A treat-to-target approach for gout confers renoprotective effect in patients with chronic kidney disease stage 3

Area of Science:

• Nephrology
• Rheumatology
• Pharmacology

Background:

• Gout and chronic kidney disease (CKD) frequently coexist, posing significant management challenges.
• Serum uric acid (sUA) reduction is crucial for managing gout and potentially slowing CKD progression.
• The "treat-to-target" (T2T) strategy aims for specific sUA levels, but its impact on eGFR in CKD patients requires further investigation.

Purpose of the Study:

• To evaluate the effect of a T2T approach for gout on estimated glomerular filtration rate (eGFR) in patients with CKD stage 3.
• To assess the correlation between serum uric acid (sUA) reduction and changes in eGFR.
• To determine the efficacy of xanthine oxidase inhibitors (XOIs) in achieving sUA targets and improving renal function.

Main Methods:

• A multicenter, observational, retrospective study involving 50 patients with gout and CKD stage 3.
• Patients received xanthine oxidase inhibitors (allopurinol or febuxostat) for at least 12 months.
• Treatment followed a T2T strategy targeting sUA levels <5-6 mg/dl within 6 months, analyzed using a linear mixed-effects model.

Main Results:

• 82% of patients achieved the target sUA levels within the study period.
• A significant median increase in eGFR of 7.54 ml/min/m² was observed in the first 6 months, stabilizing thereafter.
• Each 1 mg/dl decrease in sUA correlated with a 1.58 ml/min/m² improvement in eGFR (p < 0.001).

Conclusions:

• A T2T approach using XOIs effectively reduces sUA levels in gout patients with CKD stage 3.
• This strategy demonstrates a capacity to conserve and improve renal function, evidenced by eGFR increases.
• The findings support optimizing XOI therapy within a T2T framework for managing renal outcomes in this patient population.