Effect of urate-lowering therapy on the progression of chronic kidney disease in patients with osteoarthritis and asymptomatic hyperuricemia

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Abstract

Hyperuricemia is an independent risk factor for a wide range of internal organs’ diseases.

The aim: to examine the correlations between asymptomatic hyperuricemia (ASH) and chronic kidney disease (CKD), as well as the effect of drug urate-lowering therapy (ULT) at glomerular filtration rate (GFR) in patients with osteoarthritis (OA).

Material and methods. A retrospective cohort study including data of 1026 OA patients – 530 with BGU and 496 with normal serum uric acid (UA) values was performed. To determine the dynamics of eGFR indicators, its correlation with UA levels in the blood serum and medicamentous ULT, a cohort of patients was selected during a follow-up visit to the research center. A threshold of <360 μmol/L was fixed as target levels (TL) of serum UA. All patients received non-drug therapy aimed at ASH eliminating. Drug ULT was prescribed for persistently elevated UA level in the blood serum despite non-drug treatment, as well as for the presence of cardiovascular risk factors. Xanthine oxidase inhibitors (xOIs) – allopurinol or febuxostat – were used for ASH correction.

Results. In the group of patients with OA having elevated UA levels in the blood serum, arterial hypertension, type 2 diabetes mellitus and obesity were detected significantly more often. Moreover, the presence of ASH was associated with higher levels of glucose, total cholesterol and creatinine in blood serum. Signs of CKD, urolithiasis and chronic pyelonephritis were also significantly more often found in OA patients with ASH. It was fixed, that adjusted odds ratio (OR) for a decrease of eGFR <60 ml/min/1,73 m2 in OA patients while increasing UA level in blood serum per 1 mg/dL should be 1,5 (95% CI: 1,4–1,7). In patients with OA in combination with ASH, who reached the sUA level in the blood serum, regardless of the treatment method, there was a significant increase in eGFR after 3–9, 6–12 and 9–15 months of therapy, while in patients with persistent ASH at the same time intervals, a decrease in eGFR was observed. Moreover, achieving the target value of serum UA led to a significant reduction in the probability of CKD progression after 6–12 months (OR 0,087; 95% CI: 0,011–0,701). In the group of OA patients with ASH who received xOIs, after 6–12 and 9–15 months, a significant increase in eGFR was recorded comparatively with patients receiving non-medicamentous treatment. Along with it, the use of drug ULT significantly reduced the probability of CKD progression after 6–12 (OR 0,252; 95% CI: 0,078–0,815) and 9–15 months (OR 0,216; 95% CI: 0,057–0,822).

Conclusion. According to the data from «Saint Petersburg city register of patients with gout and asymptomatic hyperuricemia», an increase in the level of sUA in the blood serum in patients with OA who do not have signs of gout is associated with a higher prevalence of kidney diseases and the severity of their clinical course. In patients with OA and ASH, getting a CV level of sUA in blood serum, including the same obtained by means of medicamentous ULT, can have a positive effect at eGFR and slow down CKD stage progression. The development of interdisciplinary algorithms for the diagnosis and management of patients with hyperuricemia at the stage of its asymptomatic clinical course is an important strategic task, the solution of which can lead to a reduction of the incidence and intensity of renal pathology progression.

About the authors

Vadim I. Mazurov

I.I. Mechnikov North-West State Medical University of the Ministry of Healthcare of Russia; Clinical Rheumatology Hospital No. 25

Author for correspondence.
Email: maz.nwgmu@yandex.ru
ORCID iD: 0000-0002-0797-2051

MD, professor, academician of RAS, principal scientific advisor, director of the Research Institute of Rheumatology and head of the Department of therapy, rheumatology, examination of temporary disability and quality of medical care named after E.E. Eichwald, head of autoimmune center of Clinical Rheumatology Hospital No. 25, Honored Worker of Science of the Russian Federation

Russian Federation, 191014, Saint Petersburg, 41 Kirochnaya Str.; Saint Petersburg

Sergey A. Sayganov

I.I. Mechnikov North-West State Medical University of the Ministry of Healthcare of Russia

Email: sergey.saiganov@szgmu.ru
ORCID iD: 0000-0001-8325-1937

MD, professor, rector and head of the Department of hospital therapy and cardiology named after M.S. Kushakovsky

Russian Federation, 191014, Saint Petersburg, 41 Kirochnaya Str.

Roman A. Bashkinov

I.I. Mechnikov North-West State Medical University of the Ministry of Healthcare of Russia; Clinical Rheumatology Hospital No. 25

Email: bashkinov-roman@mail.ru
ORCID iD: 0000-0001-9344-1304

postgraduate student of the Department of therapy, rheumatology, examination of temporary disability and quality of medical care named after E.E. Eichwald, rheumatologist at Clinical Rheumatology Hospital No. 25

Russian Federation, 191014, Saint Petersburg, 41 Kirochnaya Str.; Saint Petersburg

Kirill V. Sapozhnikov

Project office of the North-Western Institute of Management – a branch of Russian Academy of National Economy and Public Administration under the President of the Russian Federation

Email: marinheira@rambler.ru
ORCID iD: 0000-0002-2476-7666

PhD in Medical Sciences, independent expert on research projects of Project office

Russian Federation, 199178, Saint Petersburg, 57/43 Sredny Avenue V.O.

Inna Z. Gaydukova

I.I. Mechnikov North-West State Medical University of the Ministry of Healthcare of Russia; Clinical Rheumatology Hospital No. 25

Email: ubp1976@list.ru
ORCID iD: 0000-0003-3500-7256

MD, professor, deputy director of the Research Institute of Rheumatology, professor of the Department of therapy, rheumatology, examination of temporary disability and quality of medical care named after E.E. Eichwald, rheumatologist at Clinical Rheumatology Hospital No. 25

 

Russian Federation, 191014, Saint Petersburg, 41 Kirochnaya Str.; Saint Petersburg

Daria G. Tolkacheva

Project office of the North-Western Institute of Management – a branch of Russian Academy of National Economy and Public Administration under the President of the Russian Federation

Email: tolkacheva.d@gmail.com
ORCID iD: 0000-0002-6314-4218

independent expert on research projects of Project office

 

Russian Federation, 199178, Saint Petersburg, 57/43 Sredny Avenue V.O.

Natalia A. Sableva

Project office of the North-Western Institute of Management – a branch of Russian Academy of National Economy and Public Administration under the President of the Russian Federation

Email: sablevana@gmail.com
ORCID iD: 0000-0002-5809-9221

independent expert on research projects of Project office

Russian Federation, 199178, Saint Petersburg, 57/43 Sredny Avenue V.O.

Oksana V. Inamova

I.I. Mechnikov North-West State Medical University of the Ministry of Healthcare of Russia; Clinical Rheumatology Hospital No. 25

Email: ovig74@mail.ru
ORCID iD: 0000-0001-9126-3639

PhD in Medical Sciences, deputy director of the Research Institute of Rheumatology, assistant at the Department of therapy, rheumatology, examination of temporary disability and quality of medical care named after E.E. Eichwald, chief physician of Clinical Rheumatology Hospital No. 25

Russian Federation, 191014, Saint Petersburg, 41 Kirochnaya Str.; Saint Petersburg

Marianna S. Petrova

I.I. Mechnikov North-West State Medical University of the Ministry of Healthcare of Russia; Clinical Rheumatology Hospital No. 25

Email: podagra@bk.ru
ORCID iD: 0000-0001-5261-6614

PhD in Medical Sciences, associate professor of the Department of therapy, rheumatology,
examination of temporary disability and quality of medical care named after E.E. Eichwald, I.I. Mechnikov North-West
State Medical University of the Ministry of Healthcare of Russia, deputy chief physician of Clinical Rheumatology
Hospital No. 25

Russian Federation, 191014, Saint Petersburg, 41 Kirochnaya Str.; Saint Petersburg

Alexandra Yu. Tsinserling

I.I. Mechnikov North-West State Medical University of the Ministry of Healthcare of Russia; Clinical Rheumatology Hospital No. 25

Email: aleksa.fonturenko@mail.ru
ORCID iD: 0000-0003-4860-0518

PhD in Medical Sciences, associate professor of the Department of therapy, rheumatology, examination of temporary disability and quality of medical care named after E.E. Eichwald, deputy chief physician of Clinical Rheumatology Hospital No. 25

Russian Federation, 191014, Saint Petersburg, 41 Kirochnaya Str.; Saint Petersburg

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