From the Department of Medicine, Dartmouth Hitchcock Medical Center.
Geisel School of Medicine at Dartmouth.
J Clin Rheumatol. 2019 Oct;25(7):279-283. doi: 10.1097/RHU.0000000000000850.
Hyperuricemia has been epidemiologically associated with multiple comorbidities including chronic renal failure and cardiovascular disease. Cause and effect are difficult to address, given comorbidities associated with and prevalence of metabolic syndrome. One impediment to achieving serum uric acid (sUa) levels less than or equal to 6.0 mg/DL is the concept that allopurinol might be nephrotoxic. We examined the relation of sUa less than or equal to 6.0 mg/dL to renal function over time.
This is a medical records review study of 348 hyperuricemia patients identified in 2015, as having been followed with serial uric acid measurements. After 1 year of serial urate levels, to allow for treatment, patient cohorts were defined: sUa less than or equal to 6.0 mg/dL and sUa greater than 6.0 mg/dL. A repeated measure model was used to test for an association between uric acid level and serum creatinine, while adjusting for covariates.
There was a significant difference in the least square means of serum creatinine comparing those who achieved an sUa less than or equal to 6.0 mg/dL versus sUa greater than 6.0 mg/dL (1.39 mg/dL [95% confidence interval, 1.30-1.48] vs 1.57 mg/dL [95% confidence interval, 1.46-1.69]; p = 0.0015). This is a between-group difference in creatinine of 0.18 mg/dL. If a change in serum creatinine of 0.2 is considered significant, this short-term between-group progression of renal failure approaches clinical significance.
Given that most serial measures were within the first few years of follow-up, and change in renal function occurs slowly over time, the between group difference of sUa of 0.18 mg/dL is close to a clinically significant creatinine difference of 0.2 mg/dL.
高尿酸血症与多种合并症相关，包括慢性肾衰竭和心血管疾病。鉴于代谢综合征相关的合并症和患病率，很难确定因果关系。达到血清尿酸（sUa）水平小于或等于 6.0mg/dL 的一个障碍是别嘌呤醇可能具有肾毒性的概念。我们检查了 sUa 小于或等于 6.0mg/dL 与肾功能随时间的关系。
这是一项对 2015 年确定的 348 名高尿酸血症患者的病历回顾研究，这些患者的尿酸水平进行了连续测量。在连续尿酸水平 1 年后，为了允许进行治疗，定义了患者队列：sUa 小于或等于 6.0mg/dL 和 sUa 大于 6.0mg/dL。使用重复测量模型来测试尿酸水平与血清肌酐之间的关联，同时调整协变量。
与 sUa 大于 6.0mg/dL 相比，达到 sUa 小于或等于 6.0mg/dL 的患者的血清肌酐的最小二乘均值有显著差异（1.39mg/dL[95%置信区间，1.30-1.48] vs 1.57mg/dL[95%置信区间，1.46-1.69]；p=0.0015）。这是肌酐的 0.18mg/dL 组间差异。如果血清肌酐的 0.2 变化被认为是显著的，那么这种短期组间肾功能衰竭的进展接近临床意义。
鉴于大多数连续测量值都在随访的前几年内，并且肾功能的变化随时间缓慢发生，sUa 的组间差异为 0.18mg/dL，接近临床意义上显著的肌酐差异 0.2mg/dL。
