A treat-to-target approach for gout confers renoprotective effect in patients with chronic kidney disease stage 3

Novella-Navarro, Marta; Alarcón, José; Díaz-Torné, Cèsar; Aramburu-Muñoz, Francisco; Janţă, Iustina; O, Maria Carmen Ortega de la; Prada-Ojeda, Alejandro; Sala-Icardo, Luis; Urruticoechea‐Arana, Ana; Lefebvre, Paloma García de la Peña; Calvo-Aranda, Enrique

doi:10.1007/s00296-020-04517-4

Cited by 9 publications

(11 citation statements)

References 24 publications

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“…Asymptomatic hyperuricemia and gout are continuous pathological processes of hyperuricemia. Performing interventions to treat gout in patients with CKD can have benefits such as delaying and ameliorating renal function( Novella-Navarro et al, 2020 ). This issue has been affirmed and recommended by guidelines in China and America.…”

Section: Introductionmentioning

confidence: 99%

Effect of Urate-Lowering Therapy on the Progression of Kidney Function in Patients With Asymptomatic Hyperuricemia: A Systematic Review and Meta-Analysis

Zhang

Mou

et al. 2022

Front. Pharmacol.

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Background: Hyperuricemia is involved in the risk of chronic kidney disease (CKD). However, whether urate-lowering therapy (ULT) can influence the progression of kidney function in patients with asymptomatic hyperuricemia is still controversial. We conducted a systematic review and meta-analysis to evaluate the effect of ULT on the progression of kidney function in asymptomatic hyperuricemia patients.Methods: The MEDLINE, EMBASE and Cochrane databases were searched without language, national or ethnic restrictions for randomized controlled trials published prior to November 30, 2020, that compared ULT with controlled therapy in patients with asymptomatic hyperuricemia.Results: Eleven studies were included for qualitative synthesis. ULT did not ameliorate eGFR slopes (WMD 0.36 ml/min/1.73 m2 per year, 95% CI: −0.31, 1.04), or lead to reductions in kidney events (RR 1.26; 95% CI: 0.80, 2.00) or all-cause mortality (RR 1.00; 95% CI: 0.65, 1.55), although ULT resulted in a decrease in serum uric acid levels (WMD −2.73 mg/dl; 95% CI: −3.18, −2.28) and lowered the incidence of gout episodes (0.9 vs 2.7%, RR 0.38; 95% CI: 0.17, 0.86).Conclusion: In patients with asymptomatic hyperuricemia, ULT did not decay the progression of kidney function. Long-term and larger sample studies are needed to verify the results.Systematic Review Registration: [www.crd.york.ac.uk/PROSPERO/#recordDetails], identifier [CRD42020204482].

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Section: Introductionmentioning

confidence: 99%

Effect of Urate-Lowering Therapy on the Progression of Kidney Function in Patients With Asymptomatic Hyperuricemia: A Systematic Review and Meta-Analysis

Zhang

Mou

et al. 2022

Front. Pharmacol.

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“…A study by Kim reported renal improvement in eGFR <30 ml/min/1.73m 2 , however, the difference was not signi cant (eGFR: 19.84 ml/min/1.73m 2 vs. 23.49 ml/min/1.73m 2 ) [11]. Only a previous study reported that XOIs could help conserve and improve renal function in patients with gout and stage 3 CKD, but the study did not explore the renal safety of febuxostat separately [12]. Most studies on renal protective effects of febuxostat have focused on patients with hyperuricemia and CKD or renal transplant recipients [35,36].…”

Section: Discussionmentioning

confidence: 95%

“…Allopurinol is associated with severe hypersensitivity reaction whereas benzbromarone is contraindicated in patients with a history of nephrolithiasis, thus febuxostat is commonly used in hospitals. Previous studies report that febuxostat is effective in treatment of gout patients with CKD, however, the effects on renal function are controversial, mainly under complex clinical conditions [11][12][13][14].…”

Section: Introductionmentioning

confidence: 99%

Efficacy And Renal Safety of Febuxostat In Management of Gout And Chronic Kidney Disease: A Retrospective Study

Zhang

Chen

Wang

et al. 2021

Preprint

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Background: Elevated serum urate levels are associated with renal deterioration of chronic kidney disease (CKD). Whether urate-lowering treatment with febuxostat can improve renal function or attenuate the decline of the estimated glomerular filtration rate (eGFR) is controversial. The current study sought to explore efficacy and renal safety of febuxostat in gout patients with CKD and explore factors correlated with target serum urate (sUA).Methods: The current study was a single-center retrospective study comprising male gout patients with CKD. sUA, the rate of sUA < 360 µmol/L and renal safety were analyzed in subjects who had been treated with febuxostat for more than 44 weeks. Factors correlated with target sUA were explored by logistic regression analysis. Results: A total of 87 patients who had been diagnosed with gout and CKD met the inclusion criteria for the study. Twenty-five (28.73%) patients presented with stage 2 CKD, 58 (66.67%) were diagnosed with stage 3 CKD and 4 (4.60%) were diagnosed with stage 4 CKD. Analysis of sUA level showed a significant reduction at week 44~ (598.22 ± 95.11 µmol/L vs. 429.76 ± 123.45 μmol/L; P < 0.05), and the RAT increased to 34.50%. eGFR level of all patients was 52.37 ± 11.74 ml/min/1.73cm2 at baseline and 56.51 ± 15.01 ml/min/1.73cm2 at week 44~ (P < 0.05). The findings showed improvement of eGFR level in different stages of CKD, mainly in stage 3 CKD patients (P < 0.05). After stratification based on risk factors of hypertension, diabetic mellitus, hyperlipidemia and the usage of Non-Steroidal Anti-inflammatory Drugs (NSAIDs), the findings showed that eGFR levels of patients with ≤ 1 risk factors showed significant improvement (P < 0.05). Logistic regression analysis indicated that baseline sUA level and acute arthritis were correlated with the RAT in gout and CKD patients treated with febuxostat.Conclusions: In this retrospective study, febuxostat demonstrated effective and renal safety in gout patients with CKD. Baseline sUA level and acute arthritis may affect achieving of target sUA.

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“… 141 , 142 Allopurinol (dosed to achieve target urate levels and not limited by creatinine clearance-based formulae) and febuxostat are effective and safe in people with gout and CKD, 143 , 144 and recent data suggest that lowering urate levels to achieve crystal dissolution may prevent renal function decline in people with gout. 145 , 146 However, the combination of gout and renal disease is full of uncertainties in multiple areas (pathophysiology, prognosis, management, among others) and merits focussed research. 140 …”

Section: Will Gout Management Entail Benefits On Related Diseases?mentioning

confidence: 99%

A glance into the future of gout

Sivera

Andrés

Dalbeth

2022

Therapeutic Advances in Musculoskeletal

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Gout is characterized by monosodium urate (MSU) crystal deposits in and within joints. These deposits result from persistent hyperuricaemia and most typically lead to recurrent acute inflammatory episodes (gout flares). Even though some aspects of gout are well characterized, uncertainties remain; this upcoming decade should provide further insights into many of these uncertainties. Synovial fluid analysis allows for the identification of MSU crystals and unequivocal diagnosis. Non-invasive methods for diagnosis are being explored, such as Raman spectroscopy and imaging modalities. Both ultrasound and dual-energy computed tomography (DECT) allow the detection of MSU crystals; this not only provides a mean of diagnosis, but also has furthered gout knowledge defining the presence of a preclinical deposition in asymptomatic hyperuricaemia. Scientific consensus establishes the beginning of gout as the beginning of symptoms (usually the first flare), but the concept is currently under review. For effective long-term gout management, the main goal is to promote crystal dissolution treatment by reducing serum urate below 6 mg/dL (or 5 mg/dL if faster crystal dissolution is required). Current urate-lowering therapies’ (ULTs) options are limited, with allopurinol and febuxostat being widely available, and probenecid, benzbromarone, and pegloticase available in some regions. New xanthine oxidase inhibitors and, especially, uricosurics inhibiting urate transporter URAT1 are under development; it is probable that the new decade will see a welcomed increase in the gout therapeutic armamentarium. Cardiovascular and renal comorbidities are common in gout patients. Studies determining whether optimal treatment of gout will positively impact these comorbidities are currently lacking, but will hopefully be forthcoming. Overall, the single change that will most impact gout management is greater uptake of international rheumatology society recommendations. Innovative strategies, such as nurse-led interventions based on these recommendations have recently demonstrated treatment success for people with gout.

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A treat-to-target approach for gout confers renoprotective effect in patients with chronic kidney disease stage 3

Cited by 9 publications

References 24 publications

Effect of Urate-Lowering Therapy on the Progression of Kidney Function in Patients With Asymptomatic Hyperuricemia: A Systematic Review and Meta-Analysis

Effect of Urate-Lowering Therapy on the Progression of Kidney Function in Patients With Asymptomatic Hyperuricemia: A Systematic Review and Meta-Analysis

Efficacy And Renal Safety of Febuxostat In Management of Gout And Chronic Kidney Disease: A Retrospective Study

A glance into the future of gout

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