慢性肾脏病患者降尿酸治疗与肾衰竭之间的关联
Association between urate-lowering therapy and kidney failure in patients with chronic kidney disease.
作者信息
Mouheb Agathe, Lambert Oriane, Alencar de Pinho Natalia, Jacquelinet Christian, Laville Maurice, Combe Christian, Fouque Denis, Frimat Luc, Massy Ziad A, Laville Solène M, Liabeuf Sophie
机构信息
Pharmacoepidemiology Unit, Department of Clinical Pharmacology, Amiens-Picardie University Medical Center, CHU Amiens-Picardie, Rond-Point du Professeur Christian Cabrol, 80054, Amiens Cedex, France.
MP3CV Laboratory, Jules Verne University of Picardie, 80054, Amiens, France.
出版信息
J Nephrol. 2025 Mar;38(2):597-607. doi: 10.1007/s40620-024-02179-0. Epub 2025 Jan 8.
BACKGROUND
Hyperuricemia is a hallmark of gout and a suspected risk factor for the progression of chronic kidney disease (CKD). However, the impact of urate-lowering therapy on CKD progression is subject to debate. The objective of the present study was to describe the prevalence of inappropriate urate-lowering therapy prescriptions and evaluate the association between urate-lowering therapy prescription and the progression of kidney disease in patients with CKD.
METHODS
CKD-REIN is a French, nationwide, prospective cohort of 3,033 nephrology outpatients with CKD (eGFR < 60 mL/min/1.73 m). Prescriptions of urate-lowering therapy drugs (allopurinol or febuxostat) were recorded prospectively. The appropriateness of each prescription was evaluated according to the patient's kidney function at baseline and during follow-up. Propensity score-matched, cause-specific Cox proportional hazards regression models were used to assess the association between incident urate-lowering therapy use and CKD progression (defined as the initiation of kidney replacement therapy (KRT) but also in other ways).
RESULTS
At baseline, 987 of the 3009 patients included in this study (median age: 69; men: 66%) were receiving urate-lowering therapy; 396 of these 987 patients were receiving an inappropriate prescription with regard to their kidney function. During a 5-year follow-up period, 70% of the 396 urate-lowering therapy prescriptions remained inappropriate. In the propensity score-matched cohort (n = 674), 136 patients started KRT. Compared with non- urate-lowering therapy use, urate-lowering therapy use was not significantly associated with a slowing in CKD progression, regardless of the definition used (HR 0.89, 95% CI 0.67-1.20).
CONCLUSIONS
Our real-world data emphasized the lack of reassessment of urate-lowering therapy prescriptions in patients with CKD. Urate-lowering therapy was not associated with a slowing of CKD progression.
背景
高尿酸血症是痛风的标志，也是慢性肾脏病（CKD）进展的可疑危险因素。然而，降尿酸治疗对CKD进展的影响仍存在争议。本研究的目的是描述不适当降尿酸治疗处方的患病率，并评估降尿酸治疗处方与CKD患者肾脏疾病进展之间的关联。
方法
CKD-REIN是一项在法国全国范围内进行的前瞻性队列研究，纳入了3033例CKD门诊患者（估算肾小球滤过率[eGFR]<60 mL/min/1.73 m²）。前瞻性记录降尿酸治疗药物（别嘌醇或非布司他）的处方。根据患者基线和随访期间的肾功能评估每个处方的合理性。使用倾向评分匹配的特定病因Cox比例风险回归模型评估降尿酸治疗的使用与CKD进展（定义为开始肾脏替代治疗[KRT]，也包括其他方式）之间的关联。
结果
在基线时，本研究纳入的3009例患者中有987例（中位年龄：69岁；男性：66%）正在接受降尿酸治疗；这987例患者中有396例的处方根据其肾功能是不适当的。在5年的随访期内，这396例降尿酸治疗处方中有70%仍然不适当。在倾向评分匹配队列（n = 674）中，136例患者开始了KRT。与未使用降尿酸治疗相比，无论使用何种定义，降尿酸治疗的使用与CKD进展减缓均无显著关联（风险比[HR] 0.89，95%置信区间[CI] 0.67 - 1.20）。
结论
我们的真实世界数据强调了CKD患者降尿酸治疗处方缺乏重新评估。降尿酸治疗与CKD进展减缓无关。
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