Objective  To explore the relationship between serum uric acid (SUA) and cardiovascular death (CVD) and all-cause death in maintenance hemodialysis (MHD) patients.

Methods  From January 1, 2016 to December 31, 2020, clinical data were retrospectively reviewed for 278 regular MHD patients at our Blood Purification Center. The SUA levels were divided into 4 groups according to the 2019 Chinese Guidelines for Diagnosing & Treating Gout. General data of four groups were compared and the correlation between SUA levels and clinical parameters was elucidated. Kaplan-Meier method and Cox hazard regression model were utilized for examining the relationship between SUA levels and all-cause death and CVD mortality in MHD patients.

Results  There was a mean age of (58.61±15.17) years, a median dialysis age of 45(24.00-72.00) months and a median follow-up period of 39.50(22.00-0.00) months. Kaplan-Meier survival curve indicated that overall and CVD survivals were lower in SUA <360 μmol/L group than in the other three groups (Log-rank χ²=24.859; P<0.001; Log-rank χ²=12.738; P=0.005). After adjusting for multiple confounding factors, Cox regression analysis revealed that group A1 (SUA <360 μmol/L) had a 1.672-fold higher risk of all-cause death (HR=5.322, 95% CI 1.778 to 15.931, P=0.003) and a 1.488-fold higher risk of CVD death (HR=4.426, 95% CI 1.217 to 16.098, P=0.024) than those in group A0 (360 μmol/L ≤ SUA <420 μmol/L).

Conclusions  In MHD patients, SUA level is correlated with all-cause and CVD deaths. And SUA <360 μmol/L is an independent risk factor for all-cause and CVD deaths in MHD patients.