{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T06:44:57Z","timestamp":1782715497516,"version":"3.54.5"},"reference-count":24,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,6,28]],"date-time":"2026-06-28T00:00:00Z","timestamp":1782604800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,6,28]],"date-time":"2026-06-28T00:00:00Z","timestamp":1782604800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Hemodialysis International"],"abstract":"ABSTRACT<\/jats:title>\n \n Background<\/jats:title>\n To investigate the association between serum uric acid levels and the risks of all\u2010cause and cardiovascular mortality in patients undergoing maintenance hemodialysis.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Patients receiving maintenance hemodialysis registered in 2014 in the Beijing Blood Purification Quality Control and Improvement Center database were included. Patients were stratified into low (\u2264\u2009344\u2009\u03bcmol\/L), intermediate (344\u2013464\u2009\u03bcmol\/L), and high (>\u2009464\u2009\u03bcmol\/L) serum uric acid groups. Propensity score matching (1:1:1) was performed using age, sex, diabetes, and dialysis vintage. Survival was analyzed using Kaplan\u2013Meier curves and the log\u2010rank test. Cox proportional hazards models and restricted cubic spline analyses were applied to evaluate the associations between serum uric acid levels and all\u2010cause and cardiovascular death.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n We enrolled 2070 patients in three matched groups (\n n<\/jats:italic>\n \u2009=\u2009690 per group). The median follow\u2010up was 64.0 (interquartile range, 31.1\u201372.0) months. All\u2010cause death occurred in 292\/690 (42.3%), 122\/690 (17.7%), and 210\/690 (30.4%) patients in the low\u2010, intermediate\u2010, and high\u2010serum uric acid groups, respectively. After adjusting for multiple factors, the intermediate serum uric acid group had better survival than the low\u2010 (hazard ratio, 1.82; 95% confidence interval [95% CI], 1.41\u20132.34;\n p<\/jats:italic>\n \u2009<\u20090.001) and high\u2010serum uric acid groups (hazard ratio, 2.13; 95% CI, 1.64\u20132.76;\n p<\/jats:italic>\n \u2009<\u20090.001). The pattern of cardiovascular death was consistent with that of all\u2010cause mortality, showing higher risks in both the low\u2010 and high\u2010serum uric acid groups compared with the intermediate\u2010serum uric acid group. Further restricted cubic spline analyses suggested a U\u2010shaped association between serum uric acid levels and the risks of all\u2010cause and cardiovascular mortality, with the lowest mortality risk observed at serum uric acid levels of approximately 388\u2013420\u2009\u03bcmol\/L.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Serum uric acid exhibited a U\u2010shaped association with the risks of all\u2010cause and cardiovascular death in patients undergoing maintenance hemodialysis. Both excessively low and high serum uric acid levels were associated with increased mortality risk.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/hdi.70105","type":"journal-article","created":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T05:52:01Z","timestamp":1782712321000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Nonlinear Association Between Serum Uric Acid Levels and Mortality in Maintenance Hemodialysis Patients: A Retrospective Study From the Beijing Hemodialysis Quality Control and Improvement Center"],"prefix":"10.1111","author":[{"given":"Huixian","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Nephrology, Beijing Friendship Hospital Capital Medical University Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5019-9009","authenticated-orcid":false,"given":"Zongli","family":"Diao","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Beijing Friendship Hospital Capital Medical University Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wang","family":"Guo","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Beijing Friendship Hospital Capital Medical University Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6532-4394","authenticated-orcid":false,"given":"Wenhu","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Beijing Friendship Hospital Capital Medical University Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-7323-5590","authenticated-orcid":false,"given":"Jing","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Beijing Friendship Hospital Capital Medical University Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,28]]},"reference":[{"issue":"5","key":"e_1_2_10_2_1","doi-asserted-by":"crossref","first-page":"761","DOI":"10.1053\/j.ajkd.2006.08.019","article-title":"J\u2010Shaped Mortality Relationship for Uric Acid in CKD","volume":"48","author":"Suliman M. E.","year":"2006","journal-title":"American Journal of Kidney Diseases"},{"issue":"2","key":"e_1_2_10_3_1","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1093\/ndt\/gfg563","article-title":"Serum Uric Acid Levels Show a 'J\u2010Shaped' Association With All\u2010Cause Mortality in Haemodialysis Patients","volume":"19","author":"Hsu S. P.","year":"2004","journal-title":"Nephrology, Dialysis, Transplantation"},{"issue":"1","key":"e_1_2_10_4_1","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1080\/0886022X.2020.1745234","article-title":"Low Serum Uric Acid Levels Increase the Risk of All\u2010Cause Death and Cardiovascular Death in Hemodialysis Patients","volume":"42","author":"Li M.","year":"2020","journal-title":"Renal Failure"},{"issue":"24","key":"e_1_2_10_5_1","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000003701","article-title":"Lower Serum Uric Acid Level Predicts Mortality in Dialysis Patients","volume":"95","author":"Bae E.","year":"2016","journal-title":"Medicine (Baltimore)"},{"key":"e_1_2_10_6_1","article-title":"Association of Serum Uric Acid Concentration and Its Change With Cardiovascular Death and All\u2010Cause Mortality","volume":"2020","author":"Dong Z. X.","year":"2020","journal-title":"Disease Markers"},{"issue":"10","key":"e_1_2_10_7_1","doi-asserted-by":"crossref","first-page":"1750","DOI":"10.1093\/ndt\/gfw419","article-title":"Serum Uric Acid, Protein Intake and Mortality in Hemodialysis Patients","volume":"32","author":"Park C.","year":"2017","journal-title":"Nephrology, Dialysis, Transplantation"},{"issue":"10","key":"e_1_2_10_8_1","doi-asserted-by":"crossref","first-page":"2470","DOI":"10.2215\/CJN.00670111","article-title":"Uric Acid Levels and All\u2010Cause and Cardiovascular Mortality in the Hemodialysis Population","volume":"6","author":"Latif W.","year":"2011","journal-title":"Clinical Journal of the American Society of Nephrology"},{"issue":"4","key":"e_1_2_10_9_1","doi-asserted-by":"crossref","first-page":"368","DOI":"10.23876\/j.krcp.2017.36.4.368","article-title":"Relationship Between Serum Uric Acid and Mortality Among Hemodialysis Patients: Retrospective Analysis of Korean End\u2010Stage Renal Disease Registry Data","volume":"36","author":"Kim C. S.","year":"2017","journal-title":"Kidney Research and Clinical Practice"},{"issue":"1","key":"e_1_2_10_10_1","doi-asserted-by":"crossref","DOI":"10.3390\/toxins9010020","article-title":"High Uric Acid Ameliorates Indoxyl Sulfate\u2010Induced Endothelial Dysfunction and Is Associated With Lower Mortality Among Hemodialysis Patients","volume":"9","author":"Hsu W. L.","year":"2017","journal-title":"Toxins (Basel)"},{"issue":"10","key":"e_1_2_10_11_1","doi-asserted-by":"crossref","first-page":"823","DOI":"10.1159\/000509258","article-title":"Relationship Between Serum Uric Acid and Mortality Risk in Hemodialysis Patients: A Multicenter Prospective Cohort Study","volume":"51","author":"Yang Y.","year":"2020","journal-title":"American Journal of Nephrology"},{"issue":"8","key":"e_1_2_10_12_1","doi-asserted-by":"crossref","first-page":"1196","DOI":"10.1016\/j.ekir.2020.05.021","article-title":"Serum Uric Acid and Mortality Risk Among Hemodialysis Patients","volume":"5","author":"Zawada A. M.","year":"2020","journal-title":"Kidney International Reports"},{"issue":"7","key":"e_1_2_10_13_1","doi-asserted-by":"crossref","DOI":"10.3390\/jpm15070305","article-title":"Serum Uric Acid Level as an Estimated Parameter That Predicts All\u2010Cause Mortality in Patients With Hemodialysis","volume":"15","author":"Niu S. W.","year":"2025","journal-title":"Journal of Personalized Medicine"},{"key":"e_1_2_10_14_1","doi-asserted-by":"crossref","DOI":"10.3389\/fnut.2024.1499438","article-title":"Association Between Serum Uric Acid and All\u2010Cause and Cardiovascular\u2010Related Mortality in Hemodialysis Patients","volume":"11","author":"Gan W.","year":"2024","journal-title":"Frontiers in Nutrition"},{"issue":"5","key":"e_1_2_10_15_1","doi-asserted-by":"crossref","first-page":"864","DOI":"10.1016\/j.ajkd.2003.07.016","article-title":"Malnutrition\u2010Inflammation Complex Syndrome in Dialysis Patients: Causes and Consequences","volume":"42","author":"Kalantar\u2010Zadeh K.","year":"2003","journal-title":"American Journal of Kidney Diseases"},{"issue":"3","key":"e_1_2_10_16_1","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1046\/j.1523-1755.2003.00803.x","article-title":"Reverse Epidemiology of Cardiovascular Risk Factors in Maintenance Dialysis Patients","volume":"63","author":"Kalantar\u2010Zadeh K.","year":"2003","journal-title":"Kidney International"},{"issue":"2","key":"e_1_2_10_17_1","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1016\/j.ekir.2017.01.009","article-title":"The Obesity Paradox in Kidney Disease: How to Reconcile It With Obesity Management","volume":"2","author":"Kalantar\u2010Zadeh K.","year":"2017","journal-title":"Kidney International Reports"},{"key":"e_1_2_10_18_1","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1016\/j.cca.2018.05.046","article-title":"Uric Acid and Cardiovascular Disease","volume":"484","author":"Ndrepepa G.","year":"2018","journal-title":"Clinica Chimica Acta"},{"key":"e_1_2_10_19_1","doi-asserted-by":"crossref","DOI":"10.3389\/fphar.2020.582680","article-title":"Uric Acid and Cardiovascular Disease: An Update From Molecular Mechanism to Clinical Perspective","volume":"11","author":"Yu W.","year":"2020","journal-title":"Frontiers in Pharmacology"},{"issue":"4","key":"e_1_2_10_20_1","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1053\/j.jrn.2021.06.003","article-title":"Consensus\u2010Based Recommendations for the Management of Hyperkalemia in the Hemodialysis Setting","volume":"32","author":"Fishbane S.","year":"2022","journal-title":"Journal of Renal Nutrition"},{"issue":"1","key":"e_1_2_10_21_1","doi-asserted-by":"crossref","first-page":"678","DOI":"10.1159\/000548408","article-title":"Calcium\u2010Phosphorus Metabolism in Chronic Kidney Disease and Its Relationship With Vascular Calcification","volume":"50","author":"Ran L.","year":"2025","journal-title":"Kidney & Blood Pressure Research"},{"issue":"2","key":"e_1_2_10_22_1","doi-asserted-by":"crossref","DOI":"10.3390\/jcm14020643","article-title":"Comprehensive Review of Lipid Management in Chronic Kidney Disease and Hemodialysis Patients: Conventional Approaches, and Challenges for Cardiovascular Risk Reduction","volume":"14","author":"Abidor E.","year":"2025","journal-title":"Journal of Clinical Medicine"},{"issue":"4","key":"e_1_2_10_23_1","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1007\/s10047-022-01379-4","article-title":"Removal Performance of Pre\u2010 and Post\u2010Dilution Online Hemodiafiltration Using Identical Hemodiafilters in the Same Patients","volume":"26","author":"Okada K.","year":"2023","journal-title":"Journal of Artificial Organs"},{"issue":"2","key":"e_1_2_10_24_1","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1016\/j.kint.2016.02.037","article-title":"Preservation of Residual Kidney Function in Hemodialysis Patients: Reviving an Old Concept","volume":"90","author":"Mathew A. T.","year":"2016","journal-title":"Kidney International"},{"issue":"2","key":"e_1_2_10_25_1","doi-asserted-by":"crossref","first-page":"142","DOI":"10.15171\/jrip.2017.28","article-title":"The Relationship Between Dialysis Adequacy and Serum Uric Acid in Dialysis Patients; a Cross\u2010Sectional Multi\u2010Center Study in Iranian Hemodialysis Centers","volume":"6","author":"Nemati E.","year":"2017","journal-title":"Journal of Renal Injury Prevention"}],"container-title":["Hemodialysis International"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/hdi.70105","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/hdi.70105","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/hdi.70105","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T05:52:09Z","timestamp":1782712329000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/hdi.70105"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,28]]},"references-count":24,"alternative-id":["10.1111\/hdi.70105"],"URL":"https:\/\/doi.org\/10.1111\/hdi.70105","archive":["Portico"],"relation":{},"ISSN":["1492-7535","1542-4758"],"issn-type":[{"value":"1492-7535","type":"print"},{"value":"1542-4758","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,28]]},"assertion":[{"value":"2026-01-08","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-12","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-28","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"hdi.70105"}}