Nguyen Nghia N, Mai Tan Ngoc H, Nguyen Bao T, Nguyen Thuy Diem T, Tran Tam Thanh T
Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho, VNM.
Medicine/Internal Medicine, Can Tho University of Medicine and Pharmacy, Can Tho, VNM.
Cureus. 2024 Sep 29;16(9):e70435. doi: 10.7759/cureus.70435. eCollection 2024 Sep.
Background Hyperuricemia treatment can positively influence the progression of chronic kidney disease (CKD). This study aimed to evaluate the impact of uric acid-lowering therapy on the progression of CKD after three months. Materials and methods A prospective cohort study was conducted on 126 patients with non-dialysis CKD in Can Tho Central General Hospital, Vietnam, from December 2018 to December 2019. Adopting a questionnaire survey method to collect information, including demographic characteristics, body mass index (BMI), personal history, previous medical history, diet, and use of drugs with the potential to affect the uric acid levels in the blood. Participants also underwent necessary tests, such as serum uric acid, serum creatinine, and blood lipids. Data were analyzed using SPSS software version 26.0 (IBM Corp., Armonk, NY). Results The prevalence of hyperuricemia in patients with non-dialysis CKD was 77.8%, and the average serum uric acid was 494.21 ± 131.57 µmol/L. Patients with a high-purine diet were about 18.85 times as likely to have hyperuricemia as those with a low-purine diet (p < 0.001, OR = 18.85, 95%CI: 4.233-83.938). BMI, stages of CKD, and hypertension were associated with the hyperuricemia rate (p < 0.05). After three months of treatment, 46.2% of patients achieved the serum uric acid target, and the patient group combined allopurinol with changing diet had a higher rate than the patient group changing diet only (p = 0.02). There was a moderate inverse correlation between the difference in serum uric acid and the difference in estimated glomerular filtration rate (eGFR) after treatment (r = -0.5, p = 0.001). Conclusions The effective management of hyperuricemia by combining nonpharmacological (changing diet) and/or pharmacological (allopurinol) therapies may meaningfully improve the glomerular filtration rate in non-dialysis CKD patients with hyperuricemia.
背景 高尿酸血症治疗可对慢性肾脏病（CKD）的进展产生积极影响。本研究旨在评估降尿酸治疗三个月后对CKD进展的影响。
材料与方法 2018年12月至2019年12月，在越南芹苴中央总医院对126例非透析CKD患者进行了一项前瞻性队列研究。采用问卷调查方法收集信息，包括人口统计学特征、体重指数（BMI）、个人史、既往病史、饮食以及使用可能影响血液尿酸水平的药物情况。参与者还接受了必要的检查，如血清尿酸、血清肌酐和血脂。使用SPSS 26.0软件（IBM公司，纽约州阿蒙克）进行数据分析。
结果 非透析CKD患者高尿酸血症的患病率为77.8%，平均血清尿酸为494.21±131.57µmol/L。高嘌呤饮食患者患高尿酸血症的可能性是低嘌呤饮食患者的约18.85倍（p<0.001，OR=18.85，95%CI：4.233 - 83.938）。BMI、CKD分期和高血压与高尿酸血症发生率相关（p<0.05）。治疗三个月后，46.2%的患者达到血清尿酸目标，联合使用别嘌醇并改变饮食的患者组比仅改变饮食的患者组达标率更高（p=0.02）。治疗后血清尿酸差异与估计肾小球滤过率（eGFR）差异之间存在中度负相关（r=-0.5，p=0.001）。
结论 联合非药物（改变饮食）和/或药物（别嘌醇）疗法有效管理高尿酸血症，可能对非透析高尿酸血症CKD患者的肾小球滤过率有显著改善。
