![Quantitative SERS Detection of Uric Acid via Formation of Precise Plasmonic Nanojunctions within Aggregates of Gold Nanoparticles and Cucurbit[n]uril](/_next/image?url=https%3A%2F%2Fcloudfront.jove.com%2FCDNSource%2Fteasers%2F61682.jpg&w=3840&q=50)
Effect of Urate Lowering Therapy on Renal Disease Progression in Hyperuricemic Patients with Chronic Kidney Disease
Yoonjin Kim1, Sungjoon Shin1, Kyungsoo Kim1
1From the Division of Nephrology and the Division of Rheumatology, Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang; and the Division of Rheumatology, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, South Korea.Y. Kim, MD, Research Fellow, Division of Nephrology, Department of Internal Medicine, Dongguk University Ilsan Hospital; S. Shin, MD, PhD, Associate Professor, Division of Nephrology, Department of Internal Medicine, Dongguk University Ilsan Hospital; K. Kim, MD, PhD, Professor, Division of Nephrology, Department of Internal Medicine, Dongguk University Ilsan Hospital; S. Choi, MD, Assistant Professor, Division of Rheumatology, Department of Internal Medicine, Chung-Ang University College of Medicine; K. Lee, MD, Assistant Professor, Division of Rheumatology, Department of Internal Medicine, Dongguk University Ilsan Hospital.
Insights
Urate-lowering therapy (ULT) significantly slowed kidney disease progression in patients with hyperuricemia and chronic kidney disease (CKD). A goal-directed approach to ULT showed better results than maintaining a fixed dose.
Area of Science:
- Nephrology
- Rheumatology
- Internal Medicine
Background:
- Hyperuricemia is common in patients with chronic kidney disease (CKD).
- Elevated serum uric acid levels are associated with CKD progression.
- Urate-lowering therapy (ULT) is used to manage hyperuricemia.
Purpose of the Study:
- To investigate the effect of ULT on renal disease progression in hyperuricemic patients with stage 3 CKD.
- To compare the outcomes of ULT versus no ULT in this patient population.
Main Methods:
- Retrospective review of 158 hyperuricemic patients with stage 3 CKD.
- Comparison of estimated glomerular filtration rate (eGFR) change and renal disease progression between ULT and non-ULT groups.
- Logistic regression analysis to identify risk factors for renal disease progression.
Main Results:
- The ULT group showed a significantly better eGFR change from baseline (-1.19 vs -7.37 ml/min/1.73 m(2), p = 0.001).
- The proportion of renal disease progression was lower in the ULT group (12.3% vs 27.9%, p = 0.01).
- Serum uric acid levels < 7 mg/dl reduced the risk of renal disease progression by 69.4%.
Conclusions:
- ULT significantly delays renal disease progression in hyperuricemic patients with CKD.
- Goal-directed ULT is more effective than maintaining initial ULT doses.
- Controlling serum uric acid levels is crucial for managing CKD progression.
Objective:
To determine whether urate lowering therapy (ULT) could delay renal disease progression in hyperuricemic patients with chronic kidney disease (CKD).
Methods:
We performed a retrospective review of hyperuricemic patients with stage 3 CKD followed from September 2005 to July 2014 in Dongguk University Ilsan Hospital, Goyang, Korea. A total of 158 eligible patients were identified and 65 of them were treated with ULT in addition to the usual CKD management. We divided the patients according to the use of ULT and compared the estimated glomerular filtration rate (eGFR) change from baseline value and the proportion of renal disease progression (decline of eGFR > 30% of the baseline value, initiation of dialysis or eGFR < 15 ml/min/1.73m(2)) at the time of last followup. Risk factors for renal disease progression were identified by logistic regression analysis.
Results:
After a median followup of 118.5 weeks (minimum 25, maximum 465), the ULT group showed better outcomes compared to the non-ULT group in terms of eGFR change from baseline (-1.19 ± 12.07 vs -7.37 ± 11.17 ml/min/1.73 m(2), p = 0.001) and the proportion of renal disease progression (12.3% vs 27.9%, p = 0.01). Goal-directed ULT showed better clinical outcomes compared to maintaining the initial ULT dose. Actual (area under the SUA-time curve adjusted by total observation time period) serum uric acid was significantly associated with the risk of renal disease progression (p for trend = 0.04) and actual serum uric acid level < 7 mg/dl reduced the risk of renal disease progression by 69.4%.
Conclusion:
ULT significantly delayed renal disease progression in hyperuricemic patients with CKD. Goal-directed ULT seems to be better than continuing the initial ULT prescription.
Related Concept Videos
01:25Drug Dosing in Renal Diseases: Dose Adjustments Based on Drug Clearance and Elimination Rate Constant
01:17Factors Affecting Renal Clearance: Renal Impairment
One condition associated with renal failure is uremia. Uremia is characterized by impaired glomerular filtration and fluid accumulation in the body. This condition hinders the renal clearance of drugs, resulting in drug accumulation and potential...
01:30Urinary Tract Calculi III: Medical Management
01:27Urinary Tract Calculi IV: Nutrition Therapy and Prevention
01:16Antihypertensive Drugs: Action of Diuretics
01:11Renal Failure: Dose Adjustments
Reduced renal clearance and elimination rate are common outcomes of renal impairment. These alterations lead to a prolonged elimination half-life and an altered apparent volume of distribution for drugs. As a result, dosage adjustments are typically necessary to maintain optimal drug levels in the body.
However, dosage adjustments...