The Relationship Between Uric Acid and Mortality in Hemodialysis Patients

Uric acid, the end product of purine metabolism, is an antioxidant molecule. Both low and high serum uric acid levels are associated with increased mortality. The aim is to investigate the relationship between serum uric acid levels and mortality in hemodialysis patients.

This retrospective study was conducted on hemodialysis patients in Hatay, Turkey, between 2010 and 2023. Records were reviewed, and serum uric acid levels, other laboratory tests, and hemodialysis duration were noted. Patients on hemodialysis for at least 3 months were included. A p-value of less than 0.05 was considered statistically significant.

A total of 3443 hemodialysis patients were included. The average age was 64.39 ± 13.57 years (minimum: 18 years, maximum: 90 years), and 58% were male. The mean serum uric acid level was 6.23 ± 1.43 mg/dL (range: 0.1-16). The prevalence of hyperuricemia was 39.3%, and hypouricemia was 0.2%. The median parathyroid hormone (PTH) value was lower in the group with a serum uric acid level ≤ 4 mg/dL (p < 0.001) and higher in the group with a serum uric acid level > 7 mg/dL (p < 0.001). There were significant differences in mortality among the study groups (p < 0.001). Subgroup analyses revealed that the mortality rate was higher in the patient group with serum uric acid levels ≤ 4 mg/dL and lower in the group with serum uric acid levels > 7 mg/dL (p < 0.001).

Low serum uric acid levels have been associated with increased mortality; this may be because serum uric acid is an indicator of nutritional status. Higher serum uric acid levels were associated with higher PTH levels; further studies are needed to elucidate the causal relationship. Low serum uric acid levels were associated with an increased risk of cerebrovascular disease.