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Physicians' perceptions of asymptomatic hyperuricemia in patients with chronic kidney disease: A questionnaire survey
Ran-Hui Cha1, Su Hyun Kim2, Eun Hui Bae3
1Department of Internal Medicine, National Medical Center, Seoul, Korea.
Insights
Most Korean physicians manage asymptomatic hyperuricemia (AHU) in chronic kidney disease (CKD) patients to preserve kidney function and prevent cardiovascular events. Febuxostat is the preferred treatment, despite concerns about side effects and lack of specific guidelines.
Area of Science:
- Nephrology
- Internal Medicine
- Cardiology
Background:
- Asymptomatic hyperuricemia (AHU) is linked to chronic kidney disease (CKD) and cardiovascular disease progression.
- Optimal management strategies for AHU in CKD patients remain inconsistent.
- Physician perceptions on AHU diagnosis and treatment in CKD patients in Korea were investigated.
Purpose of the Study:
- To survey Korean physicians' perceptions and practices regarding the diagnosis and management of asymptomatic hyperuricemia (AHU) in patients with chronic kidney disease (CKD).
- To understand the rationale behind treatment decisions and identify barriers to managing AHU in this population.
Main Methods:
- A questionnaire survey was distributed to members of the Korean Society of Nephrology.
- The survey focused on the diagnosis, treatment thresholds, and management strategies for AHU in CKD patients.
- Data were collected from 158 responding physicians.
Main Results:
- A significant proportion of physicians identified hyperuricemia in male and female CKD patients based on serum uric acid levels (>7.0 or >8.0 mg/dL).
- Over 80% of physicians reported treating AHU, prioritizing renal function preservation and cerebro-cardiac protection.
- Febuxostat was the preferred uric acid-lowering agent (ULA), with treatment initiation often occurring at serum uric acid levels >8.0 or >9.0 mg/dL, and target levels often set below 6.0 or 7.0 mg/dL.
Conclusions:
- The majority of Korean physicians actively manage asymptomatic hyperuricemia in CKD patients.
- Treatment is primarily aimed at preventing CKD progression and cerebro-cardiovascular complications.
- Key challenges include concerns regarding adverse reactions to ULAs and the absence of specific Korean guidelines.
Background:
Hyperuricemia is associated with the development and progression of chronic kidney disease (CKD) as well as cardiovascular diseases. However, there is no consistent recommendation regarding the treatment of asymptomatic hyperuricemia (AHU) in CKD patients. Here, we surveyed Korean physicians' perceptions regarding the diagnosis and management of AHU in CKD patients.
Methods:
Questionnaires on the management of AHU in CKD patients were emailed to regular members registered with the Korean Society of Nephrology.
Results:
A total of 158 members answered the questionnaire. Among the respondents, 49.4%/41.1% were considered hyperuricemic in male CKD patients whereas 36.7%/20.9% were considered hyperuricemic in female CKD patients when defined by serum uric acid level over 7.0/8.0 mg/dL, respectively. A total of 80.4% reported treating AHU in CKD patients. The most important reasons to treat AHU in CKD patients were renal function preservation followed by cerebro-cardiac protection. Majority of respondents (59.5%) thought that uric acid-lowering agents (ULAs) were the most effective method for controlling serum uric acid levels. Approximately 80% chose febuxostat as the preferred medication. A total of 32.3% and 31.0%, respectively, initiated ULA treatment if the serum uric acid level was more than 8.0 or 9.0 mg/dL, respectively. In addition, 39.2% and 30.4% answered that target serum uric acid levels of less than 6.0 or 7.0 mg/dL, respectively, were appropriate. The two major hurdles to prescribing ULAs were concerns of adverse reactions and the existing lack of evidence (i.e., the absence of Korean guidelines).
Conclusion:
Most Korean physicians treat AHU in CKD patients to prevent CKD progression and cerebro-cardiovascular complications.