Could uric acid to high density lipoprotein-cholesterol ratio be considered as a marker of hemodialysis sufficiency?

Yıl 2023, , 86 - 91, 31.01.2023

Mustafa Çapraz , Orhan Coşkun

https://doi.org/10.16899/jcm.1223641

Öz

Aim: Hemodialysis (HD) is one of the most widely utilized renal replacement therapies in individuals with end-stage chronic kidney disease (CKD). The purpose of this study was to compare the Uric acid to HDL cholesterol ratio (UHR) levels of well-treated HD patients to those of those who had inadequate HD therapy.
Materials and Methods: Data on HD patients were acquired from patient files and the institution's database. A URR value of more than 70% designated the sufficient HD group, whereas less than 70% defined the insufficient HD group. Furthermore, laboratory data, such as the UHR of the study groups, were compared.
Results: The UHRs for adequate and inadequate HD were 0.160±04 and 0.20±0.07, respectively. The UHR of patients with insufficient HD was substantially greater than that of the subjects with sufficient HD (p=0.004). Besides, UHR was substantially and positively connected with urea before HD (r=0.37, p=0.001), urea after HD (r=0.39, p=0.001), serum creatinine before HD (r=0.48, p0.001), serum creatinine after HD (r=0.45, p0.001), and negatively correlated with URR (r=-0.29, p=0.008), according to correlation analyses. In individuals with chronic renal disease, a UHR value higher than 0.16 exhibited 67% sensitivity and 57% specificity in detecting inadequate HD.
Conclusion: We propose that UHR, in addition to URR, might be used to determine HS sufficiency in CKD patients undergoing HD therapy.

Anahtar Kelimeler

Hemodialysis, uric acid to HDL cholesterol ratio, urea reduction ratio

Ürik asit yüksek yoğunluklu lipoprotein-kolesterol oranı, hemodiyaliz yeterliliğinin bir belirteci olarak kabul edilebilir mi?

Öz

Amaç: Hemodiyaliz (HD), son dönem kronik böbrek hastalığı (KBH) olan bireylerde en yaygın kullanılan renal replasman tedavilerinden biridir. Bu çalışmanın amacı, iyi tedavi edilen HD hastalarının Ürik asit / HDL kolesterol oranı (UHR) düzeylerini, yetersiz HD tedavisi almayanlarınkilerle karşılaştırmaktı.
Gereç ve Yöntem: HD hastalarına ilişkin veriler, hasta dosyalarından ve kurumun veri tabanından elde edildi. URR değerinin %70'in üzerinde olması yeterli HD grubunu, %70'in altında olması ise yetersiz HD grubunu tanımlamıştır. Ayrıca, çalışma gruplarının UHR'si gibi laboratuvar verileri karşılaştırıldı.
Bulgular: Yeterli ve yetersiz HD için UHR'ler sırasıyla 0,160±04 ve 0,20±0,07 idi. Yetersiz HD'si olan hastaların UHR'si, yeterli HD'si olan deneklerden önemli ölçüde daha yüksekti (p=0.004). Ayrıca UHR, HD öncesi üre (r=0,37, p=0,001), HD sonrası üre (r=0,39, p=0,001), HD öncesi serum kreatinin (r=0,48, p0,001), serum Korelasyon analizlerine göre HD sonrası kreatinin (r=0.45, p0.001) ve URR ile negatif korelasyon (r=-0.29, p=0.008). Kronik böbrek hastalığı olan bireylerde, 0,16'dan yüksek bir UHR değeri, yetersiz HD'yi saptamada %67 duyarlılık ve %57 özgüllük sergilemiştir.
Sonuç: HD tedavisi gören KBH hastalarında HS yeterliliğini belirlemek için URR'ye ek olarak UHR'nin kullanılabileceğini öneriyoruz.

Anahtar Kelimeler

Hemodiyaliz, Ürik Asit HDL oranı, Üre düşüş oranı

Kaynakça

• 1. Li Z, Lew NL, Lazarus JM, Lowrie EG. Comparing the urea reduction ratio and the urea product as outcome-based measures of hemodialysis dose. Am J Kidney Dis. 2000;35(4):598-605. doi:10.1016/S0272-6386(00)70004-7
• 2. Oberg BP, McMenamin E, Lucas FL, et al. Increased prevalence of oxidant stress and inflammation in patients with moderate to severe chronic kidney disease. Kidney Int. 2004;65(3):1009-1016. doi:10.1111/j.1523-1755.2004.00465.x
• 3. Ruiz S, Pergola PE, Zager RA, Vaziri ND. Targeting the transcription factor Nrf2 to ameliorate oxidative stress and inflammation in chronic kidney disease. Kidney Int. 2013;83(6):1029-1041. doi:10.1038/ki.2012.439
• 4. Kir HM, Eraldemir C, Dervisoglu E, Caglayan C, Kalender B. Effects of chronic kidney disease and type of dialysis on serum levels of adiponectin, TNF-alpha and high sensitive C-reactive protein. Clin Lab. 2012;58(5-6):495-500.
• 5. Brito F, Almeida S, Figueredo CM, Bregman R, Suassuna JH, Fischer RG. Extent and severity of chronic periodontitis in chronic kidney disease patients. J Periodontal Res. 2012;47(4):426-430. doi:10.1111/j.1600-0765.2011.01449.x
• 6. Glantzounis GK, Tsimoyiannis EC, Kappas AM, Galaris DA. Uric acid and oxidative stress. Curr Pharm Des. 2005;11(32):4145-4151. doi:10.2174/138161205774913255
• 7. Obermayr RP, Temml C, Gutjahr G, Knechtelsdorfer M, Oberbauer R, Klauser-Braun R. Elevated uric acid increases the risk for kidney disease. J Am Soc Nephrol. 2008;19(12):2407-2413. doi:10.1681/ASN.2008010080
• 8. Duman TT, Kocak MZ, Atak BM, Erkus E. Serum uric acid is correlated with HbA1c levels in type 2 diabetes mellitus. Exp Bio Res 2018;1(1):6-9. doi:10.30714/j-ebr.2018136918
• 9. Atak BM, Duman TT, Kocak MZ, Savli H. Serum uric acid level is associated with type 2 diabetes mellitus and diabetic regulation. Exp Bio Res. 2018;1(4):135-139. doi:10.30714/j-ebr.2018443416
• 10. Kocak MZ, Aktas G, Erkus E, Sincer I, Atak B, Duman T. Serum uric acid to HDL-cholesterol ratio is a strong predictor of metabolic syndrome in type 2 diabetes mellitus. Rev Assoc Med Bras. 2019;65(1):9-15. doi:10.1590/1806-9282.65.1.9
• 11. Aktas G, Kocak MZ, Bilgin S, Atak BM, Duman TT, Kurtkulagi O. Uric acid to HDL cholesterol ratio is a strong predictor of diabetic control in men with type 2 diabetes mellitus. Aging Male. 2020;23(5):1098-1102. doi:10.1080/13685538.2019.1678126
• 12. Zhang Y-N, Wang Q-Q, Chen Y-S, Shen C, Xu C-F. Association between serum uric acid to hdl-cholesterol ratio and non-alcoholic fatty liver disease in lean chinese adults. Int J Endocrinol. 2020;2020:1-6. doi:10.1155/2020/5953461
• 13. Rosolowsky ET, Ficociello LH, Maselli NJ, et al. High-normal serum uric acid is associated with impaired glomerular filtration rate in nonproteinuric patients with type 1 diabetes. Clin J Am Soc Nephrol. 2008;3(3):706-713. doi:10.2215/CJN.04271007
• 14. Cai XL, Han XY, Ji LN. High-normal serum uric acid is associated with albuminuria and impaired glomerular filtration rate in Chinese type 2 diabetic patients. Chin Med J (Engl). 2011;124(22):3629-3634.
• 15. See LC, Kuo CF, Chuang FH, et al. Serum uric acid is independently associated with metabolic syndrome in subjects with and without a low estimated glomerular filtration rate. J Rheumatol. 2009;36(8):1691-1698. doi:10.3899/jrheum.081199
• 16. Nadeem M, Stephen L, Schubert C, Davids MR. Association between periodontitis and systemic inflammation in patients with end-stage renal disease. SADJ : journal of the South African Dental Association = tydskrif van die Suid-Afrikaanse Tandheelkundige Vereniging. 2009; 64: 470-3.
• 17. Noack B, Genco RJ, Trevisan M, Grossi S, Zambon JJ, De Nardin E. Periodontal infections contribute to elevated systemic C-reactive protein level. J Periodontol. 2001;72(9):1221-1227. doi:10.1902/jop.2000.72.9.1221
• 18. Pejcic A, Kesic LJ, Milasin J. C-reactive protein as a systemic marker of inflammation in periodontitis. European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clin Microbiol 2011; 30: 407-14.
• 19. Stenvinkel, Peter et al. “Chronic Inflammation in Chronic Kidney Disease Progression: Role of Nrf2.” Kidney international reports vol. 6,7 1775-1787. 4 May. 2021. doi:10.1016/j.ekir.2021.04.023
• 20. Brennan E, Kantharidis P, Cooper ME, Godson C. Pro-resolving lipid mediators: regulators of inflammation, metabolism and kidney function. Nat Rev Nephrol. 2021;17(11):725-739. doi:10.1038/s41581-021-00454-y
• 21. Agraharkar M, Nair V, Patlovany M. Recovery of renal function in dialysis patients. BMC Nephrol. 2003;4:9. Published 2003 Oct 16. doi:10.1186/1471-2369-4-9
• 22. Bani-Hani S, Showkat A. Renal function recovery in dialysis dependent patients. Tenn Med. 2013;106(8):36-40.
• 23. Valga F, Monzón T, Vega-Diaz N, Rodriguez-Perez JC, Ruiz-Santana S. Inflammation and hemodialysis adequacy: Are C-reactive protein levels influenced by dialysis dose? Nefrologia (Engl Ed). 2021 Jul 5:S0211-6995(21)00112-0.
• 24. Hajji M, Khedher R, Mrad M, et al. Effects of Zinc supplementation on serum copper to Zinc and CRP to albumin ratios in hemodialysis patients. J Med Biochem. 2021;40(2):193-198. doi:10.5937/jomb0-26698
• 25. Ridker PM, Rane M. Interleukin-6 Signaling and Anti-Interleukin-6 Therapeutics in Cardiovascular Disease. Circ Res. 2021;128(11):1728-1746. doi:10.1161/CIRCRESAHA.121.319077