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

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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 22. Bani-Hani S, Showkat A. Renal function recovery in dialysis dependent patients. Tenn Med. 2013;106(8):36-40.
23. 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. 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. 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