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Abstract
Background Under the hypothesis that hyperuricemia is a potentially modifiable risk factor for progression of CKD, there has been numerous small, single-center studies that have shown that use of urate-lowering therapy (ULT) delayed CKD progression in patients with hyperuricemia or CKD. However, recent three multicenter, randomized controlled trials have not shown beneficial effect of ULT on the progression of CKD among CKD patients without gout and in DM patients with albuminuria.
Objectives We investigated whether ULT may have a beneficial effect on the progression of CKD in gout patients.
Methods Gout patients who took the study medication for more than 1 year were identified from the Cardiovascular Safety of Febuxostat or Allopurinol in Patients with Gout (CARES) trial, which is a large, multicenter, randomized controlled trial. We analyzed the estimated glomerular filtration rate (eGFR) slope (mL/min/1.73 m2 per year) using the CKD-EPI equation. Using logistic regression, we investigated risk factors for CKD progression, defined as eGFR slope of lower than 0 mL/min/1.73 m2 per year.
Results During the study period [median (interquartile range, IQR) 3.1 (2.0-4.8) year], 4,144 patients performed median (IQR) 12 (9~15) creatinine tests, the GFR slope was analyzed as median (IQR) 0.5 (-0.8-1.6). The median (IQR) values of the GFR slope were -1.2 (-2.3--0.5) in the CKD progression group (n=1,590) and 1.3 (0.7-2.2) in the CKD progression delayed group (n=2,554). After adjusting well known factors associated with CKD progression, average level of serum uric acid ≥ 6 mg/dL during study period was significantly associated with CKD progression (adjusted odds ratio 1.73; 95% confidence interval 1.49-2.01, p < 0.0001).
Conclusion This study showed that eGFR did not decrease in more than half of gout patients after long term febuxostat or allopurinol administration. ULT may have a beneficial effect on slowing the progression of CKD in gout patients.
Changes of estimated glomerular filtration rate during febuxostat or allupurinol administration.
Acknowledgements We were able to access the CARES trial data through the Vivli company, and re-analyzed data of the CARES trial without financial support from any company.
Disclosure of Interests None declared