Department of Rheumatology, Immunology and Allergy, Christchurch Hospital, Christchurch, New Zealand.
Department of Medicine, University of Otago, Christchurch, Christchurch, New Zealand.
Intern Med J. 2019 Jul;49(7):838-842. doi: 10.1111/imj.14163.
The management of gout in chronic kidney disease and end-stage renal disease is challenging and remains controversial. There are limited data on the use of urate-lowering therapy in people receiving dialysis.
To estimate the point prevalence of gout, gout treatment and achievement of target serum urate (SU) among adults treated with long-term dialysis.
Three secular cohorts of adults receiving dialysis for at least 90 days on 1 February 2017, 1 January 2016 and 1 January 2015 were identified. Medical records were reviewed for SU concentrations. Results were compared between haemodialysis (HD) and peritoneal dialysis (PD), and participants prescribed and not prescribed urate-lowering therapy. The percentage reduction in SU 24- and 48-h post-HD was estimated based on data from a previous study. SU concentrations were then used to estimate the percentage time the SU was <0.36 mmol/L using linear interpolation.
Of 216 dialysis patients, 61 (point prevalence 28.2%, 95% confidence interval 22.35-34.8%) had a diagnosis of gout. The mean (SD) age among those with gout was 61 years (14.4), 46 (75.4%) were men and 18 (31.1%) identified as Māori or Pacific Island. Forty-two (68.9%) were prescribed allopurinol (mean (SD) dose 116.0 ± 66.9 mg/day). 46% had a predialysis SU ≤0.36 mmol/L on less than 25% of occasions and 23% were below target on 76-100% of occasions. SU was below target 41% of time, with no statistically significant difference in those on HD or PD (P = 0.39), and those prescribed or not prescribed allopurinol (P = 0.55).
Gout is experienced by approximately one in four adults treated with dialysis and two-thirds are prescribed allopurinol. A minority have SU at a target sufficient to prevent gout despite allopurinol and HD. A treat to target SU should be considered in those with SU above target.
慢性肾脏病和终末期肾病患者的痛风管理具有挑战性，且仍存在争议。接受透析治疗的人群中降尿酸治疗的应用数据有限。
评估至少接受 90 天透析治疗的成年人中痛风的现患率、痛风治疗及达标血清尿酸（SU）情况。
2017 年 2 月 1 日、2016 年 1 月 1 日和 2015 年 1 月 1 日，分别确定了三个接受透析治疗至少 90 天的成年人时间序列队列。回顾医疗记录，以获取 SU 浓度。比较血液透析（HD）和腹膜透析（PD）患者、以及接受和未接受降尿酸治疗的患者之间的结果。根据先前研究的数据，估计 HD 治疗后 24 小时和 48 小时时 SU 降低百分比。然后，使用 SU 浓度，通过线性内插法估计 SU ＜0.36mmol/L 的时间百分比。
在 216 名透析患者中，61 名（现患率 28.2%，95%置信区间 22.35-34.8%）诊断为痛风。痛风患者的平均（SD）年龄为 61 岁（14.4），46 名（75.4%）为男性，18 名（31.1%）为毛利人或太平洋岛民。42 名（68.9%）患者接受别嘌醇治疗（平均（SD）剂量为 116.0 ± 66.9mg/天）。46%的患者在不到 25%的时间里，透析前 SU ≤0.36mmol/L，23%的患者在 76-100%的时间里达到目标值。SU 达标时间占 41%，但在接受 HD 或 PD 治疗的患者（P = 0.39）以及接受或未接受别嘌醇治疗的患者（P = 0.55）之间无统计学差异。
约四分之一接受透析治疗的成年人患有痛风，其中三分之二的患者接受别嘌醇治疗。尽管使用了别嘌醇和 HD，但仍有少数患者的 SU 未能达到足以预防痛风的目标值。对于 SU 高于目标值的患者，应考虑 SU 达标治疗。
