Urate-Lowering Therapy in Moderate to Severe Chronic Kidney Disease

• Published in: Permanente journal 2018, Vol.22 (4), p.17-142
• Main Authors: Levy, Gerald, Shi, Jiaxiao M, Cheetham, T Craig, Rashid, Nazia
• Format: Article
• Language: English
• Subjects: Aged; Allopurinol - therapeutic use; Cohort Studies; Febuxostat - therapeutic use; Female; Glomerular Filtration Rate; Gout Suppressants - therapeutic use; Humans; Hyperuricemia - blood; Hyperuricemia - complications; Hyperuricemia - drug therapy; Male; Middle Aged; Original Research & Contributions; Probenecid - therapeutic use; Renal Insufficiency, Chronic - blood; Renal Insufficiency, Chronic - complications; Retrospective Studies; Risk Factors; Severity of Illness Index; Uric Acid - blood; Uricosuric Agents - therapeutic use
• ISSN: 1552-5767; 1552-5775
• DOI: 10.7812/tpp/17-142

Hyperuricemia is an independent risk factor for progression of kidney disease. To determine whether lowering serum uric acid level (sUA) to below 6 mg/dL (target) improves mild to moderate chronic kidney disease (CKD) and whether CKD stage influences the benefit of lowering sUA to target. Retrospective epidemiologic cohort study conducted over 8 years. Estimated glomerular filtration rate (eGFR) was required in the 6 months preceding the index date (defined as first occurrence of sUA < 7 mg/dL), and at least 1 sUA and eGFR were required during follow-up. Patients were urate-lowering therapy (ULT) naïve, aged 18 years or older, and had CKD Stages 2 to 4 at baseline. Health Plan enrollment with drug benefit was required. Exclusions included active cancer, dialysis, or other kidney disease. A 30% decrease or 30% improvement in eGFR from baseline. A total of 12,751 patients met inclusion criteria; 2690 patients received ULT during follow-up and 10,061 did not. Target sUA was achieved in 1118 patients (42%) receiving ULT. A 30% improvement in eGFR was likelier in patients who achieved the target (odds ratio [OR] = 1.78, p < 0.001). Pairwise comparison of CKD stages showed a 30% improvement in eGFR in CKD Stage 2 (OR = 2.26, p = 0.017) and Stage 3 (OR = 2.23, p < 0.001) but not Stage 4 (OR = 1.50, p = 0.081). Patients who achieve an American College of Rheumatology target sUA below 6 mg/dL during ULT have higher rates of eGFR improvement, especially in CKD Stages 2 and 3.