A treat-to-target approach for gout confers renoprotective effect in patients with chronic kidney disease stage 3
Por:
Novella-Navarro, M, Cabrera-Alarcon, JL, Diaz-Torne, C, Aramburu-Munoz, F, Janta, I, de la O, MCO, Prada-Ojeda, A, Sala-Icardo, L, Urruticoechea-Arana, A, Lefebvre, PGD, Calvo-Aranda, E
Publicada:
1 jul 2020
Resumen:
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.
Filiaciones:
Novella-Navarro, M:
Hosp Univ Torrejon de Ardoz, Rheumatol Dept, Madrid, Spain
Spanish Soc Rheumatol GEACSER, Crystal Induced Arthrit Study Grp, Madrid, Spain
Cabrera-Alarcon, JL:
CNIC, Bioinformat Unit, GENOXPHOS Grp, Madrid, Spain
Diaz-Torne, C:
Hosp Santa Creu & Sant Pau, Rheumatol Dept, Barcelona, Spain
Spanish Soc Rheumatol GEACSER, Crystal Induced Arthrit Study Grp, Madrid, Spain
Aramburu-Munoz, F:
Hosp Univ HM Sanchinarro, Rheumatol Dept, Madrid, Spain
Janta, I:
Hosp Gen Univ Gregorio Maranon, Rheumatol Dept, Madrid, Spain
Spanish Soc Rheumatol GEACSER, Crystal Induced Arthrit Study Grp, Madrid, Spain
de la O, MCO:
Hosp Univ Infanta Elena, Rheumatol Dept, Madrid, Spain
Spanish Soc Rheumatol GEACSER, Crystal Induced Arthrit Study Grp, Madrid, Spain
Prada-Ojeda, A:
Hosp Univ Torrejon de Ardoz, Rheumatol Dept, Madrid, Spain
Spanish Soc Rheumatol GEACSER, Crystal Induced Arthrit Study Grp, Madrid, Spain
Sala-Icardo, L:
Hosp Univ Torrejon de Ardoz, Rheumatol Dept, Madrid, Spain
Urruticoechea-Arana, A:
Hosp Can Misses, Rheumatol Dept, Ibiza, Spain
Lefebvre, PGD:
Hosp Univ HM Sanchinarro, Rheumatol Dept, Madrid, Spain
Calvo-Aranda, E:
Hosp Univ Infanta Leonor, Rheumatol Dept, Ave Gran Via Este, Madrid 28031, Spain
Spanish Soc Rheumatol GEACSER, Crystal Induced Arthrit Study Grp, Madrid, Spain
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