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

Autor: Novella-Navarro M; Rheumatology Department, Hospital Universitario Torrejon de Ardoz, Madrid, Spain.; Crystal-induced Arthritis Study Group, Spanish Society of Rheumatology (GEACSER), Madrid, Spain., Cabrera-Alarcon JL; Bioinformatic Unit/GENOXPHOS-Group, Centro Nacional Investigaciones Cardiovasculares (CNIC), Madrid, Spain., Diaz-Torne C; Rheumatology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.; Crystal-induced Arthritis Study Group, Spanish Society of Rheumatology (GEACSER), Madrid, Spain., Aramburu-Muñoz F; Rheumatology Department, Hospital Universitario HM Sanchinarro, Madrid, Spain., Janta I; Rheumatology Department, Hospital General Universitario Gregorio Marañon, Madrid, Spain.; Crystal-induced Arthritis Study Group, Spanish Society of Rheumatology (GEACSER), Madrid, Spain., Ortega de la O MC; Rheumatology Department, Hospital Universitario Infanta Elena, Madrid, Spain.; Crystal-induced Arthritis Study Group, Spanish Society of Rheumatology (GEACSER), Madrid, Spain., Prada-Ojeda A; Rheumatology Department, Hospital Universitario Torrejon de Ardoz, Madrid, Spain.; Crystal-induced Arthritis Study Group, Spanish Society of Rheumatology (GEACSER), Madrid, Spain., Sala-Icardo L; Rheumatology Department, Hospital Universitario Torrejon de Ardoz, Madrid, Spain., Urruticoechea-Arana A; Rheumatology Department, Hospital Can Misses, Ibiza, Spain., García de la Peña Lefebvre P; Rheumatology Department, Hospital Universitario HM Sanchinarro, Madrid, Spain., Calvo-Aranda E; Rheumatology Department, Hospital Universitario Infanta Leonor, Avenida Gran Via del Este, 80, 28031, Madrid, Spain. ecalvoa@hotmail.com.; Crystal-induced Arthritis Study Group, Spanish Society of Rheumatology (GEACSER), Madrid, Spain. ecalvoa@hotmail.com.
Jazyk: angličtina
Zdroj: Rheumatology international [Rheumatol Int] 2020 Jul; Vol. 40 (7), pp. 1081-1087. Date of Electronic Publication: 2020 Jan 25.
DOI: 10.1007/s00296-020-04517-4
Abstrakt: The aim of this study was to assess changes in the estimated glomerular filtration rate (eGFR) in gouty patients with chronic kidney disease (CKD) using a "treat-to-target" (T2T) approach in gout. This multicenter observational retrospective study included patients diagnosed with gout and CKD stage 3 taking xanthine oxidase inhibitors (XOIs) (allopurinol or febuxostat) for at least 12 months. All patients were treated using a T2T strategy according to national gout guidelines to achieve the target levels of serum uric acid (sUA; < 5-6 mg/dl) within 6 months of the first visit. The primary outcome was to assess changes in eGFR. The effects of independent variables were analyzed over eGFR in a linear mixed-effects (LME) model. Fifty patients with gout and CKD stage 3 treated with XOIs with a T2T strategy for 12 months were included. Eighty-two percent of the patients achieved the sUA target during the study period. The improvement seen in eGFR was higher during the first 6 months, showing a median increase of 7.54 ml/min/m 2 (SE = 1.25) and trending towards stability over 12 months. For every 1 mg/dl of decrease in sUA, an improvement of 1.5 ml/min/m 2 in eGFR was observed (coefficient ± SE: - 1.58 ± 0.26) (p < 0.001) with no differences between type and dosage of XOIs treatment, colchicine administration, age, sex, and smoking status. A reduction in sUA levels using a T2T approach with XOIs at an optimal dose is possible and could help conserve and improve renal function in gouty patients with CKD stage 3.
Databáze: MEDLINE
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