title: Effect of Urate Lowering Therapy on Renal Disease Progression in Hyperuricemic Patients with Chronic Kidney Disease.
abstract: OBJECTIVE
  To determine whether urate lowering therapy (ULT) could delay renal disease progression in hyperuricemic patients with chronic kidney disease (CKD).
  
  
  METHODS
  We performed a retrospective review of hyperuricemic patients with stage 3 CKD followed from September 2005 to July 2014 in Dongguk University Ilsan Hospital, Goyang, Korea. A total of 158 eligible patients were identified and 65 of them were treated with ULT in addition to the usual CKD management. We divided the patients according to the use of ULT and compared the estimated glomerular filtration rate (eGFR) change from baseline value and the proportion of renal disease progression (decline of eGFR > 30% of the baseline value, initiation of dialysis or eGFR < 15 ml/min/1.73m(2)) at the time of last followup. Risk factors for renal disease progression were identified by logistic regression analysis.
  
  
  RESULTS
  After a median followup of 118.5 weeks (minimum 25, maximum 465), the ULT group showed better outcomes compared to the non-ULT group in terms of eGFR change from baseline (-1.19 ± 12.07 vs -7.37 ± 11.17 ml/min/1.73 m(2), p = 0.001) and the proportion of renal disease progression (12.3% vs 27.9%, p = 0.01). Goal-directed ULT showed better clinical outcomes compared to maintaining the initial ULT dose. Actual (area under the SUA-time curve adjusted by total observation time period) serum uric acid was significantly associated with the risk of renal disease progression (p for trend = 0.04) and actual serum uric acid level < 7 mg/dl reduced the risk of renal disease progression by 69.4%.
  
  
  CONCLUSIONS
  ULT significantly delayed renal disease progression in hyperuricemic patients with CKD. Goal-directed ULT seems to be better than continuing the initial ULT prescription.
authors.affiliation: From the Division of Nephrology and the Division of Rheumatology, Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang; and the Division of Rheumatology, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, South Korea.Y. Kim, MD, Research Fellow, Division of Nephrology, Department of Internal Medicine, Dongguk University Ilsan Hospital; S. Shin, MD, PhD, Associate Professor, Division of Nephrology, Department of Internal Medicine, Dongguk University Ilsan Hospital; K. Kim, MD, PhD, Professor, Division of Nephrology, Department of Internal Medicine, Dongguk University Ilsan Hospital; S. Choi, MD, Assistant Professor, Division of Rheumatology, Department of Internal Medicine, Chung-Ang University College of Medicine; K. Lee, MD, Assistant Professor, Division of Rheumatology, Department of Internal Medicine, Dongguk University Ilsan Hospital.
authors.forename: Yoonjin
authors.initials: Y
authors.lastname: Kim
authors.affiliation: From the Division of Nephrology and the Division of Rheumatology, Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang; and the Division of Rheumatology, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, South Korea.Y. Kim, MD, Research Fellow, Division of Nephrology, Department of Internal Medicine, Dongguk University Ilsan Hospital; S. Shin, MD, PhD, Associate Professor, Division of Nephrology, Department of Internal Medicine, Dongguk University Ilsan Hospital; K. Kim, MD, PhD, Professor, Division of Nephrology, Department of Internal Medicine, Dongguk University Ilsan Hospital; S. Choi, MD, Assistant Professor, Division of Rheumatology, Department of Internal Medicine, Chung-Ang University College of Medicine; K. Lee, MD, Assistant Professor, Division of Rheumatology, Department of Internal Medicine, Dongguk University Ilsan Hospital.
authors.forename: Sungjoon
authors.initials: S
authors.lastname: Shin
authors.affiliation: From the Division of Nephrology and the Division of Rheumatology, Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang; and the Division of Rheumatology, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, South Korea.Y. Kim, MD, Research Fellow, Division of Nephrology, Department of Internal Medicine, Dongguk University Ilsan Hospital; S. Shin, MD, PhD, Associate Professor, Division of Nephrology, Department of Internal Medicine, Dongguk University Ilsan Hospital; K. Kim, MD, PhD, Professor, Division of Nephrology, Department of Internal Medicine, Dongguk University Ilsan Hospital; S. Choi, MD, Assistant Professor, Division of Rheumatology, Department of Internal Medicine, Chung-Ang University College of Medicine; K. Lee, MD, Assistant Professor, Division of Rheumatology, Department of Internal Medicine, Dongguk University Ilsan Hospital.
authors.forename: Kyungsoo
authors.initials: K
authors.lastname: Kim
authors.affiliation: From the Division of Nephrology and the Division of Rheumatology, Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang; and the Division of Rheumatology, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, South Korea.Y. Kim, MD, Research Fellow, Division of Nephrology, Department of Internal Medicine, Dongguk University Ilsan Hospital; S. Shin, MD, PhD, Associate Professor, Division of Nephrology, Department of Internal Medicine, Dongguk University Ilsan Hospital; K. Kim, MD, PhD, Professor, Division of Nephrology, Department of Internal Medicine, Dongguk University Ilsan Hospital; S. Choi, MD, Assistant Professor, Division of Rheumatology, Department of Internal Medicine, Chung-Ang University College of Medicine; K. Lee, MD, Assistant Professor, Division of Rheumatology, Department of Internal Medicine, Dongguk University Ilsan Hospital.
authors.forename: Sangtae
authors.initials: S
authors.lastname: Choi
authors.affiliation: From the Division of Nephrology and the Division of Rheumatology, Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang; and the Division of Rheumatology, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, South Korea.Y. Kim, MD, Research Fellow, Division of Nephrology, Department of Internal Medicine, Dongguk University Ilsan Hospital; S. Shin, MD, PhD, Associate Professor, Division of Nephrology, Department of Internal Medicine, Dongguk University Ilsan Hospital; K. Kim, MD, PhD, Professor, Division of Nephrology, Department of Internal Medicine, Dongguk University Ilsan Hospital; S. Choi, MD, Assistant Professor, Division of Rheumatology, Department of Internal Medicine, Chung-Ang University College of Medicine; K. Lee, MD, Assistant Professor, Division of Rheumatology, Department of Internal Medicine, Dongguk University Ilsan Hospital. lkh24217@hanmail.net.
authors.forename: Kwanghoon
authors.initials: K
authors.lastname: Lee
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D015897:Comorbidity; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D033461:Hyperuricemia / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D056910:Republic of Korea; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D013997:Time Factors; D016896:Treatment Outcome; D014528:Uricosuric Agents / Q000627:therapeutic use*
chemical_list: D014528:Uricosuric Agents
keywords: ANTIHYPERURICEMICS; CHRONIC KIDNEY DISEASES; HYPERURICEMIA