Effect of Urate Lowering Therapy on Renal Disease Progression in Hyperuricemic Patients with Chronic Kidney Disease

Kim, Yoonjin; Shin, So Young; Kim, Kyung-Soo; Choi, Sehoon; Lee, Kwang-Hoon

doi:10.3899/jrheum.150067

Cited by 11 publications

(10 citation statements)

References 20 publications

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“…It was reported that SUA level was independently associated with the progression of LN and prediction of future development of pulmonary hypertension in SLE patients [ 8 , 9 ]. Urate lowering therapy (ULT) could dramatically modify the course of renal disease in HUA patients with chronic kidney disease (CKD) and the risk of renal disease progression can be reduced by 69.4% with SUA level < 420 μmol/l [ 10 ]. Therefore, greater emphasis needs to be placed on CKD patients with HUA, even during the early stages of the disease.…”

Section: Introductionmentioning

confidence: 99%

The prevalence, subtypes and associated factors of hyperuricemia in lupus nephritis patients at chronic kidney disease stages 1-3

Liu

Gong²,

Ren

et al. 2017

Oncotarget

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There is a high prevalence of hyperuricemia (HUA) in the chronic kidney disease (CKD) population. However, there’s a dearth of research on HUA’s prevalence, subtypes, early detection, and treatment strategies of HUA in lupus nephritis (LN) patients. The aim of this study is to address these knowledge gaps. LN patients presenting to the Department of Nephrology at Shanghai Rui Jin Hospital from January 2011 to January 2016 were recruited. The effective sample size was derived using the power analysis. The demographic, clinical and laboratory characteristics of the LN patients with HUA were compared with those of patients without HUA. Two statistical models for analyzing HUA were built and compared using the receiver operating characteristic (ROC) curve analysis. The total prevalence of HUA in the cohort was 40.11%. The subtypes of HUA included urate underexcretion-type, overproduction-type and combined-type, which proportion being 67.7%, 9.7% and 22.6% respectively. The CKD stage was closely associated with the prevalence of HUA in patients with LN. The other significant associated factors were hypertension, triglycerides, serum creatinine, serum albumin, hemoglobin, parathyroid hormone, phosphorus, calcium, etc. The statistical algorithm successfully identified LN patients at risk of HUA. In conclusion, there was a high prevalence of HUA in LN patients at CKD stages 1–3, and renal underexcretion hyperuricemia was the most prevalent subtype. The occurrence of HUA in LN may be related to renal insufficiency, metabolic disorder and lupus itself. Early care coordination programs can employ risk models to improve HUA prevention and target interventions in LN patients.

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Section: Introductionmentioning

confidence: 99%

The prevalence, subtypes and associated factors of hyperuricemia in lupus nephritis patients at chronic kidney disease stages 1-3

Liu

Gong²,

Ren

et al. 2017

Oncotarget

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“…Nonetheless, drugs targeting to decrease serum UA level have emerged as promising therapeutic options for slowing CKD progression for patients with mild‐to‐moderate CKD (eGFR ≥ 30 mL/min/1.73 m 2 ) . One longitudinal study has found that the unfavorable effect of elevated UA trajectories on progression to ESRD is differentially higher among patients with CKD without using urate‐lowering agents at baseline .…”

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confidence: 99%

Comparative Renoprotective Effect of Febuxostat and Allopurinol in Predialysis Stage 5 Chronic Kidney Disease Patients: A Nationwide Database Analysis

Hsu

Chang

et al. 2019

Clin Pharma and Therapeutics

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Hyperuricemia has been associated with chronic kidney disease (CKD) progression. The antihyperuricemic febuxostat's potential renoprotective effect has been demonstrated in stage 1-3 CKD. Large-scale studies comparing the renoprotective potential of febuxostat and allopurinol in advanced CKD are lacking. We exclusively selected 6,057 eligible patients with predialysis stage 5 CKD prescribed either febuxostat or allopurinol using the National Health Insurance Research Database in Taiwan during 2012-2015. There were 69.57% of allopurinol users and 42.01% febuxostat users who required long-term dialysis (P < 0.0001). The adjusted hazard ratio (HR) of 0.65 (95% confidence interval (CI) 0.60-0.70) indicated near 35% lower hazards of long-term dialysis with febuxostat use. The renal benefit of febuxostat was consistent across most patient subgroups and/or using the propensity score-matched cohort. The adjusted HR was 0.66 (95% CI, 0.61-0.70) for long-term dialysis or death. In conclusion, lower risk of progression to dialysis was observed in predialysis stage 5 CKD febuxostat users without compromising survival.

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“…Perspectives on improving kidney disease through maintenance of serum urate below the target level were presented in recent observational studies. Statistically significantly lower likelihood of kidney disease progression resulted from long-term ULT, and individuals who had achieved the target serum urate concentration by dose adjustment had better renal outcomes compared to those maintained on the initial dosage, as reported by Kim et al [37]. This scheme was supported by Levy and colleagues [38,39] who claimed that lowering the serum urate concentration below 6 mg/dL resulted in higher rates of eGFR improvement.…”

Section: Discussionmentioning

confidence: 65%

The Role of a “Treat-to-Target” Approach in the Long-Term Renal Outcomes of Patients with Gout

Kim

Song

Choi

2019

JCM

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Background: Although gout is accompanied by the substantial burden of kidney disease, there are limited data to assess renal function as a therapeutic target. This study evaluated the importance of implementing a “treat-to-target” approach in relation to renal outcomes. Methods: Patients with gout who underwent continuous urate-lowering therapy (ULT) for at least 12 months were included. The effect of ULT on renal function was investigated by means of a sequential comparison of the estimated glomerular filtration rate (eGFR). Results: Improvement in renal function was only demonstrated in subjects in whom the serum urate target of <6 mg/dL was achieved (76.40 ± 18.81 mL/min/1.73 m2 vs. 80.30 ± 20.41 mL/min/1.73 m2, p < 0.001). A significant difference in the mean change in eGFR with respect to serum urate target achievement was shown in individuals with chronic kidney disease stage 3 (−0.35 ± 3.87 mL/min/1.73 m2 vs. 5.33 ± 11.64 mL/min/1.73 m2, p = 0.019). Multivariable analysis predicted that patients ≥65 years old had a decreased likelihood of improvement (OR 0.31, 95% CI 0.13–0.75, p = 0.009). Conclusions: The “treat-to-target” approach in the long-term management of gout is associated with better renal outcomes, with a greater impact on those with impaired renal function.

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Effect of Urate Lowering Therapy on Renal Disease Progression in Hyperuricemic Patients with Chronic Kidney Disease

Abstract: ULT significantly delayed renal disease progression in hyperuricemic patients with CKD. Goal-directed ULT seems to be better than continuing the initial ULT prescription.

Cited by 11 publications

References 20 publications

The prevalence, subtypes and associated factors of hyperuricemia in lupus nephritis patients at chronic kidney disease stages 1-3

The prevalence, subtypes and associated factors of hyperuricemia in lupus nephritis patients at chronic kidney disease stages 1-3

Comparative Renoprotective Effect of Febuxostat and Allopurinol in Predialysis Stage 5 Chronic Kidney Disease Patients: A Nationwide Database Analysis

The Role of a “Treat-to-Target” Approach in the Long-Term Renal Outcomes of Patients with Gout

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