Uric acid/creatinine ratio – a risk factor for cardiovascular mortality in hemodialysis patients

Medical Review (Med. pregled), 2025, 61(1), 26-32.

R. Koycheva, S. Alekova

Department of Internal Medicine and General Medicine, Medical Faculty, Trakia University, Stara Zagora, Bulgaria

Abstract. Introduction. Hemodialysis is the most common form of renal replacement therapy. Cardiovascular death is the cause of death in over 50% In CKD stage 5. The aim of this study was to determine the role of the uric acid/creatinine (UA/Cr) ratio as a risk factor for cardiovascular death in this patient population. Methods. A total of 60 patients (38 men and 22 women) were followed for a period of 24 months. The laboratory data of pre-dialysis parameters of kidney function and lipid profile were examined. UA/Cr was calculated and the patients were divided into two groups according to the obtained median value – 0.49. A Cox regression analysis was performed to assess the role of UA/Cr in predicting cardiovascular mortality, as well as a Kaplan-Meier survival analysis of the two groups of patients. Results. Patients with UA/Cr above 0.49 had longer dialysis treatment, significantly lower creatinine, albumin, triglycerides and TG/HDL-C ratio compared to the group with UA/Cr below 0.49. Non-survival patients had significantly higher UA/Cr ratio, lower body mass index (BMI), lower creatinine, urea, albumin, phosphates, total cholesterol, LDL-cholesterol and triglyceride/HDL-cholesterol (TG/HDL-C) ratio. Cox regression analysis to assess the association of UA/Cr with cardiovascular mortality showed that UA/Cr ratio was an independent risk factor (HR 2.49 [95% CI 1.86-4.55], p<0.05). The UA/Cr ratio retained its characteristics after adjusting for age, sex, duration of HD treatment and the presence of diabetes mellitus – model 1 (HR 2.10 [95% CI 1.32-4.17], p=0.01), as well as after additional adjusting for albumin, phosphates, total cholesterol, triglycerides and the TG/HDL-C ratio in model 2 (HR 1.78 [95% CI 1.14-3.75], p=0.01). Conclusion. The UA/Cr ratio is an independent risk factor for cardiovascular mortality in dialysis patients. Its application has greater significance in the risk stratification of these patients than the values of serum uric acid and creatinine separately.

Key words: uric acid/creatinine ratio, cardiovascular mortality, hemodialysis

Address for correspondence: Reneta Koycheva, MD, e-mail: koychevar@abv.bg