Dr. Yen's Clinic, Taoyuan City, Taiwan.
Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.
Int J Med Sci. 2021 Apr 29;18(12):2599-2606. doi: 10.7150/ijms.59698. eCollection 2021.
Chronic kidney disease (CKD) has emerged as a global health concern. Many studies have identified an association between hyperuricemia and CKD, and some studies have revealed that urate-lowering therapy (ULT) can attenuate CKD progression. However, only a few studies have explored the role of ULT in the prevention of new onset CKD. To compare the risk of incident CKD between users and nonusers of ULT in patients with gout, we conducted a 13-year population-based retrospective cohort study. Overall incidence of CKD was compared between 7126 ULT users and 7126 matched ULT nonusers. The CKD incidence rate for both the users and nonusers of ULT was 1.7 per 100 person-years, after adjusting for sex, age, region of residence, comorbidities, and medications used. No significant difference in CKD risk (adjusted hazard ratio [aHR]: 0.97; 95% confidence interval [CI]: 0.88-1.07) was noted between the ULT users and nonusers. In the subgroup of patients with diabetes mellitus (DM) and without hypertension (HT), ULT tended to be associated with lower risk of incident CKD (aHR: 0.52; 0.95% CI: 0.28-0.97). Compared with the risk of new onset CKD in patients receiving xanthine oxidase inhibitors, those receiving uricosuric agents seemed to have a lower risk of developing CKD (aHR: 0.81, 95% CI: 0.67-0.99). This population-based cohort study indicated that ULT is not associated with lower risk of CKD development. However, in the subgroup of patients with DM and without HT, ULT is associated with significantly lower risk of incident CKD.
慢性肾脏病（CKD）已成为全球关注的健康问题。许多研究已经确定了高尿酸血症与 CKD 之间的关联，一些研究还揭示了尿酸降低治疗（ULT）可以减缓 CKD 的进展。然而，只有少数研究探讨了 ULT 在预防新发性 CKD 中的作用。为了比较痛风患者使用和不使用 ULT 者发生 CKD 的风险，我们进行了一项为期 13 年的基于人群的回顾性队列研究。在 7126 名 ULT 用户和 7126 名匹配的 ULT 非使用者中比较了 CKD 的总体发生率。在调整了性别、年龄、居住地区、合并症和使用的药物后，ULT 用户和非使用者的 CKD 发生率均为每 100 人年 1.7 例。ULT 用户和非使用者的 CKD 风险无显著差异（调整后的危险比[aHR]：0.97；95%置信区间[CI]：0.88-1.07）。在没有高血压（HT）的糖尿病（DM）患者亚组中，ULT 倾向于与较低的新发 CKD 风险相关（aHR：0.52；95%CI：0.28-0.97）。与使用黄嘌呤氧化酶抑制剂的患者新发 CKD 的风险相比，使用促尿酸排泄剂的患者似乎发生 CKD 的风险较低（aHR：0.81，95%CI：0.67-0.99）。这项基于人群的队列研究表明，ULT 与降低 CKD 发生风险无关。然而，在没有 HT 的 DM 患者亚组中，ULT 与新发 CKD 的风险显著降低相关。
