根据达到目标血清尿酸水平的患者的肾功能调整非布司他剂量的需求：一项回顾性队列研究。

Febuxostat dose requirement according to renal function in patients who achieve target serum urate levels: A retrospective cohort study.

机构信息

Department of Rheumatology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, 05505 Seoul, Republic of Korea.

Information Medicine, Big Data Research Center, Asan Medical Center, Seoul, Republic of Korea.

出版信息

Joint Bone Spine. 2024 Mar;91(2):105668. doi: 10.1016/j.jbspin.2023.105668. Epub 2023 Nov 29.

DOI:10.1016/j.jbspin.2023.105668

PMID:38036062

Abstract

OBJECTIVES

To determine the febuxostat dose requirement according to renal function in patients who achieve target serum urate (SU) levels.

METHODS

Of 3153 gout patients who underwent febuxostat treatment, 873 patients with an initial SU level>6mg/dL were included and categorized by the estimated glomerular filtration rate: normal, chronic kidney disease (CKD) stage 3, and stages 4-5. Ninety-five patients with insufficient follow-up were further excluded. The dose of febuxostat in patients who achieved the SU target (< 6mg/dL) was defined as the average daily dosage at the time of SU target achievement.

RESULTS

The cohort of 778 gout patients had a median age of 52.0 years (IQR, 41.0-63.0) and comprised 711 (91.4%) men. The mean SU at febuxostat initiation was higher in the CKD 4-5 (9.6 [± 3.1] mg/dL) than in the other groups (CKD 3, 8.7 [± 1.7]; normal, 8.4 [± 1.7]; P<0.001). Patients achieved target SU at a median of 4.0 (1.9-9.6) months and in those who achieved target SU, the dose of febuxostat at the time of SU target achievement was significantly lower in the CKD 4-5 group (50.0 [± 16.5] mg) than in the other groups (vs. CKD stage 3, 60.0 [± 19.5] mg; P<0.01, vs. normal, 60.0 [± 19.8] mg; P<0.01). Furthermore, CKD stage 4-5 had a negative correlation with the febuxostat dose requirement (Beta: -2.334, P<0.05).

CONCLUSION

Among patients who achieved SU target, those with severely decreased renal function (CKD 4-5) required a lower febuxostat dose to achieve the target SU level compared to patients with normal or mild renal impairment.

摘要

目的

根据肾功能确定达到目标血清尿酸（SU）水平的患者的非布司他剂量需求。

方法

在接受非布司他治疗的 3153 例痛风患者中，纳入了 873 例初始 SU 水平>6mg/dL 的患者，并根据估计肾小球滤过率进行分类：正常、慢性肾脏病（CKD）3 期和 4-5 期。进一步排除了 95 例随访不足的患者。达到 SU 目标（<6mg/dL）的患者的非布司他剂量定义为达到 SU 目标时的平均日剂量。

结果

778 例痛风患者的队列平均年龄为 52.0 岁（IQR，41.0-63.0），其中 711 例（91.4%）为男性。非布司他起始时，CKD 4-5 组的平均 SU 水平较高（9.6[±3.1]mg/dL），高于其他组（CKD 3 组为 8.7[±1.7]mg/dL，正常组为 8.4[±1.7]mg/dL；P<0.001）。患者在中位数为 4.0（1.9-9.6）个月时达到 SU 目标，在达到 SU 目标的患者中，达到 SU 目标时的非布司他剂量在 CKD 4-5 组显著低于其他组（50.0[±16.5]mg 比 CKD 3 组 60.0[±19.5]mg；P<0.01，比正常组 60.0[±19.8]mg；P<0.01）。此外，CKD 4-5 期与非布司他剂量需求呈负相关（Beta：-2.334，P<0.05）。