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Trimethoprim-sulfamethoxazole and hypouricemia
G M Chertow1, J L Seifter, C L Christiansen
1Renal Division, Brigham and Women's Hospital, Boston, MA 02115, USA.
Clinical Nephrology
|September 1, 1996
Summary
High-dose trimethoprim-sulfamethoxazole (TMP-SMX) significantly reduces serum uric acid levels in hospitalized patients. This finding challenges the notion of an HIV-related defect causing hypouricemia in AIDS patients.
Area of Science:
- Medical Research
- Pharmacology
- Nephrology
Background:
- Hypouricemia is observed in patients with Acquired Immunodeficiency Syndrome (AIDS).
- Previous research attributed hypouricemia to an HIV-related renal urate transport defect.
- This study investigated trimethoprim-sulfamethoxazole (TMP-SMX) as an alternative cause of hypouricemia.
Purpose of the Study:
- To test the hypothesis that high-dose TMP-SMX administration causes hypouricemia.
- To evaluate the association between TMP-SMX and changes in serum uric acid concentration.
Main Methods:
- Retrospective analysis of data from 45 hospitalized patients with Pneumocystis carinii pneumonia (PCP).
- Blinded review of sociodemographic, clinical, and laboratory data.
- Primary outcome: percent change in serum uric acid from baseline to hospital day 5 +/- 1.
Main Results:
- TMP-SMX administration was associated with a 37% +/- 12% reduction in serum uric acid (p = 0.005).
- This reduction was significant after adjusting for age, sex, race, HIV status, renal function, serum sodium, and diuretic/glucocorticoid use.
- Patients receiving TMP-SMX were older and less likely to be HIV-seropositive compared to those on other treatments.
Conclusions:
- High-dose TMP-SMX treatment is strongly associated with reduced serum uric acid concentrations in hospitalized PCP patients.
- This finding suggests TMP-SMX as a potential cause of hypouricemia, independent of HIV status.
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