VALUE OF GOAL DIRECTED URATE LOWERING THERAPY IN SLOWING THE PROGRESSION OF RENAL DISEASE IN HYPERURICEMIC PATIENTS WITH CHRONIC KIDNEY DISEASE

Abstract

Background Although uric acid has been known to exert a role in the progression of chronic kidney disease (CKD), only a few studies evaluated the renoprotective role of urate lowering therapy (ULT) in patients with hyperuricemia and CKD

Objectives To determine whether ULT could delay the renal disease progression in hyperuricemic patients with 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 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 greater than 30% of the baseline value, initiation of dialysis or eGFR <15 mL/min/1.73m2) at the time of last follow-up. Risk factors for renal disease progression were identified by logistic regression analysis.

Results After 1050±759 days of follow-up, the ULT group showed better outcomes compared to non-ULT group in terms of eGFR change from baseline (-1.19±12.07 vs. -7.37±11.17 mL/min/1.73m2, p=0.001) and the proportion of renal disease progression (12.3% vs. 27.9%, p=0.019). Goal directed ULT showed better clinical outcomes compared to maintaining the initial ULT dose. Mean serum uric acid was significantly associated with the risk of renal disease progression (P for trend=0.04) and mean serum uric acid level <7 mg/dL reduced the risk of renal disease progression by 69.4%.

Conclusions ULT significantly delayed the renal disease progression in hyperuricemic patients with CKD. Goal-directed ULT seems to be better than continuing the initial ULT prescription.