Association between the serum uric acid-to-creatinine ratio and cardiovascular mortality in maintenance hemodialysis patients

Background Uric acid is a risk factor for death in hemodialysis patients, but its exact role is still unclear. The serum uric acid-to-serum creatinine (SUA/SCr) ratio is a new indicator. This study aimed to clarify the relationship between this indicator and cardiovascular death in maintenance hemod...

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Main Authors: Wanqing Huang, Ning Ding, Yanping Zhang, Dongxia Qiu, Lin Wei, Chen Zhao, Zhuo Ren, Qian Wang, Kaiming Ren, Jiuxu Bai, Ning Cao
Format: Article
Language:English
Published: Taylor & Francis Group 2025-12-01
Series:Renal Failure
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Online Access:https://www.tandfonline.com/doi/10.1080/0886022X.2025.2509787
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Summary:Background Uric acid is a risk factor for death in hemodialysis patients, but its exact role is still unclear. The serum uric acid-to-serum creatinine (SUA/SCr) ratio is a new indicator. This study aimed to clarify the relationship between this indicator and cardiovascular death in maintenance hemodialysis patients.Methods Kaplan-Meier analysis was used to compare all-cause and cardiovascular mortality. Restricted cubic splines were used to plot the relationships between SUA/SCr and all-cause and cardiovascular mortality. Multivariable Cox regression was used to analyze the relationships between SUA/SCr and the risk of all-cause death or cardiovascular death. The C statistic was calculated to test the model discrimination performance. The net reclassification index was calculated to demonstrate the prediction accuracy of SUA and SUA/SCr.Results Kaplan-Meier analysis showed that all-cause and cardiovascular mortality were significantly higher in the highest SUA/SCr quartile (p < 0.001, for both). Restricted cubic splines indicate a nonlinear relationship between SUA/SCr and cardiovascular mortality. Multivariable Cox regression analysis showed that there was no significant difference in all-cause mortality, but patients with the highest SUA/SCr quartile had a higher risk of cardiovascular death (HR = 4.023, 95% CI, 1.979–8.179; p < 0.001; HR = 4.339, 95% CI, 2.091–9.002; p < 0.001; HR = 2.747, 95% CI, 1.170–6.450; p = 0.020). The C-statistic of the SUA/SCr model was greater than those of the SUA and SCr models alone. The NRI demonstrated that the SUA/SCr ratio was superior to SUA alone in the prediction of cardiovascular death.Conclusions In maintenance hemodialysis patients patients, higher levels of SUA/SCr are associated with a greater risk of cardiovascular mortality.
ISSN:0886-022X
1525-6049