Department of Nephrology, Nippon Medical School Chiba Hokusoh Hospital.
Department of Nephrology, Nippon Medical School Hospital.
J Nippon Med Sch. 2022 Aug 27;89(4):360-367. doi: 10.1272/jnms.JNMS.2022_89-401. Epub 2021 Nov 26.
Febuxostat is recommended for lowering serum uric acid (sUA) concentration in chronic kidney disease (CKD) patients with hyperuricemia. However, it remains uncertain how febuxostat affects associations between several laboratory variables related to glomerular filtration and renal tubular reabsorption of uric acid.
We retrospectively analyzed the records of 148 patients with CKD and hyperuricemia: 122 were treated with febuxostat, and 26 were not. Clinical and laboratory variables were used to calculate estimated glomerular filtration rate (eGFR), fractional excretion of uric acid (FEUA), and estimated 24-h urinary excretion of uric acid (eEUA). We examined correlations of those variables and compared patients who did and did not receive febuxostat.
eGFR and FEUA were significantly inversely regardless of febuxostat-treatment status. eGFR was significantly inversely correlated with sUA in patients who received febuxostat, but not in those who did not. Similarly, there was a significant positive correlation between FEUA and eEUA only in patients treated with febuxostat.
FEUA increased as eGFR decreased in our patients. Febuxostat changed correlation patterns for clinical and laboratory variables. Additional administration of uricosuric agents might help further lower sUA by increasing FEUA and eEUA in patients treated with febuxostat.
别嘌醇推荐用于降低慢性肾脏病（CKD）伴高尿酸血症患者的血清尿酸（sUA）浓度。然而，目前尚不清楚别嘌醇如何影响与肾小球滤过和尿酸肾小管重吸收相关的几个实验室变量之间的关联。
我们回顾性分析了 148 例 CKD 伴高尿酸血症患者的记录：122 例接受别嘌醇治疗，26 例未接受。使用临床和实验室变量来计算估算肾小球滤过率（eGFR）、尿酸分数排泄（FEUA）和估计的 24 小时尿酸排泄量（eEUA）。我们检查了这些变量的相关性，并比较了接受和未接受别嘌醇治疗的患者。
无论是否接受别嘌醇治疗，eGFR 和 FEUA 均呈显著负相关。在接受别嘌醇治疗的患者中，eGFR 与 sUA 呈显著负相关，但在未接受别嘌醇治疗的患者中则无此相关性。同样，仅在接受别嘌醇治疗的患者中，FEUA 与 eEUA 之间存在显著正相关。
在我们的患者中，FEUA 随着 eGFR 的降低而增加。别嘌醇改变了临床和实验室变量的相关模式。在接受别嘌醇治疗的患者中，额外使用尿酸排泄剂可能有助于通过增加 FEUA 和 eEUA 进一步降低 sUA。
