Yamaguchi Akinori, Harada Makoto, Yamada Yosuke, Hashimoto Koji, Kamijo Yuji
Department of Nephrology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan.
BMC Nephrol. 2017 May 18;18(1):162. doi: 10.1186/s12882-017-0572-z.
The ability of antihyperuricemic therapy to exert renoprotective effects in patients with chronic kidney disease (CKD) is controversial. In the present study, we studied patient characteristics that may mask favorable impact of antihyperuricemic therapy on the progression of CKD.
This was a single-center, retrospective, follow-up study. One-hundred and seventy-eight CKD patients with hyperuricemia who received febuxostat therapy were included in this study. Mean serum uric acid (mUA) level after treatment and changes in estimated glomerular filtration rate (ΔeGFR) over 6 months were measured and their correlation was examined. Patients were divided into two groups based on mUA, and their ΔeGFR were compared. These analyses were evaluated in various subgroups.
Febuxostat therapy markedly decreased UA level in any CKD stage patients without resulting in serious adverse events. eGFRs of CKD patients in the mUA < 6.0 mg/dl group were maintained, whereas those in the mUA ≥ 6.0 mg/dl group decreased. A significant inverse correlation was observed between mUA and ΔeGFR (r = -0.16, p = 0.019). The renoprotective effects of febuxostat were significant in the following subgroups: male patients, age < 70 years, systolic blood pressure < 130 mmHg, normal cholesterol levels, and absence of diabetes. Coexisting vascular risk factors appear to exert additive masking effects against febuxostat renoprotection.
The results of this study suggest that various vascular risk factors markedly attenuate the renoprotective effects of febuxostat.
抗高尿酸血症疗法对慢性肾脏病（CKD）患者发挥肾脏保护作用的能力存在争议。在本研究中，我们研究了可能掩盖抗高尿酸血症疗法对CKD进展有利影响的患者特征。
这是一项单中心、回顾性、随访研究。本研究纳入了178例接受非布司他治疗的高尿酸血症CKD患者。测量治疗后的平均血清尿酸（mUA）水平以及6个月内估算肾小球滤过率（ΔeGFR）的变化，并检查它们之间的相关性。根据mUA将患者分为两组，并比较他们的ΔeGFR。在各个亚组中进行了这些分析。
非布司他治疗显著降低了任何CKD阶段患者的尿酸水平，且未导致严重不良事件。mUA < 6.0 mg/dl组的CKD患者的eGFR得以维持，而mUA≥6.0 mg/dl组的患者eGFR下降。观察到mUA与ΔeGFR之间存在显著的负相关（r = -0.16，p = 0.019）。非布司他的肾脏保护作用在以下亚组中显著：男性患者、年龄<70岁、收缩压<130 mmHg、胆固醇水平正常以及无糖尿病。并存的血管危险因素似乎对非布司他的肾脏保护作用具有累加的掩盖效应。
本研究结果表明，各种血管危险因素显著减弱了非布司他的肾脏保护作用。
