title: Management of asymptomatic hyperuricaemia in patients with chronic kidney disease by Japanese nephrologists: a questionnaire survey.
abstract: OBJECTIVE
  Hyperuricaemia is associated with chronic kidney disease (CKD) progression and cardiovascular events (CVE). In a US study, only 4% of rheumatologists initiated urate-lowering therapy in patients with asymptomatic hyperuricaemia (AHU). The present study aimed to clarify how Japanese board-certified nephrologists manage AHU in CKD patients.
  
  
  METHODS
  Questionnaires on management of AHU in CKD stage 3 or more were mailed to 1500 Japanese board-certified nephrologists, excluding paediatricians and urologists, randomly selected from the directory of the Japanese Society of Nephrology (n = 2976).
  
  
  RESULTS
  Five hundred and ninety-five nephrologists (40%) responded. Most nephrologists (84-89%) recommended that AHU in patients in CKD stages 3-5 should be treated, but fewer nephrologists (63%) recommended that AHU in patients of CKD stage 5D should be treated. The serum urate level to start urate-lowering therapy and the target serum urate level to be achieved (mg/dL) were 8.2 ± 0.9 and 6.9 ± 0.9, 8.4 ± 0.9 and 7.0 ± 1.0, 8.6 ± 1.0 and 7.3 ± 1.1, and 9.1 ± 1.2 and 7.8 ± 1.3 at stages 3, 4, 5 and 5D, respectively. The most frequently used maximal dosage of allopurinol was 100 mg/day at each stage. Benzbromarone was used in 52% of patients at stage 3, but only in 29%, 13% and 5% of patients at stages 4, 5 and 5D, respectively. The most important reasons to treat AHU at CKD stages 3-5 were prevention of CKD progression (45%), CVE (33%), gout (18%) and urolithiasis (3%).
  
  
  CONCLUSIONS
  Most Japanese nephrologists treat AHU in pre-dialysis CKD with an aim to prevent CKD progression or CVE mainly by allopurinol.
authors.affiliation: Department of Nephrology, Iwate Prefectural Central Hospital, Morioka, Japan. izaya-n@ra2.so-net.ne.jp
authors.forename: Izaya
authors.initials: I
authors.lastname: Nakaya
authors.forename: Tamehachi
authors.initials: T
authors.lastname: Namikoshi
authors.forename: Yuki
authors.initials: Y
authors.lastname: Tsuruta
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nakata
authors.forename: Yugo
authors.initials: Y
authors.lastname: Shibagaki
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Onishi
authors.forename: Shunichi
authors.initials: S
authors.lastname: Fukuhara
mesh_terms: D002908:Chronic Disease; D005919:Glomerular Filtration Rate; D006801:Humans; D033461:Hyperuricemia / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D007564:Japan; D007674:Kidney Diseases / Q000150:complications*; D011795:Surveys and Questionnaires; D014527:Uric Acid / Q000097:blood
chemical_list: D014527:Uric Acid