爱尔兰卫生系统中慢性肾脏病患者的痛风患病率和治疗情况：一项全国性研究。
Prevalence and treatment of gout among patients with chronic kidney disease in the Irish health system: A national study.
机构信息
Division of Nephrology, Department of Medicine, University Hospital Limerick, Limerick, Ireland.
Graduate Entry Medical School, University of Limerick, Limerick, Ireland.
出版信息
PLoS One. 2019 Jan 25;14(1):e0210487. doi: 10.1371/journal.pone.0210487. eCollection 2019.
BACKGROUND
Gout is a common inflammatory arthritis associated with adverse clinical outcomes. Under treatment is common in the general population. The aim of this study was to determine the prevalence of gout and its treatment among patients with chronic kidney disease (CKD).
METHODS
We conducted a multi-centre cross sectional study of patients (n = 522) who attended specialist nephrology clinics in Ireland. Standardized data collection tool recorded clinical characteristics and medication use at clinic visits and kidney function was assessed with standardised creatinine measurements and Estimated Glomerular Filtration Rate (eGFR). The prevalence of gout and the corresponding use of urate lowering therapies (ULT) were determined. Multivariate logistic regression explored correlates of gout expressed as Odds Ratios (OR) and 95% Confidence Intervals (CI) adjusting for demographic and clinical characteristics.
RESULTS
Overall prevalence of gout was 16.6% and increased significantly from 7.5% in Stage 1-2 CKD to 22.8% in stage 4-5 CKD, P< 0.005. Prevalence increased with age (P < 0.005) and was higher in men than women (19.1% versus 10.3% P< 0.005). Overall, 67.9% of gout patients with CKD were treated with ULT, and the percentage increased with advancing stage of CKD from 55.6% in Stage 1-2 to 77.4% in Stage 4-5, P<0.005. Multivariable modelling identified men (vs women), OR, 1.95 (0.95-4.03), serum albumin, OR 1.09 (1.02-1.16) per 1 g/L lower, poorer kidney function, OR 1.11 (1.01-1.22) per 5 ml/min/1.73m2 lower, and rising parathyroid hormone levels, OR 1.38 (1.08-1.77) per 50 pg/ml higher as disease correlates.
CONCLUSIONS
Gout is common in CKD and increases with worsening kidney function in the Irish health system. Over two thirds of patients with gout were receiving ULT, increasing to 77% of patients with advanced CKD. Greater awareness of gout in CKD, its treatment and the effectiveness of treatment strategies should be vigorously monitored to improve patient outcomes.
背景
痛风是一种常见的炎症性关节炎，与不良临床结局相关。在一般人群中，接受治疗是常见的。本研究的目的是确定慢性肾脏病（CKD）患者中痛风的患病率及其治疗情况。
方法
我们对在爱尔兰专门的肾病诊所就诊的 522 名患者（n=522）进行了一项多中心横断面研究。标准化的数据收集工具记录了就诊时的临床特征和药物使用情况，并通过标准化肌酐测量和估计肾小球滤过率（eGFR）评估肾脏功能。确定了痛风的患病率以及相应的尿酸降低治疗（ULT）的使用情况。多变量逻辑回归分析探讨了痛风的相关性，表现为比值比（OR）和 95%置信区间（CI），并调整了人口统计学和临床特征。
结果
痛风的总体患病率为 16.6%，从 CKD 1-2 期的 7.5%显著增加到 CKD 4-5 期的 22.8%，P<0.005。患病率随年龄增长而增加（P<0.005），且男性高于女性（19.1%比 10.3%，P<0.005）。总体而言，67.9%的 CKD 痛风患者接受了 ULT 治疗，随着 CKD 分期的进展，接受 ULT 治疗的比例从 1-2 期的 55.6%增加到 4-5 期的 77.4%，P<0.005。多变量模型确定男性（与女性相比），OR，1.95（0.95-4.03），血清白蛋白，OR 1.09（1.02-1.16）每降低 1g/L，肾功能更差，OR 1.11（1.01-1.22）每降低 5ml/min/1.73m2，甲状旁腺激素水平升高，OR 1.38（1.08-1.77）每增加 50pg/ml。
结论
痛风在 CKD 中很常见，并且随着爱尔兰卫生系统中肾功能的恶化而增加。超过三分之二的痛风患者正在接受 ULT 治疗，在 CKD 晚期患者中这一比例上升到 77%。应大力监测 CKD 中痛风的认识、治疗及其治疗策略的有效性，以改善患者结局。
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