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


DOI: https://dx.doi.org/10.18565/therapy.2023.7.56-71

Mazurov V.I., Sayganov S.A., Bashkinov R.A., Sapozhnikov K.V., Gaydukova I.Z., Tolkacheva D.G., Sableva N.A., Inamova O.V., Petrova M.S., Zinserling А.Yu.

1) I.I. Mechnikov North-West State Medical University of the Ministry of Healthcare of Russia, Saint Petersburg; 2) Clinical Rheumatology Hospital No. 25, Saint Petersburg; 3) 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
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 57 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.
Keywords: asymptomatic hyperuricemia, urate-lowering therapy, osteoarthritis, chronic kidney disease
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About the Autors

Vadim I. Mazurov, 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, I.I. Mechnikov North-West State Medical University of the Ministry of Healthcare of Russia, head of autoimmune center of Clinical Rheumatology Hospital No. 25, Honored Worker of Science of the Russian Federation. Address: 191014, Saint Petersburg, 41 Kirochnaya Str.
E-mail: maz.nwgmu@yandex.ru
ORCID: https://orcid.org/0000-0002-0797-2051
Sergey A. Sayganov, MD, professor, rector and head of the Department of hospital therapy and cardiology named after M.S. Kushakovsky, I.I. Mechnikov North-West State Medical University of the Ministry of Healthcare of Russia. Address: 191014, Saint Petersburg, 41 Kirochnaya Str.
E-mail: sergey.saiganov@szgmu.ru
ORCID: https://orcid.org/0000-0001-8325-1937
Roman A. Bashkinov, postgraduate student 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, rheumatologist at Clinical Rheumatology Hospital No. 25. Address: 191014, Saint Petersburg, 41 Kirochnaya Str.
E-mail: bashkinov-roman@mail.ru
ORCID: https://orcid.org/0000-0001-9344-1304
Kirill V. Sapozhnikov, PhD in Medical Sciences, independent expert on research projects of 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. Address: 199178, Saint Petersburg, 57/43 Sredny Avenue V.O.
E-mail: marinheira@rambler.ru
ORCID: https://orcid.org/0000-0002-2476-7666
Inna Z. Gaydukova, 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,
I.I. Mechnikov North-West State Medical University of the Ministry of Healthcare of Russia, rheumatologist at Clinical Rheumatology Hospital No. 25. Address: 191014, Saint Petersburg, 41 Kirochnaya Str.
E-mail: ubp1976@list.ru
ORCID: https://orcid.org/0000-0003-3500-7256
Daria G. Tolkacheva, independent expert on research projects of 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. Address: 199178, Saint Petersburg, 57/43 Sredny Avenue V.O.
E-mail: tolkacheva.d@gmail.com
ORCID: https://orcid.org/0000-0002-6314-4218
Natalia A. Sableva, independent expert on research projects of 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. Address: 199178, Saint Petersburg, 57/43 Sredny Avenue V.O.
E-mail: sablevana@gmail.com
ORCID: https://orcid.org/0000-0002-5809-9221
Oksana V. Inamova, 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, I.I. Mechnikov North-West State Medical University of the Ministry of Healthcare of Russia, chief physician of Clinical Rheumatology Hospital No. 25. Address: 191014, Saint Petersburg, 41 Kirochnaya Str.
E-mail: ovig74@mail.ru
ORCID: https://orcid.org/0000-0001-9126-3639
Marianna S. Petrova, 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. Address: 191014, Saint Petersburg, 41 Kirochnaya Str.
E-mail: podagra@bk.ru
ORCID: https://orcid.org/0000-0001-5261-6614
Alexandra Yu. Tsinserling, senior laboratory assistant at 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, rheumatologist at Clinical Rheumatology Hospital No. 25. Address: 191014, Saint Petersburg, 41 Kirochnaya Str.
E-mail: aleksa.fonturenko@mail.ru
ORCID: https://orcid.org/0000-0003-4860-0518


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