Study on the Outcome of Treatment of Hyperuricemia with Febuxostat in Patients with Chronic Kidney Disease
Abstract:
Hyperuricemia, previously thought as a consequence of renal impairement,
has been recently identified as an independent risk factor for the development of
Chronic Kidney disease. This study was done to find out the effect of treatment
of hyperuricemia in CKD patients. This observational study was conducted at Jubilee
memorial hospital and Dr sm csi medical college, Trivandrum. The study population
included 200 patients with CKD with hyperuricemia from the department of General
medicine and department of Nephrology. Detailed history, anthropometry and clinical
examination were recorded from all patients and serum uric acid levels and GFR before
and 3 months after treatment were compared. Other study parameters were analysed
within the CKD group. Treatment
response of hyperuricemia with febuxostat among various stages of CKD was observed.
Comparing prevalence hyperuricemia among different stages of CKD after 3month treatment
with febuxostat, there was significant association between different stages of CKD
and uric acid (p value=0.000). The present
observational study suggests that febuxostat may slow the progression of mild-to-moderate
CKD. Prevalence
of hyperuricemia is significantly higher in chronic kidney diseases patients, especially
stages 3 and 4. Uric acid level is significantly higher in overweight CKD subjects.
Keywords: Hyperuricemia, CKD, GFR.
References:
[1].Johnson, R. J., Lanaspa, M. A., & Gaucher, E. A. (2011). Uric acid: a
danger signal from the RNA world that may have a role in the epidemic of obesity,
metabolic syndrome, and cardiorenal disease: evolutionary considerations. Seminars in Nephrology, 31(5), 394–399.
[2].Mazzali
M, Kanellis J, Han L, et al. Hyperuricemia induces a primary renal arteriolopathy
in rats by a blood pressure independent mechanism. Am J Physiol Renal Physiol. 2002;
282(6): F991-F997.
[3].Omori, H., Kawada,
N., Inoue, K., Ueda, Y., Yamamoto, R., Matsui, I., …Rakugi H. (2012). Use of xanthine
oxidase inhibitor febuxostat inhibits renal interstitial inflammation and fibrosis
in unilateral ureteral obstructive nephropathy. Clin Exp Nephrol, 16,549–556. https://doi.org/10.1007/s10157-012-0609.
[4].Sezai, A., Soma,
M., Nakata, K., Hata, M., Yoshitake, I., Wakui, S., … Shiono, M. (2013). Comparison
of febuxostat and allopurinol for hyperuricemia in cardiac surgery patients (NU-FLASH
Trial) Circ J,77,2043–2049. https://doi.org/10.1253/circj.CJ-13-0082.
[5]. Sircar, D.,
Chatterjee, S., Waikhom, R., Golay, V., Raychaudhury, A., Chatterjee, S.,
&Pandey, R. (2015). Efficacy of febuxostat for slowing the GFR decline in
patients with CKD and asymptomatic hyperuricemia:
a 6-month, double-blind, randomized, placebo-controlled trial. Am J
Kidney Dis,66,945–950. https://doi.org/10.1053/j.ajkd.2015.05.017.
[6].Tanaka, K., Nakayama,
M., Kanno, M., Kimura, H., Watanabe, K., Tani, Y., … Watanabe, T. (2015). Reno-protective
effects of febuxostat in hyperuricemic patients with chronic kidney disease: a parallel-group,
randomized, controlled trial. Clin Exp Nephrol,19,1044–1053. https://doi.org/10.1007/s10157-015-1095-1.
[7].Verzola, D., Ratto, E., Villaggio, B., Parodi, E. L., Pontremoli, R.,
Garibotto, G., & Viazzi, F. (2014). Uric acid promotes apoptosis in human
proximal tubule cells by oxidative stress and activation of NAPDH oxidase NOX
4. PloS ONE,9(12). https://doi.org/10.1371/journal.pone.0115210.