Fülöp Tibor, Koch Christian A, Norris Lindsey T, Rodríguez Betzaida, Szarvas Tibor, Lengvárszky Zsolt, Csongrádi Éva, Dixit Mehul P
From the Medical Services, Ralph H. Johnson VA Medical Center, Charleston, the Department of Medicine III, Technical University of Dresden, Dresden, Germany, the Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, University of Mississippi Medical Center, Jackson, the Department of Medicine, Division of Nephrology, University of Mississippi Medical Center, Jackson, the Department of Mathematics, Louisiana State University, Shreveport, the Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary, and the Department of Pediatrics, Division of Pediatric Nephrology, University of Mississippi Medical Center, Jackson.
South Med J. 2018 Sep;111(9):549-555. doi: 10.14423/SMJ.0000000000000862.
Uric acid (UA) control may be insufficient in chronic kidney disease (CKD) patients in the current era. It is unclear, however, whether this is the result of environmental effects, patient anthropometrics or insufficient dosing of medical therapy (allopurinol).
We have collected data on multiple clinical and laboratory parameters of 114 CKD clinic patients attending the nephrology clinic of the University of Mississippi Medical Center with an estimated glomerular filtration rate <45 mL · min · 1.73 m. We assessed the correlates of UA levels and the allopurinol doses along with achieved serum UA and urine pH.
The cohort consisted of middle-aged to elderly patients with a mean (± standard deviation) age of 62.1 (11.6) years; 45.6% were female, 68.4% were African American and 47.4% had a history of gout. The mean UA level was 7.7 (2.49) mg/dL (range 3.1-16), allopurinol dose was 192 (99) mg/day (range 50-450) and estimated glomerular filtration rate was 23.8 (11.3) mL · min · 1.73 m. While the overall serum bicarbonate level was 25 (3.2) mEq/L, urine pH was <6 in 60.5% of the cohort. Significant univariate correlates of the administered doses of allopurinol were weight ( 0.317, = 0.001), body mass index (BMI; 0.313, = 0.001), and female sex (0.198; = 0.035). Achieved UA levels correlated directly with BMI ( 0.201, = 0.036) but inversely with the allopurinol dose ( -0.196; = 0.036). During logistic regression analysis with stepwise selection, only weight (β 0.313, = 0.001) and sex (β -0.190, = 0.039) proved to be predictive of the allopurinol dose; as for the achieved UA level, only BMI (β 0.271, = 0.006) and the allopurinol dose (β -0.258; = 0.009) had a significant effect.
In patients with advanced CKD, conventional dosing recommendations for allopurinol are unlikely to suffice in reaching target serum UA goals. In our cohort, larger-than-usual allopurinol doses were well tolerated.
在当前时代，慢性肾脏病（CKD）患者的尿酸（UA）控制可能并不充分。然而，尚不清楚这是环境因素、患者人体测量学指标的影响，还是药物治疗（别嘌醇）剂量不足所致。
我们收集了密西西比大学医学中心肾脏病门诊114例估计肾小球滤过率<45 mL·min·1.73 m²的CKD门诊患者的多项临床和实验室参数数据。我们评估了UA水平、别嘌醇剂量与达到的血清UA及尿液pH值之间的相关性。
该队列包括中年至老年患者，平均（±标准差）年龄为62.1（11.6）岁；45.6%为女性，68.4%为非裔美国人，47.4%有痛风病史。平均UA水平为7.7（2.49）mg/dL（范围3.1 - 16），别嘌醇剂量为192（99）mg/天（范围50 - 450），估计肾小球滤过率为23.8（11.3）mL·min·1.73 m²。虽然总体血清碳酸氢盐水平为25（3.2）mEq/L，但60.5%的队列患者尿液pH值<6。别嘌醇给药剂量的显著单因素相关因素为体重（r = 0.317，P = 0.001）、体重指数（BMI；r = 0.313，P = 0.001）和女性性别（r = 0.198；P = 0.035）。达到的UA水平与BMI直接相关（r = 0.201，P = 0.036），但与别嘌醇剂量呈负相关（r = -0.196；P = 0.036）。在逐步选择的逻辑回归分析中，只有体重（β = 0.313，P = 0.001）和性别（β = -0.190，P = 0.039）被证明是别嘌醇剂量的预测因素；至于达到的UA水平，只有BMI（β = 0.271，P = 0.006）和别嘌醇剂量（β = -0.258；P = 0.009）有显著影响。
在晚期CKD患者中，别嘌醇的传统给药建议不太可能足以达到目标血清UA水平。在我们的队列中，大于常规剂量的别嘌醇耐受性良好。
