Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.
Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon.
BMC Nephrol. 2020 Aug 31;21(1):378. doi: 10.1186/s12882-020-02037-8.
Uricemia dramatically rises with the stage of chronic kidney disease (CKD) and correlates with its mortality. Hemodialysis (HD) being the most used treatment at the end stage in sub-Saharan Africa, we sought to evaluate its efficacy on the clearance of uric acid (UAc) when used alone and twice per week.
A cross-sectional study of all consenting patients with CKD stage 5 recruited at random during HD sessions in a reference Centre in Cameroon from January to April 2017. We collected socio-demographic data, relevant clinical information, HD related variables, and measured serum uric acid (SUA) levels before and after the dialysis to assess the uric acid clearance. A clearance between 65 and 80% and above 80% was considered as low and good efficacy of HD respectively. Statistical analysis was performed using SPSS version 21.0. Factors associated with HD efficacy were assessed using Fisher's exact test and are presented with their odds ratios (OR) and 95% confidence levels.
One hundred four patients (53 females) were included. The mean age was 49.9 ± 13.3 years. Hypertension (25%) and chronic glomerulonephritis (16%) were the main suspected etiologies of CKD. The median time on renal replacement therapy by HD was 3 years [1; 6]. The prevalence of hyperuricemia was 81.9%. The means of SUA levels were 78.8 ± 13.8 mg/L and 26.4 ± 6.6 mg/L respectively before and after dialysis. Mean SUA clearance was 66% ± 10%. The efficacy of HD on UAc was moderate in 92 (63.9%) and good in 2 (1.4%) patients. Excess weight (OR 0.4 [0.2; 0.9]) and Kt/Vurea < 1.2 (OR 0.1 [0.04; 0.2]) significantly reduces the efficacy of HD.
HD used alone for 2 sessions per week has a moderate efficacy on uric acid clearance in CKD. Therefore, we should improve the Kt/V (> 1.2), and combine HD to uric acid lowering drugs and diet modifications to increase its efficacy.
血尿酸（UAc）随着慢性肾脏病（CKD）的分期显著升高，与死亡率相关。血液透析（HD）是撒哈拉以南非洲末期 CKD 最常用的治疗方法，我们旨在评估其单独使用和每周两次使用时对 UAc 清除的效果。
2017 年 1 月至 4 月期间，在喀麦隆一个参考中心，我们对随机选择的在 HD 治疗期间同意参加的所有 CKD 5 期患者进行了一项横断面研究。我们收集了社会人口统计学数据、相关临床信息、HD 相关变量，并在透析前后测量了血清 UAc（SUA）水平，以评估 UAc 清除率。清除率在 65%至 80%之间和大于 80%分别被认为是 HD 的低和高效。使用 SPSS 版本 21.0 进行统计分析。使用 Fisher 精确检验评估与 HD 疗效相关的因素，并以比值比（OR）及其 95%置信水平呈现。
共纳入 104 名患者（53 名女性）。平均年龄为 49.9±13.3 岁。高血压（25%）和慢性肾小球肾炎（16%）是 CKD 的主要疑似病因。HD 肾脏替代治疗的中位时间为 3 年[1；6]。高尿酸血症的患病率为 81.9%。透析前和透析后的 SUA 水平均值分别为 78.8±13.8mg/L 和 26.4±6.6mg/L。SUA 清除率的平均值为 66%±10%。92 名（63.9%）患者的 HD 对 UAc 的疗效为中度，2 名（1.4%）患者的疗效为良好。超重（OR 0.4[0.2；0.9]）和 Kt/Vurea<1.2（OR 0.1[0.04；0.2]）显著降低了 HD 的疗效。
每周单独进行 2 次 HD 治疗对 CKD 患者的 UAc 清除具有中等疗效。因此，我们应该提高 Kt/V（>1.2），并将 HD 与降低尿酸药物和饮食调整相结合，以提高其疗效。
