Relationship between uric acid and technique failure in patients on continuous ambulatory peritoneal dialysis: a long-term observational cohort study

• Published in: BMJ open Vol. 7; no. 4; p. e010816
• Main Authors: Hsieh, Yao-Peng, Chang, Chia-Chu, Kor, Chew-Teng, Yang, Yu, Wen, Yao-Ko, Chiu, Ping-Fang, Lin, Chi-Chen
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.04.2017; BMJ Publishing Group
• Subjects: Adult; Aged; Calcium phosphates; Cardiovascular disease; Cerebrovascular disease; Cohort analysis; Cohort Studies; Comorbidity; Coronary vessels; Creatinine; Dendritic cells; Diabetes; Dialysate; Failure analysis; Female; Health risk assessment; Hemoglobin; Humans; Hypertension; Hyperuricemia - blood; Hyperuricemia - epidemiology; Infections; Kidney diseases; Kidney Failure, Chronic - blood; Kidney Failure, Chronic - epidemiology; Kidney Failure, Chronic - therapy; Laboratories; Longitudinal Studies; Male; Metabolism; Middle Aged; Mortality; Multivariate Analysis; Neutrophils; Observational studies; Patients; Peritoneal dialysis; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Peritonitis - epidemiology; Proportional Hazards Models; Renal Medicine; Retrospective Studies; Risk factors; Survival analysis; Taiwan - epidemiology; Transplants & implants; Treatment Failure; Uric acid; Uric Acid - blood; Variables; Vein & artery diseases; continuous ambulatory peritoneal dialysis (CAPD); end stage renal disease; peritonitis; technique failure; uric acid
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2015-010816

ObjectivesUric acid (UA) is the product of purine or nucleotide metabolism via the pathway of xanthine oxidase or xanthine dehydrogenase. Although epidemiological studies assessing the role of UA in cardiovascular disease or mortality have produced inconsistent results, the correlation between UA and technique failure in patients on continuous ambulatory peritoneal dialysis (CAPD) remains to be assessed.DesignA retrospective cohort study.SettingPatients starting CAPD between 2001 and 2009 in a single centre in Taiwan.ParticipantsA total of 371 patients on CAPD.Primary outcome measuresAll-cause and peritonitis-related technique failure.ResultsA cohort of 371 participants (43.9% male) was enrolled in the study with a mean age of 55.7±15.9 years at the start of CAPD. During the study period, technique failure occurred in 41 (34.4%) patients in the hyperuricaemia group compared with 49 (19.4%) in the normouricaemia group (p=0.003). In the multivariate Cox regression models, hyperuricaemia at baseline was significantly associated with both a higher risk of technique failure (HR 1.24; 95% CI 1.09 to 1.42, p=0.001) and peritonitis-related technique failure (HR 1.29; 95% CI 1.07 to 1.57, p=0.008).ConclusionsUA was shown to be associated with all-cause and peritonitis-related technique failure in our study. Patients on CAPD with hyperuricaemia should be closely monitored and strategies of increasing survival on CAPD should be taken.