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Background <p>Hyperuricemia is a hallmark of gout and a suspected risk factor for the progression of chronic kidney disease (CKD). However, the impact of urate-lowering therapy on CKD progression is subject to debate. The objective of the present study was to describe the prevalence of inappropriate urate-lowering therapy prescriptions and evaluate the association between urate-lowering therapy prescription and the progression of kidney disease in patients with CKD.</p> Methods <p>CKD-REIN is a French, nationwide, prospective cohort of 3,033 nephrology outpatients with CKD (eGFR &lt; 60&#xa0;mL/min/1.73 m<sup>2</sup>). Prescriptions of urate-lowering therapy drugs (allopurinol or febuxostat) were recorded prospectively. The appropriateness of each prescription was evaluated according to the patient’s kidney function at baseline and during follow-up. Propensity score-matched, cause-specific Cox proportional hazards regression models were used to assess the association between incident urate-lowering therapy use and CKD progression (defined as the initiation of kidney replacement therapy (KRT) but also in other ways).</p> Results <p>At baseline, 987 of the 3009 patients included in this study (median age: 69; men: 66%) were receiving urate-lowering therapy; 396 of these 987 patients were receiving an inappropriate prescription with regard to their kidney function. During a 5-year follow-up period, 70% of the 396 urate-lowering therapy prescriptions remained inappropriate. In the propensity score-matched cohort (<i>n</i> = 674), 136 patients started KRT. Compared with non- urate-lowering therapy use, urate-lowering therapy use was not significantly associated with a slowing in CKD progression, regardless of the definition used (HR<sub>KRT</sub> 0.89, 95% CI 0.67–1.20).</p> Conclusions <p>Our real-world data emphasized the lack of reassessment of urate-lowering therapy prescriptions in patients with CKD. Urate-lowering therapy was not associated with a slowing of CKD progression.</p> Graphical abstract <p></p>

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Association between urate-lowering therapy and kidney failure in patients with chronic kidney disease

  • 期刊论文

  • 发表日期：

    2025年1月8日

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  • Agathe Mouheb,
  • Oriane Lambert,
  • Natalia Alencar de Pinho,
  • Christian Jacquelinet,
  • Maurice Laville,
  • Christian Combe,
  • Denis Fouque,
  • Luc Frimat,
  • Ziad A. Massy,
  • Solène M. Laville,
  • Sophie Liabeuf,
  • Natalia Alencar de Pinho,
  • Dorothée Cannet,
  • Christian Combe,
  • Denis Fouque,
  • Luc Frimat,
  • Aghilès Hamroun,
  • Yves-Edouard Herpe,
  • Christian Jacquelinet,
  • Oriane Lambert,
  • Céline Lange,
  • Maurice Laville,
  • Sophie Liabeuf,
  • Ziad A. Massy,
  • Marie Metzger,
  • Pascal Morel,
  • Christophe Pascal,
  • Roberto Pecoits-Filho,
  • Joost Schantsra,
  • Bénédicte Stengel,
  • Thierry Hannedouche,
  • Bruno Moulin,
  • Sébastien Mailliez,
  • Gaétan Lebrun,
  • Éric Magnant,
  • Gabriel Choukroun,
  • Benjamin Deroure,
  • Adeline Lacraz,
  • Guy Lambrey,
  • Jean Philippe Bourdenx,
  • Marie Essig,
  • Thierry Lobbedez,
  • Raymond Azar,
  • Hacène Sekhri,
  • Mustafa Smati,
  • Mohamed Jamali,
  • Alexandre Klein,
  • Michel Delahousse,
  • Christian Combe,
  • Séverine Martin,
  • Isabelle Landru,
  • Eric Thervet,
  • Ziad Massy,
  • Philippe Lang,
  • Xavier Belenfant,
  • Pablo Urena,
  • Carlos Vela,
  • Luc Frimat,
  • Dominique Chauveau,
  • Viktor Panescu,
  • Christian Noel,
  • François Glowacki,
  • Maxime Hoffmann,
  • Maryvonne Hourmant,
  • Dominique Besnier,
  • Angelo Testa,
  • F. Kuentz,
  • Philippe Zaoui,
  • Charles Chazot,
  • Laurent Juillard,
  • Stéphane Burtey,
  • Adrien Keller,
  • N. Kamar,
  • Denis Fouque,
  • Maurice Laville

摘要

Background

Hyperuricemia is a hallmark of gout and a suspected risk factor for the progression of chronic kidney disease (CKD). However, the impact of urate-lowering therapy on CKD progression is subject to debate. The objective of the present study was to describe the prevalence of inappropriate urate-lowering therapy prescriptions and evaluate the association between urate-lowering therapy prescription and the progression of kidney disease in patients with CKD.

Methods

CKD-REIN is a French, nationwide, prospective cohort of 3,033 nephrology outpatients with CKD (eGFR < 60 mL/min/1.73 m2). Prescriptions of urate-lowering therapy drugs (allopurinol or febuxostat) were recorded prospectively. The appropriateness of each prescription was evaluated according to the patient’s kidney function at baseline and during follow-up. Propensity score-matched, cause-specific Cox proportional hazards regression models were used to assess the association between incident urate-lowering therapy use and CKD progression (defined as the initiation of kidney replacement therapy (KRT) but also in other ways).

Results

At baseline, 987 of the 3009 patients included in this study (median age: 69; men: 66%) were receiving urate-lowering therapy; 396 of these 987 patients were receiving an inappropriate prescription with regard to their kidney function. During a 5-year follow-up period, 70% of the 396 urate-lowering therapy prescriptions remained inappropriate. In the propensity score-matched cohort (n = 674), 136 patients started KRT. Compared with non- urate-lowering therapy use, urate-lowering therapy use was not significantly associated with a slowing in CKD progression, regardless of the definition used (HRKRT 0.89, 95% CI 0.67–1.20).

Conclusions

Our real-world data emphasized the lack of reassessment of urate-lowering therapy prescriptions in patients with CKD. Urate-lowering therapy was not associated with a slowing of CKD progression.

Graphical abstract