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Meta-Analysis
. 2019 Jan 14;20(1):18.
doi: 10.1186/s12882-018-1143-7.

Serum uric acid and cardiovascular mortality in chronic kidney disease: a meta-analysis

Qimei Luo  1   2 , Xi Xia  1   2 , Bin Li  1   2 , Zhenchuan Lin  1   2 , Xueqing Yu  1   2 , Fengxian Huang  3   4
Affiliations
Meta-Analysis

Serum uric acid and cardiovascular mortality in chronic kidney disease: a meta-analysis

Qimei Luo et al. BMC Nephrol. .

Abstract

Background: Conflicting results have been reported from studies evaluating serum uric acid (SUA) levels as an independent risk factor for cardiovascular mortality in patients with chronic kidney disease (CKD).

Methods: We systematically searched MEDLINE, Web of Science, and bibliographies of retrieved articles to identify studies reporting on the association between SUA levels and cardiovascular mortality in patients with CKD. Random-effects models were used to calculate the pooled hazard ratios (HR) and corresponding 95% confidence intervals (CI).

Results: We included 11 studies with an overall sample of 27,081 patients with CKD in this meta-analysis. By meta-analysis, restricted to 7 studies (n = 11,050), patients with the highest SUA were associated with an increased risk of cardiovascular mortality (HR 1.47, 95% CI 1.11-1.96) compared with patients with the lowest SUA. There was no indication of publication bias or significant heterogeneity (I2 = 40.4%; P = 0.109). Meta-analysis of 10 studies (n = 26,660) indicated that every 1 mg/dl increase in SUA levels increased a 12% risk in cardiovascular mortality (HR 1.12, 95% CI 1.02-1.24), with significant heterogeneity (I2 = 79.2%, P < 0.001).

Conclusions: Higher SUA levels are associated with significantly increased risk of cardiovascular mortality in patients with CKD. More designed studies, especially randomized controlled trials, should be conducted to determine whether high SUA levels is a potentially modifiable risk factor for cardiovascular mortality in patients with CKD.

Keywords: Cardiovascular mortality; Chronic kidney disease; Meta-analysis; Serum uric acid.

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Figures

Fig. 1
Fig. 1
Flow chart of study selection of included studies. Abbreviation: CKD, chronic kidney disease
Fig. 2
Fig. 2
Forest plot and summary hazard ratio for the association of serum uric acid as a category variable and cardiovascular mortality in patients with chronic kidney disease. Abbreviations: CI, confidence interval; DM, diabetes mellitus; HR, hazard ratio; NDM, non-diabetes mellitus
Fig. 3
Fig. 3
Forest plot and summary hazard ratio for the association of serum uric acid as a continuous variable (per 1 mg/dl increment) and cardiovascular mortality in patients with chronic kidney disease. Abbreviations: CI, confidence interval; DM, diabetes mellitus; HR, hazard ratio; NDM, non-diabetes mellitus
Fig. 4
Fig. 4
Forest plot and summary hazard ratio of subgroup analysis for the association of serum uric acid as a continuous variable (per 1 mg/dl increment) and cardiovascular mortality in patients with chronic kidney disease. Abbreviations: CI, confidence interval; DM, diabetes mellitus; HD, hemodialysis; HR, hazard ratio; NDM, non-diabetes mellitus; PD, peritoneal dialysis; PCS, prospective cohort study; RCT, randomized controlled trail; RCS, retrospective cohort study
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