Krishnamurthy Aneesa, Lazaro Deana, Stefanov Dimitre G, Blumenthal David, Gerber Donald, Patel Sheetal
From the SUNY Downstate Medical Center, Veterans Administration New York Harbor, Brooklyn, NY.
J Clin Rheumatol. 2017 Jan;23(1):1-5. doi: 10.1097/RHU.0000000000000480.
Hyperuricemia is associated with development of gout, hypertension, and renal disease. The impact of allopurinol, a urate-lowering therapy, on renal function is unclear, especially in patients with chronic kidney disease who are at higher risk of hypersensitivity reaction.
The aim of this study was to determine the effect of allopurinol on kidney function in hyperuricemic male veterans.
This is a retrospective cohort study using pharmacy, medical, and laboratory records of veterans enrolled at the Veterans Administration New York Harbor Healthcare System, Brooklyn campus. Fifty patients with hyperuricemia defined as a serum uric acid greater than 7 mg/dL (average of ~9 mg/dL), newly started on allopurinol for any reason, with evidence of treatment compliance, were matched by age, race, sex, and estimated glomerular filtration rate (EGFR) to 50 hyperuricemic control subjects. The retrospective cases were observed from October 2000 until November 2006, at which time there was a change in the laboratory analyzer, making further comparisons inappropriate.
On average, patients treated with a mean 221 (SD, 96) mg/d dose of allopurinol achieved 11.9 mL/min higher GFR (95% confidence interval, 4.8-11.9 mg/d dose; P = 0.01) than did the control group. Treatment effect was found to depend on the initial EGFR, as indicated by the significant treatment by initial EGFR interaction (P = 0.004) and increased with a higher initial EGFR. The allopurinol-treated group had a 0.10 mg/dL lower final creatinine level (95% confidence interval, 0.003-0.20 mg/dL; P = 0.04) than did the control subjects, adjusted for initial creatinine and age. The average length of follow-up was 3.4 years. There were 5 mild adverse events in the treated cases.
Treatment of hyperuricemic patients with allopurinol over an average of 3.4 years resulted in a significant improvement of kidney function in this male cohort from the Veterans Administration Healthcare System. Clinicians should consider this potential benefit of allopurinol in the treatment of patients with hyperuricemia, those with overall maintained renal function.
高尿酸血症与痛风、高血压及肾脏疾病的发生相关。别嘌醇作为一种降尿酸治疗药物，其对肾功能的影响尚不清楚，尤其是在发生超敏反应风险较高的慢性肾脏病患者中。
本研究旨在确定别嘌醇对高尿酸血症男性退伍军人肾功能的影响。
这是一项回顾性队列研究，利用纽约港退伍军人管理局医疗保健系统布鲁克林校区登记的退伍军人的药房、医疗和实验室记录。50例高尿酸血症患者（定义为血清尿酸大于7mg/dL，平均约9mg/dL），因任何原因新开始使用别嘌醇，且有治疗依从性证据，根据年龄、种族、性别和估计肾小球滤过率（EGFR）与50例高尿酸血症对照受试者匹配。回顾性病例观察时间为2000年10月至2006年11月，此时实验室分析仪发生了变化，使得进一步比较变得不合适。
平均而言，接受平均剂量为221（标准差，96）mg/d别嘌醇治疗的患者，其肾小球滤过率（GFR）比对照组高11.9mL/min（95%置信区间，4.8-11.9mg/d剂量；P=0.01）。如初始EGFR的显著治疗交互作用所示（P=0.004），治疗效果取决于初始EGFR，并随初始EGFR升高而增加。调整初始肌酐和年龄后，别嘌醇治疗组的最终肌酐水平比对照组低0.10mg/dL（95%置信区间，0.003-0.20mg/dL；P=0.04）。平均随访时间为3.4年。治疗病例中有5例轻度不良事件。
在退伍军人管理局医疗保健系统的这个男性队列中，对高尿酸血症患者平均使用别嘌醇治疗3.4年可使肾功能显著改善。临床医生在治疗高尿酸血症患者（肾功能总体保持的患者）时应考虑别嘌醇的这一潜在益处。
