Kim Woo-Joong, Song Jung Soo, Choi Sang Tae
Division of Rheumatology, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul 06974, Korea.
J Clin Med. 2019 Jul 20;8(7):1067. doi: 10.3390/jcm8071067.
: Although gout is accompanied by the substantial burden of kidney disease, there are limited data to assess renal function as a therapeutic target. This study evaluated the importance of implementing a "treat-to-target" approach in relation to renal outcomes. : Patients with gout who underwent continuous urate-lowering therapy (ULT) for at least 12 months were included. The effect of ULT on renal function was investigated by means of a sequential comparison of the estimated glomerular filtration rate (eGFR). : Improvement in renal function was only demonstrated in subjects in whom the serum urate target of <6 mg/dL was achieved (76.40 ± 18.81 mL/min/1.73 m vs. 80.30 ± 20.41 mL/min/1.73 m, < 0.001). A significant difference in the mean change in eGFR with respect to serum urate target achievement was shown in individuals with chronic kidney disease stage 3 (-0.35 ± 3.87 mL/min/1.73 m vs. 5.33 ± 11.64 mL/min/1.73 m, = 0.019). Multivariable analysis predicted that patients ≥65 years old had a decreased likelihood of improvement (OR 0.31, 95% CI 0.13-0.75, = 0.009). : The "treat-to-target" approach in the long-term management of gout is associated with better renal outcomes, with a greater impact on those with impaired renal function.
尽管痛风伴有严重的肾脏疾病负担，但评估肾功能作为治疗靶点的数据有限。本研究评估了实施“达标治疗”方法对肾脏结局的重要性。纳入接受持续降尿酸治疗（ULT）至少12个月的痛风患者。通过对估计肾小球滤过率（eGFR）进行序贯比较来研究ULT对肾功能的影响。仅在血清尿酸目标达到<6mg/dL的受试者中显示出肾功能改善（76.40±18.81mL/min/1.73m²对80.30±20.41mL/min/1.73m²，P<0.001）。在3期慢性肾脏病患者中，eGFR平均变化相对于血清尿酸目标达成情况存在显著差异（-0.35±3.87mL/min/1.73m²对5.33±11.64mL/min/1.73m²，P=0.019）。多变量分析预测，≥65岁的患者改善可能性降低（OR 0.31，95%CI 0.13 - 0.75，P=0.009）。痛风的长期管理中采用“达标治疗”方法与更好的肾脏结局相关，对肾功能受损者影响更大。
