Dilara ERDEM, Fatma Ayerden EBİNÇ, Hatice ŞAHİN, Gülay Ulusal OKYAY, Gökhan ERDEM, Mehmet Deniz AYLI
Turkish Journal of Nephrology - 2026;35(4):304-311
Background: Evidence regarding the clinical implications of uric acid (UA) levels in end-stage kidney disease remains inconsistent, reflecting the complexity of its prognostic role. Findings from prior investigations into UA and mortality in dialysis cohorts have been conflicting. Accordingly, this study sought to explore whether longitudinally averaged serum UA levels are associated with all-cause mortality among patients undergoing peritoneal dialysis (PD). Methods: This retrospective observational cohort study included 50 adult patients who initiated PD between January 1, 2012, and July 31, 2022. Serum UA levels were measured every 3 months from PD initiation until death, transfer to hemodialysis, transplantation, or end of follow-up. Time-averaged UA was calculated as the mean of all measurements per patient. The primary endpoint was all-cause mortality. Predictive accuracy was evaluated through receiver operating characteristic (ROC) curve analysis and survival assessment using the Kaplan-Meier method. Results: The median age at PD initiation was 52.5 years (interquartile range [IQR]: 37.8-59), and 52% were male. Ten patients (20%) died during follow-up. Median time to death was 570 days (IQR, 193-1691). The ROC analysis identified a time-averaged UA cutoff of 5.75 mg/dL (sensitivity = 80%, specificity = 75%; area under the curve = 0.739, 95% CI = 0.579-0.898, P = .021). Kaplan-Meier survival curves demonstrated a significantly greater mortality risk among patients with UA levels below the identified cutoff (log-rank P = .009). Conclusion: Lower time-averaged UA levels were associated with increased mortality risk in PD patients. These exploratory findings require validation in larger multicenter studies.
