Comprehensive Conservative Management Versus Dialysis in Uric Acid Control

Background: Hyperuricemia is a well-known problem in end-stage kidney disease. Currently, the end-stage kidney disease patients may be treated with comprehensive conservative management, hemodialysis, or peritoneal dialysis, which impact uric acid levels distinctly. We assessed the impact of these strategies on uric acid control and identified the factors that influence it. Methods: We conducted a preliminary case-control study comparing patients in comprehensive conservative management, hemodialysis and peritoneal dialysis. For each patient, we evaluated demographic characteristics, comorbidities, body mass index, protein intake, urine output and blood test results. Results: In the entire population, uric acid levels were slightly higher in the comprehensive conservative management group. Furthermore, uric acid control was influenced primarily by body mass index (beta = -0.005, p = 0.03) and treatment modality (beta = -0.0026, p = 0.05). In comprehensive conservative management, body mass index (beta = -0.007, p = 0.02) and urine urea excretion (beta = 0.014, p = 0.04) were independent predictors of uric acid level. Conversely, only the suggested protein intake (beta = 0.16, p = 0.05), potassium levels (beta = -0.046, p = 0.04) and allopurinol therapy (beta = -0.073, p = 0.03) were independent predictors of uric acid in hemodialysis patients. Finally, only the recommended protein intake (B = -0.005, p = 0.03) was associated with uric acid levels in patients undergoing peritoneal dialysis. Conclusions: In our series, uric acid control correlates with the treatment modality used for end-stage kidney disease and dietary protein intake.