대한신장학회

논문분류	춘계학술대회 초록집
제목	Association of serum uric acid level and coronary artery stenosis severity in end stage renal disease patients
저자	Hye YUN2, Hye jeong CHO2, Sang hoon KIM3, Jun chul KIM4, Mi jung LEE2, Dong ho YANG2, *So-young LEE2
출판정보	2017; 2017(1):
키워드	Chronic kidney disease, Coronary stenosis, Cardiovascular disease, Hemodialysis, Uric acid
초록	Objectives : Hyperuricemia is common in end stage renal disease (ESRD) patients, and many previous studies have reported associations between hyperuricemia and adverse cardiovascular outcomes, which are the major cause of death in these patients. We investigated the relationship between serum uric acid levels and the severity of coronary stenosis in ESRD patients on maintenance hemodialysis (MHD). Methods : All patients had ESRD and were treated with MHD at the CHA Bundang Medical Center hemodialysis center between 2005 and 2015. We selected patients who started MHD treatment in our center and underwent coronary angiography to address chest discomfort that began after initiation of MHD. Among 721 patients who started MHD treatment, 102 patients underwent coronary angiographic tests complaining of chest discomfort new since initiation of MHD. We collected data on uric acid levels and coronary artery luminal diameter, defining luminal diameter narrowing of more than 50% in any major coronary artery as critical-stenosis. Results : The mean age of the study population was 62.3 ± 10.8 years, and 54.4% of the population was male. Hyperuricemia (serum uric acid level > 6.0 mg/dL in females and > 7.0mg/dL in males [58]) affected 47.7% of the total study population, and it was more prevalent in the critical-stenosis group (73.0% vs. 13.1%. P<0.001). The coronary angiographic test diagnosed 52 patients (57.7%) with critical coronary artery stenosis; the remaining 38 (42.4%) composed the non criticalstenosis group. The mean uric acid level was 6.6 ± 2.2 md/dL, and that was significantly higher in the critical-stenosis group (4.9 ±1.4 vs. 7.8 ±2.0 P <0.001). Compared with the non-critical-stenosis group, patients with criticalstenosis had significantly higher WBC (7378.4 ± 2723.5 vs. 9016.7 ± 4456.8, P=0.036) and glucose levels (141.4 ± 64.8 vs. 198.4 ± 111.9, P=0.003). Serum protein (6.6 ± 0.9 vs. 6.2 ± 0.8, P=0.037) and calcium levels (9.2 ± 1.0 vs. 8.7 ± 1.0, P=0.015) were significantly lower in the critical-stenosis group. We performed a binary logistic regression analysis to assess the effects of covariates on critical coronary artery stenosis, using variables found to be significantly correlated with critical-stenosis in the univariate analysis. The only independent predictor of critical-stenosis was serum uric acid level in multivariate analysis (P <0.001). Conclusions : High serum uric acid levels were associated with critical coronary artery stenosis in ESRD patients. The association remained important despite adjustment for other possible risk factors. Further research is needed to investigate the biological role of uric acid and determine whether decreasing serum uric acid levels reduces the risk of severe coronary artery disease in ESRD patients.
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