Serum uric acid-to-albumin ratio as a novel predictor of all-cause mortality and cardiovascular events in hemodialysis patients: a retrospective cohort study.

Background: Cardiovascular disease (CVD) is the leading cause of death in patients undergoing hemodialysis. The uric acid-to-albumin ratio (UAR), a novel marker, has been linked to cardiovascular diseases. However, its role in patients undergoing hemodialysis has not yet been studied. We aimed to investigate the association between UAR and the all-cause mortality and CVD events in hemodialysis patients. Methods: This single center retrospective cohort study was conducted between January 2021 and April 2024. Based on baseline UAR values, patients were categorized into tertiles. The associations between UAR and clinical outcomes were examined using Univariate and multivariate Cox regression models. Kaplan-Meier curves were used to estimate cumulative survival and CVD-free survival rates. Results: A total of 310 patients undergoing hemodialysis were included. During the 40-month follow-up period, 101 (32.6%) died, and 105 (33.9%) experienced new-onset CVD events. Kaplan-Meier survival curves showed significantly higher mortality rates in the middle and high UAR groups than in the low UAR group (Log rank= 10.684, Conclusion: This study demonstrates for the first time that UAR is independently and significantly associated with all-cause mortality and CVD events in patients undergoing hemodialysis. These findings position UAR as a composite biomarker integrating inflammatory, metabolic, and nutritional pathways and provide a novel perspective for improving outcomes in patients undergoing hemodialysis.