstrate that the GNRI is a strong predictor of overall mortality in HD patients. However, cardiovascular mortality was not associated with GNRI values, and did not differ among the GNRI quartiles. The GNRI score can be considered a simple and reliable marker of predictor for mortality risk in Japanese HD patients.

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Faster Transport Status and Mortality in Anuric Patients Undergoing Continuous Ambulatory Peritoneal Dialysis

Blood Purification ◽

10.1159/000433416 ◽

2015 ◽

Vol 40 (2) ◽

pp. 160-166 ◽

Cited By ~ 2

Author(s):

Liping Xiong ◽

Li Fan ◽

Qingdong Xu ◽

Qian Zhou ◽

Huiyan Li ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Models ◽

Increased Risk ◽

All Cause Mortality ◽

History Of ◽

The Relationship

Background: There are limited data regarding the relationship between transport status and mortality in anuric continuous ambulatory peritoneal dialysis (CAPD) patients. Methods: According to the dialysate to plasma creatinine ratio (D/P Cr), 292 anuric CAPD patients were stratified to faster (D/P Cr ≥0.65) and slower transport groups (D/P Cr <0.65). The Cox proportional hazards models were used to evaluate the association of transport status with mortality. Results: During a median follow-up of 22.1 months, 24% patients died, 61.4% of them due to cardiovascular disease (CVD). Anuric patients with faster transport were associated with an increased risk of all-cause mortality (HR (95% CI) = 2.16 (1.09-4.26)), but not cardiovascular mortality, after adjustment for confounders. Faster transporters with pre-existing CVD had a greater risk for death compared to those without any history of CVD. Conclusion: Faster transporters were independently associated with high all-cause mortality in anuric CAPD patients. This association was strengthened in patients with pre-existing CVD.

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Prospective Study of Serum Uric Acid Levels and First Stroke Events in Chinese Adults With Hypertension

Frontiers in Physiology ◽

10.3389/fphys.2021.807420 ◽

2021 ◽

Vol 12 ◽

Author(s):

Feng Hu ◽

Longlong Hu ◽

Rihua Yu ◽

Fengyu Han ◽

Wei Zhou ◽

...

Keyword(s):

Uric Acid ◽

Serum Uric Acid ◽

Proportional Hazards ◽

Survival Curve ◽

Cox Proportional Hazards ◽

Chinese Adults ◽

Stroke Event ◽

Kaplan Meier ◽

Cox Proportional Hazards Models ◽

The Relationship

Objectives: We investigated the association between serum uric acid (SUA) levels and the risk of the first stroke in Chinese adults with hypertension.Methods: A total of 11, 841 hypertensive patients were selected from the Chinese Hypertension Registry for analysis. The relationship between SUA levels and first stroke was determined using multivariable Cox proportional hazards regression, smoothing curve fitting, and Kaplan–Meier survival curve analysis.Results: During a median follow-up of 614 days, 99 cases of the first stroke were occurred. Cox proportional hazards models indicated that SUA levels were not significantly associated with the first stroke event [adjusted-hazard ratio (HR) per SD increase: 0.98, 95% CI 0.76–1.26, P = 0.889]. In comparison to the group without hyperuricemia (HUA), there were no significantly higher risks of first stroke events (adjusted-HR: 1.22, 95% CI 0.79–1.90, P = 0.373) in the population with HUA. However, in the population less than 60 years old, subjects with HUA had a significantly higher risk of the first stroke than the population without HUA (adjusted-HR: 4.89, 95% CI 1.36–17.63, P = 0.015). In subjects older than 60 years, we did not find a significant relationship between HUA and first stroke (adjusted-HR: 0.97, 95% CI 0.60–1.56, P = 0.886). Survival analysis further confirmed this discrepancy (log-rank P = 0.013 or 0.899 for non-aging or aging group).Conclusion: No significant evidence in the present study indicated that increased SUA levels were associated with the risk of first stroke in the Chinese adults with hypertension. Age played an interactive role in the relationship between HUA and the first stroke event.

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The association of mean telomere length with all-cause, cerebrovascular and cardiovascular mortality

Bioscience Reports ◽

10.1042/bsr20192306 ◽

2019 ◽

Vol 39 (10) ◽

Cited By ~ 1

Author(s):

Yu-qing Huang ◽

Kenneth Lo ◽

Ying-qing Feng ◽

Bin Zhang

Keyword(s):

Telomere Length ◽

Cardiovascular Mortality ◽

Proportional Hazards ◽

Additive Model ◽

Cox Proportional Hazards ◽

Cell Aging ◽

Age Related ◽

All Cause Mortality ◽

The Relationship

Abstract Mean telomere length (MLT) is a marker of cell aging and may associate with age-related diseases. However, the relationship between MLT and mortality risk remains unclear. We aimed to investigate the relationship between MLT and all-cause, cerebrovascular and cardiovascular mortality among adults in United States. We analyzed data were from National Health and Nutrition Examination Survey (NHANES, 1999–2002) with follow-up data through 31 December 2015. Based on MLT, participants were categorized into low, middle and high groups. Multivariate Cox proportional hazards regression, subgroup analysis and generalized additive model (GAM) were performed by using hazard ratios (HRs) and 95% confidence intervals (CIs). A total of 7827 participants were included in analysis (48.18% male). After 158.26 months of follow-up on average, there were 1876 (23.97%), 87 (1.11%) and 243 (3.10%) onset of all-cause, cerebrovascular and cardiovascular mortality. After adjustment for potential confounders, using the low group as the reference, HRs for all-cause (0.87 and 0.86), cerebrovascular (0.75 and 0.75) and cardiovascular mortality (1.01 and 0.69) for the middle to high groups were not statistically significant (all P>0.05 for trend). MLT was non-linearly related to all-cause mortality but not to cerebrovascular and cardiovascular mortality. It was the first study to demonstrate the non-linear relationship between MLT and all-cause mortality.

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