“This may indicate that patients with higher UA levels should be referred earlier to pre-dialysis care in order to guarantee appropriate preparation for start of dialysis,” researchers concluded in an online report in BMC Nephrology (2014;15:91).
Hakan Nacak, MD, of Leiden University Medical Center in Leiden, The Netherlands, and colleagues analyzed data from 131 patients in the PREPARE-2 study, an observational prospective cohort study that includes incident pre-dialysis patients with chronic kidney disease stages 4-5. The median follow-up was 14.9 months until the start of dialysis, kidney transplantation, death, or censoring.
The patients had a mean baseline UA level of 8.0 mg/dL and a mean 1.61 mL/min/1.73 m2 decline in estimated glomerular filtration rate (eGFR) per year. The change in eGFR decline with each 1 mg/dL increment in baseline UA was a non-significant − 0.14 after adjusting for demographic factors, comorbidities, diet, body mass index, blood pressure, and other potential confounders. Each 1 mg/dL increment in baseline UA was associated with a significant 26% increased risk of starting dialysis, after adjusting for the same potential confounders. “Since UA was not associated with decline in renal function in our cohort, this association [between UA and dialysis initiation] might be explained by clinical symptoms such as gout that relate to UA accumulation. … Painful and disabling symptoms of gout arthritis could have contributed to the decision of the nephrologist and patient to start dialysis.”
Another explanation, they noted, could be that high UA levels might have resulted in other symptoms or clinical conditions such as kidney stones or hypertension that affect the decision to start dialysis.