Aoun Mabel, Salloum Rayane, Dfouni Antoine, Sleilaty Ghassan, Chelala Dania
Clin Nephrol. 2020 Aug;94(2):61-69. doi: 10.5414/CN109867.
Febuxostat is initiated in chronic kidney disease (CKD) patients to lower uric acid but without any renal dosing scheme. This study aimed to determine a formula that predicts the effective dose of febuxostat in patients with an estimated glomerular filtration rate (eGFR) < 60 mL/min and asymptomatic hyperuricemia.
This is a retrospective analysis of 100 CKD patients treated with febuxostat for asymptomatic hyperuricemia in two private Lebanese clinics. Patients with gout were excluded. Collected variables were age, sex, weight, serum creatinine, serum uric acid (sUA) before and after febuxostat, dose of febuxostat used, and diuretic use. Multiple regression analysis was used to derive a formula predicting the dose of febuxostat based on eGFR (2009 Chronic Kidney Disease Epidemiology Collaboration equation), baseline sUA, and sUA reduction ratio. A prospective cohort of 24 patients was then used to validate the derived model.
100 patients were included with a median age of 71.5 years (interquartile range (IQR), 64.2 - 79.0); 69% were men. Median baseline sUA was 9.1 mg/dL (IQR, 8.4 - 10.1). Mean eGFR was 31.80 ± 12.96 mL/min/1.73m. Of the included patients, 18% had CKD stage 3a, 36% had CKD stage 3b, 38% had CKD stage 4, and 8% had non-dialysis CKD stage 5. A formula was computed to predict febuxostat dosing. Variables that were predictive of febuxostat dose and used in the final equation were eGFR, diuretic use, baseline sUA, and sUA reduction ratio. The validation cohort showed no significant difference between the expected sUA and the measured one (p = 0.16).
With this new formula, physicians can initiate febuxostat in CKD patients at an effective dose for any desired sUA reduction ratio.
非布司他用于慢性肾脏病（CKD）患者以降低尿酸水平，但尚无肾脏给药方案。本研究旨在确定一个公式，用于预测估算肾小球滤过率（eGFR）<60 mL/min且无症状高尿酸血症患者的非布司他有效剂量。
这是一项对黎巴嫩两家私立诊所中接受非布司他治疗无症状高尿酸血症的100例CKD患者的回顾性分析。排除痛风患者。收集的变量包括年龄、性别、体重、血清肌酐、非布司他治疗前后的血清尿酸（sUA）、所用非布司他剂量以及利尿剂使用情况。采用多元回归分析得出一个基于eGFR（2009年慢性肾脏病流行病学协作组方程）、基线sUA和sUA降低率来预测非布司他剂量的公式。随后使用24例患者的前瞻性队列对推导模型进行验证。
纳入100例患者，中位年龄71.5岁（四分位间距（IQR），64.2 - 79.0）；69%为男性。基线sUA中位数为9.1 mg/dL（IQR，8.4 - 10.1）。平均eGFR为31.80±12.96 mL/min/1.73m²。纳入患者中，18%为CKD 3a期，36%为CKD 3b期，38%为CKD 4期，8%为非透析CKD 5期。计算出一个预测非布司他给药剂量的公式。最终方程中用于预测非布司他剂量的变量为eGFR、利尿剂使用情况、基线sUA和sUA降低率。验证队列显示预期sUA与实测sUA之间无显著差异（p = 0.16）。
借助这个新公式，医生可以针对任何期望的sUA降低率，以有效剂量在CKD患者中起始使用非布司他。
