Kim Yoonjin, Shin Sungjoon, Kim Kyungsoo, Choi Sangtae, Lee Kwanghoon
From the Division of Nephrology and the Division of Rheumatology, Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang; and the Division of Rheumatology, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, South Korea.Y. Kim, MD, Research Fellow, Division of Nephrology, Department of Internal Medicine, Dongguk University Ilsan Hospital; S. Shin, MD, PhD, Associate Professor, Division of Nephrology, Department of Internal Medicine, Dongguk University Ilsan Hospital; K. Kim, MD, PhD, Professor, Division of Nephrology, Department of Internal Medicine, Dongguk University Ilsan Hospital; S. Choi, MD, Assistant Professor, Division of Rheumatology, Department of Internal Medicine, Chung-Ang University College of Medicine; K. Lee, MD, Assistant Professor, Division of Rheumatology, Department of Internal Medicine, Dongguk University Ilsan Hospital.
J Rheumatol. 2015 Nov;42(11):2143-8. doi: 10.3899/jrheum.150067. Epub 2015 Oct 1.
To determine whether urate lowering therapy (ULT) could delay renal disease progression in hyperuricemic patients with chronic kidney disease (CKD).
We performed a retrospective review of hyperuricemic patients with stage 3 CKD followed from September 2005 to July 2014 in Dongguk University Ilsan Hospital, Goyang, Korea. A total of 158 eligible patients were identified and 65 of them were treated with ULT in addition to the usual CKD management. We divided the patients according to the use of ULT and compared the estimated glomerular filtration rate (eGFR) change from baseline value and the proportion of renal disease progression (decline of eGFR > 30% of the baseline value, initiation of dialysis or eGFR < 15 ml/min/1.73m(2)) at the time of last followup. Risk factors for renal disease progression were identified by logistic regression analysis.
After a median followup of 118.5 weeks (minimum 25, maximum 465), the ULT group showed better outcomes compared to the non-ULT group in terms of eGFR change from baseline (-1.19 ± 12.07 vs -7.37 ± 11.17 ml/min/1.73 m(2), p = 0.001) and the proportion of renal disease progression (12.3% vs 27.9%, p = 0.01). Goal-directed ULT showed better clinical outcomes compared to maintaining the initial ULT dose. Actual (area under the SUA-time curve adjusted by total observation time period) serum uric acid was significantly associated with the risk of renal disease progression (p for trend = 0.04) and actual serum uric acid level < 7 mg/dl reduced the risk of renal disease progression by 69.4%.
ULT significantly delayed renal disease progression in hyperuricemic patients with CKD. Goal-directed ULT seems to be better than continuing the initial ULT prescription.
确定降尿酸治疗（ULT）是否能延缓慢性肾脏病（CKD）高尿酸血症患者的肾病进展。
我们对2005年9月至2014年7月在韩国高阳东国大学一山医院随访的3期CKD高尿酸血症患者进行了回顾性研究。共确定了158例符合条件的患者，其中65例除接受常规CKD管理外还接受了ULT治疗。我们根据ULT的使用情况对患者进行分组，并比较末次随访时估计肾小球滤过率（eGFR）相对于基线值的变化以及肾病进展的比例（eGFR下降超过基线值的30%、开始透析或eGFR<15 ml/min/1.73m²）。通过逻辑回归分析确定肾病进展的危险因素。
中位随访118.5周（最短25周，最长465周）后，ULT组在eGFR相对于基线的变化方面（-1.19±12.07 vs -7.37±11.17 ml/min/1.73 m²，p = 0.001）和肾病进展比例方面（12.3% vs 27.9%，p = 0.01）均显示出比非ULT组更好的结果。目标导向的ULT与维持初始ULT剂量相比显示出更好的临床结果。实际（根据总观察时间段调整的血清尿酸时间曲线下面积）血清尿酸与肾病进展风险显著相关（趋势p值=0.04），实际血清尿酸水平<7 mg/dl可使肾病进展风险降低69.4%。
ULT显著延缓了CKD高尿酸血症患者的肾病进展。目标导向的ULT似乎优于继续初始ULT处方。
