Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
BMC Nephrol. 2014 Apr 16;15:63. doi: 10.1186/1471-2369-15-63.
The role of hyperuricemia in disease progression of autosomal dominant polycystic kidney disease (ADPKD) has not been defined well. We investigated the association of serum uric acid (sUA) with renal function and the effect of hypouricemic treatment on the rate of renal function decline.
This is a single-center, retrospective, observational cohort study. A total of 365 patients with ADPKD who had estimated glomerular filtration rate (eGFR) ≥ 15 mL/min/1.73 m2 and who were followed up for > 1 year were included in our analysis. Hyperuricemia was defined by a sUA level of ≥ 7.0 mg/dL in male and ≥ 6.0 mg/dL in female or when hypouricemic medications were prescribed.
Hyperuricemia was associated with reduced initial eGFR, independent of age, sex, hypertension, albuminuria, and total kidney volume. During a median follow-up period of over 6 years, patients with hyperuricemia showed a faster annual decline in eGFR (-6.3% per year vs. -0.9% per year, p = 0.008). However, after adjusting for age, sex, hypertension and initial eGFR, sUA was no longer associated with either annual eGFR decline or the development of ESRD. Among 53 patients who received hypouricemic treatment, the annual eGFR decline appeared to be attenuated after hypouricemic treatment (pretreatment vs. posttreatment: -5.3 ± 8. 2 vs. 0.2 ± 6.2 mL/min/1.73 m2 per year, p = 0.001 by Wilcoxon signed-rank test).
Although hyperuricemia was associated with reduced eGFR, it was not an independent factor for renal progression in ADPKD. However, the correction of hyperuricemia may attenuate renal function decline in some patients with mild renal insufficiency.
高尿酸血症在常染色体显性多囊肾病（ADPKD）疾病进展中的作用尚未明确。我们研究了血清尿酸（sUA）与肾功能的关系，以及低尿酸血症治疗对肾功能下降速度的影响。
这是一项单中心、回顾性、观察性队列研究。共纳入 365 例 eGFR≥15mL/min/1.73m2且随访时间>1 年的 ADPKD 患者。高尿酸血症定义为男性 sUA 水平≥7.0mg/dL，女性 sUA 水平≥6.0mg/dL，或给予降尿酸药物治疗。
高尿酸血症与初始 eGFR 降低有关，与年龄、性别、高血压、白蛋白尿和总肾体积无关。在中位随访 6 年以上期间，高尿酸血症患者的 eGFR 年下降速度更快（-6.3%/年比-0.9%/年，p=0.008）。然而，在校正年龄、性别、高血压和初始 eGFR 后，sUA 与 eGFR 年下降率或 ESRD 的发生均无相关性。在 53 例接受降尿酸治疗的患者中，降尿酸治疗后 eGFR 年下降速度似乎减弱（治疗前 vs. 治疗后：-5.3±8.2 vs. 0.2±6.2mL/min/1.73m2/年，Wilcoxon 符号秩检验，p=0.001）。
尽管高尿酸血症与 eGFR 降低有关，但它不是 ADPKD 患者肾功能进展的独立因素。然而，在一些轻度肾功能不全的患者中，纠正高尿酸血症可能会减缓肾功能下降速度。
