非布司他治疗稳定期肾移植受者高尿酸血症的疗效与安全性。
Efficacy and safety of febuxostat in the treatment of hyperuricemia in stable kidney transplant recipients.
作者信息
Sofue Tadashi, Inui Masashi, Hara Taiga, Nishijima Yoko, Moriwaki Kumiko, Hayashida Yushi, Ueda Nobufumi, Nishiyama Akira, Kakehi Yoshiyuki, Kohno Masakazu
机构信息
Division of Nephrology and Dialysis, Department of Cardiorenal and Cerebrovascular Medicine, Kagawa University, Kagawa.
Department of Urology, Tokyo Women's Medical University, Tokyo.
出版信息
Drug Des Devel Ther. 2014 Feb 17;8:245-53. doi: 10.2147/DDDT.S56597. eCollection 2014.
BACKGROUND
Post-transplant hyperuricemia (PTHU), defined as serum uric acid concentration ≥7.0 mg/dL or need for treatment with allopurinol or benzbromarone, reduces long-term allograft survival in kidney transplant recipients. Febuxostat, a new nonpurine selective xanthine oxidase inhibitor, is well tolerated in patients with moderate renal impairment. However, its efficacy and safety in kidney recipients with PTHU is unclear. We therefore assessed the efficacy and safety of febuxostat in stable kidney transplant recipients with PTHU.
METHODS
Of 93 stable adult kidney transplant recipients, 51 were diagnosed with PTHU (PTHU group) and 42 were not (NPTHU group). Of the 51 patients with PTHU, 26 were treated with febuxostat (FX group) and 25 were not (NFX group), at the discretion of each attending physician. One-year changes in serum uric acid concentrations, rates of achievement of target uric acid (<6.0 mg/dL), estimated glomerular filtration rates in allografts, and adverse events were retrospectively analyzed in the FX, NFX, and NPTHU groups.
RESULTS
The FX group showed significantly greater decreases in serum uric acid (-2.0±1.1 mg/dL versus 0.0±0.8 mg/dL per year, P<0.01) and tended to show a higher rate of achieving target uric acid levels (50% versus 24%; odds ratio 3.17 [95% confidence interval 0.96-10.5], P=0.08) than the NFX group. Although baseline allograft estimated glomerular filtration rates tended to be lower in the FX group than in the NFX group (40±14 mL/min/1.73 m(2) versus 47±19 mL/min/1.73 m(2)), changes in allograft estimated glomerular filtration rate were similar (+1.0±4.9 mL/min/1.73 m(2) versus -0.2±6.9 mL/min/1.73 m(2) per year, P=0.50). None of the patients in the FX group experienced any severe adverse effects, such as pancytopenia or attacks of gout, throughout the entire study period. Nephrologists were more likely than urologists to start febuxostat in kidney transplant recipients with PTHU (69% versus 8%).
CONCLUSION
Treatment with febuxostat sufficiently lowered uric acid levels without severe adverse effects in stable kidney transplant recipients with PTHU.
背景
移植后高尿酸血症（PTHU）定义为血清尿酸浓度≥7.0mg/dL或需要用别嘌醇或苯溴马隆治疗，它会降低肾移植受者的长期移植肾存活率。非布司他是一种新型非嘌呤选择性黄嘌呤氧化酶抑制剂，在中度肾功能损害患者中耐受性良好。然而，其在PTHU肾移植受者中的疗效和安全性尚不清楚。因此，我们评估了非布司他在稳定的PTHU肾移植受者中的疗效和安全性。
方法
在93例稳定的成年肾移植受者中，51例被诊断为PTHU（PTHU组），42例未被诊断为PTHU（非PTHU组）。在51例PTHU患者中，根据每位主治医师的判断，26例接受非布司他治疗（FX组），25例未接受治疗（NFX组）。对FX组、NFX组和非PTHU组的血清尿酸浓度的一年变化、达到目标尿酸（<6.0mg/dL）的比率、移植肾的估计肾小球滤过率以及不良事件进行回顾性分析。
结果
FX组血清尿酸下降幅度显著大于NFX组（每年-2.0±1.1mg/dL对0.0±0.8mg/dL，P<0.01），且达到目标尿酸水平的比率有更高的趋势（50%对24%；优势比3.17[95%置信区间0.96-10.5]，P=0.08）。虽然FX组移植肾的基线估计肾小球滤过率往往低于NFX组（40±14mL/min/1.73m²对47±19mL/min/1.73m²），但移植肾估计肾小球滤过率的变化相似（每年+1.0±4.9mL/min/1.73m²对-0.2±6.9mL/min/1.73m²，P=0.50）。在整个研究期间，FX组没有患者出现任何严重不良反应，如全血细胞减少或痛风发作。在PTHU肾移植受者中，肾病科医生比泌尿科医生更倾向于开始使用非布司他治疗（69%对8%）。
结论
在稳定的PTHU肾移植受者中，非布司他治疗可充分降低尿酸水平且无严重不良反应。
Zotero 插件