Nonlinearity Association between Hyperuricemia and All-cause Mortality of Patients with Chronic Kidney Disease

Abstract

Abstract Background: Controversy surrounds the role of serum uric acid and whether treatment intervention is favorable in retarding the progress of chronic kidney disease (CKD). The association of serum uric acid levels and CKD patients’ mortality risk needs to furtherly be determined by large sample cohort studies. Methods: The National Health and Nutrition Examination Survey (NHANES) participants with CKD patients from 1998 to 2017 were enrolled to the study. Multivariable Cox regression models were used to reveal the association of serum uric acid concentrations and CKD mortality risks. Results: 9891 CKD patients were enrolled to the study and 3698 individuals deceased during the follow-up. Increasing serum uric acid levels are independently relevant to higher mortality risks of CKD patients (HR per SD increase). A restricted cubic spline curve showed a nonlinear association between serum uric acid and CKD mortality risks (p for nonlinearity = 0.046). CKD patients with higher levels of serum uric acid (≥ 5.900 mg/dL) show a significant increment of mortality risks (HR = 1.102, 95% CI: 1.043-1.165). Sensitivity analysis demonstrated that the results were stable and robust. Conclusions: High serum uric acid levels (≥ 5.900 mg/dL) may be associated with increasing mortality risks in CKD patients. CKD populations with high serum uric acid may benefit from lowering the serum uric acid.