期刊论文详细信息
The Permanente Journal | |
Urate-Lowering Therapy in Moderate to Severe Chronic Kidney Disease | |
Gerald Levy, MD, MBA1  | |
DOI : 10.7812/TPP/17-142 | |
学科分类:医学(综合) | |
来源: Permanente Medical Group | |
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【 摘 要 】
Context: Hyperuricemia is an independent risk factor for progression of kidney disease.Objective: 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.Design: 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.Main Outcome Measures: A 30% decrease or 30% improvement in eGFR from baseline.Results: 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).Conclusion: 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.【 授权许可】
Unknown
【 预 览 】
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RO201910253731301ZK.pdf | 21382KB | ![]() |