# Serum Uric Acid Level as an Estimated Parameter That Predicts All-Cause Mortality in Patients with Hemodialysis

## TL;DR

Serum uric acid levels can predict mortality in hemodialysis patients, with different thresholds based on comorbidity levels.

## Contribution

The study identifies distinct uric acid thresholds for predicting mortality in ESKD patients based on comorbidity index.

## Key findings

- High uric acid (>8.6 mg/dL) increases mortality risk in ESKD patients with low comorbidities (CCI < 4).
- Low uric acid (<5.8 mg/dL) increases mortality risk in ESKD patients with high comorbidities (CCI ≥ 4).
- Personalized management of uric acid levels using CCI improves mortality prediction in hemodialysis patients.

## Abstract

Background: Serum uric acid (UA) in end-stage kidney disease (ESKD) patients serves as a critical indicator for nutrition and inflammation, showing a U-shaped association with all-cause mortality. Methods: Our study assessed UA’s survival predictive value in 2615 ESKD patients, stratified by the Charlson Comorbidity Index (CCI) into groups of <4 (n = 1107) and ≥4 (n = 1508). Results: Cox regression revealed distinct patterns. For ESKD patients with CCI < 4, UA levels > 8.6 mg/dL were a mortality risk factor (HR: 1.61, 95% CI: 1.01–2.38) compared to 7.1–7.7 mg/dL. Conversely, in patients with CCI ≥ 4, UA levels < 5.8 mg/dL were a mortality risk factor (HR: 1.53, 95% CI: 1.20–1.95) compared to >8.6 mg/dL. Conclusions: Higher serum UA in ESKD patients with high comorbidities (CCI ≥ 4) is not a risk factor. Low UA should be prevented across all ESKD patients. A personalized approach using CCI and corresponding serum UA levels offers a key reference for managing UA in hemodialysis patients.