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Chen XJ, Eirin A, Kane GC, Misra S, Textor SC, Lerman A, Lerman LO. Impact of Serum Uric Acid Levels on Outcomes following Renal Artery Revascularization in Patients with Renovascular Disease. Int J Hypertens 2019; 2019:3872065. [PMID: 30838132 PMCID: PMC6374789 DOI: 10.1155/2019/3872065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 12/30/2018] [Accepted: 01/14/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Percutaneous transluminal renal angioplasty (PTRA) improves blood pressure (BP) and renal function only in selected patients with atherosclerotic renovascular disease (ARVD). Hyperuricemia is associated with elevated risk for hypertension and chronic renal disease, but its role in renovascular hypertension is unclear. We hypothesized that hyperuricemia negatively impacts renal and BP outcomes among patients with ARVD undergoing PTRA. METHODS This retrospective, observational cohort study included 94 patients with ARVD and preserved systolic cardiac function, who underwent PTRA at Mayo Clinic, Rochester, Minnesota. Renal, BP, and mortality outcomes were compared among patients according to their serum uric acid (SUA) levels. Multivariate analysis was used to determine significant predictors of renal, BP, and mortality outcomes after PTRA. RESULTS Compared to patients with normal basal SUA levels (≤5.7 mg/dl), patients with very high SUA (≥8.7 mg/dl) had lower baseline estimated glomerular filtration rate (eGFR), more extensive use of antihypertensive and diuretic drugs, increased baseline systolic blood pressure (SBP), and elevated left ventricular mass index. After PTRA, multiple logistic regression analysis showed that, compared to normal SUA, very high SUA was associated with decreased odds ratio (OR) of change in eGFR (adjusted OR=0.90; 95% confidence interval [CI], 0.86-0.95), but not of change in SBP. In multivariate linear analysis SUA independently predicted delta urine protein/creatinine ratio (β: 26.0; 95% confidence interval, 13.9 to 38.1). CONCLUSION Severe hyperuricemia in patients with AVRD may have a negative impact on outcomes of renal revascularization.
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Affiliation(s)
- Xiao-jun Chen
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
- Department of Nephrology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Alfonso Eirin
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Garvan C. Kane
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Sanjay Misra
- Division of Vascular and Interventional Radiology, Mayo Clinic, Rochester, MN, USA
| | - Stephen C. Textor
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Amir Lerman
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Lilach O. Lerman
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
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152
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Radović A, Milinković N, Stošović M, Dopsaj V, Ignjatović S. The relationship between uric acid concentration and cardiovascular risk: Retrospective analysis of patients on hemodialysis. ARHIV ZA FARMACIJU 2019. [DOI: 10.5937/arhfarm1905323r] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
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153
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Shen X, Li J, Fu Q, Liu L, Gao X, Chen X, Chen P, Wang C. Comparison of efficacy and safety between febuxostat and allopurinol in early post-renal transplant recipients with new onset of hyperuricemia. J Clin Pharm Ther 2018; 44:318-326. [PMID: 30582178 PMCID: PMC7379739 DOI: 10.1111/jcpt.12794] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 09/16/2018] [Accepted: 10/26/2018] [Indexed: 12/31/2022]
Abstract
What is known and objective Febuxostat and allopurinol are xanthine oxidase inhibitors for urate‐lowering therapy. The efficacy and safety of febuxostat and allopurinol have been mostly reported in hyperuricemia patients with normal renal function. Here, we aimed to compare the effects of these two drugs in early post‐renal transplant recipients, focusing on evaluating the urate‐lowering effect and recovery of allograft renal function. Methods A retrospective cohort study was performed in early post‐renal transplant recipients with new onset of hyperuricemia receiving febuxostat or allopurinol therapy. Serum uric acid (UA) and estimated glomerular filtration rate (eGFR) were detected on days 3, 7 and 15 and months 1, 3 and 6 after therapy initiation. Liver and blood functions were monitored and other adverse events were recorded. Results and discussion A total of 48 and 33 patients were enrolled in the febuxostat and allopurinol groups, respectively. Significant UA‐lowering effects were observed on day 3 in both groups. Febuxostat caused a more rapid UA decline, starting on day 3 and lasting for 1 month. The most apparent contrast was found in UA level (267.25 ± 93.66 vs 334.18 ± 96.56 μmol/L, P = 0.003) on day 7; 62.5% and 30.3% of patients achieved target UA level in febuxostat and allopurinol groups respectively on day 3 (P = 0.004), but there was no significant difference between two groups from days 15 to months 6. The median times to achieve target UA level were 3 and 5 days in febuxostat and allopurinol groups respectively (P = 0.002). The eGFR levels and recovering rates were gradually upregulated but no significant differences were found between two groups. No abnormities related to febuxostat or allopurinol were observed. What is new and conclusion This is the first comprehensive evaluation of UA‐lowering effects of febuxostat and allopurinol in early post‐renal transplant recipients. Febuxostat caused a marginally quicker serum UA‐lowering effect than allopurinol, but there was no advantage for long‐term use of febuxostat. The drugs had no significant differences in impacting renal allograft function recovery, and both were well tolerated.
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Affiliation(s)
- Xiaoju Shen
- Department of Pharmacy, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Department of Pharmacy, The First Affiliated Hospital, Guangxi Medical University, Nanning, China
| | - Jingjie Li
- Center of Reproductive Medicine, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Qian Fu
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Longshan Liu
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiang Gao
- Department of Pharmacy, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiao Chen
- Department of Pharmacy, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Pan Chen
- Department of Pharmacy, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Changxi Wang
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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154
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Kim DG, Choi HY, Kim HY, Lee EJ, Huh KH, Kim MS, Nam CM, Kim BS, Kim YS. Association between post-transplant serum uric acid levels and kidney transplantation outcomes. PLoS One 2018; 13:e0209156. [PMID: 30550582 PMCID: PMC6294369 DOI: 10.1371/journal.pone.0209156] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 12/02/2018] [Indexed: 12/22/2022] Open
Abstract
Background Serum uric acid (UA) level has been reported to be associated with chronic allograft nephropathy and graft failure in patients who undergo kidney transplantation (KT). However, the role of serum UA level in renal graft survival remains controversial. Objective This study aimed to investigate the effect of mean serum UA level during two different post-KT periods on long-term renal graft outcomes in a large population cohort in which living donor KT prevails. Material and methods A retrospective cohort study was performed using KT data prospectively collected at a single institution. Patients (n = 2,993) were divided into low-, normal-, and high-UA groups according to the mean serum UA level within the first year (1-YR) and 1–5 years (5-YR) after transplantation. Results In the 1-YR Cox proportional hazards analysis, the low- and high-UA groups had a significantly decreased and increased risk, respectively, for overall graft failure (OGF), death-censored graft failure (DCGF), and composite event (return to dialysis, retransplantation, death from graft dysfunction, and 40% decline in estimated glomerular filtration rate) compared with the normal-UA group. Similarly, in the 5-YR analysis, the low-UA group had a significantly reduced risk of DCGF compared with the normal-UA group, whereas the high-UA group had a significantly increased risk of all three graft outcomes. In a marginal structural model, hyperuricemia had a significant causal effect on worsening graft outcomes, with consideration of all confounding variables (OGF: hazard ratio [HR] 2.27, 95% confidence interval [CI] 1.33–3.78; DCGF: HR 2.38, 95% CI 1.09–4.9; composite event: HR 3.05, 95% CI 1.64–5.49). Conclusions A low-to-normal serum UA level within the first year and 1–5 years after KT is an independent factor for better renal allograft outcomes in the long-term follow-up period rather than high serum UA level.
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Affiliation(s)
- Deok Gie Kim
- Department of Transplantation Surgery, Severance Hospital, Yonsei University Health System, Seoul, South Korea
| | - Hoon Young Choi
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Ha Yan Kim
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, South Korea
| | - Eun Ju Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, South Korea
| | - Kyu Ha Huh
- Department of Transplantation Surgery, Severance Hospital, Yonsei University Health System, Seoul, South Korea
- Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea
- The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, South Korea
| | - Myoung Soo Kim
- Department of Transplantation Surgery, Severance Hospital, Yonsei University Health System, Seoul, South Korea
- Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea
- The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, South Korea
| | - Chung Mo Nam
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Beom Seok Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
- The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, South Korea
- * E-mail: (YSK); (BSK)
| | - Yu Seun Kim
- Department of Transplantation Surgery, Severance Hospital, Yonsei University Health System, Seoul, South Korea
- Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea
- The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, South Korea
- * E-mail: (YSK); (BSK)
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Fan W, Hou J, Zhu W, Zhang S, Shao K, Quan F, Chen W. The mechanism of the preventive effect of Shen’an capsule on the calcium oxalate crystal-induced early renal injury based on metabolomics. Biomed Chromatogr 2018; 32:e4374. [PMID: 30141275 DOI: 10.1002/bmc.4374] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 08/09/2018] [Accepted: 08/17/2018] [Indexed: 12/25/2022]
Affiliation(s)
- Wei Fan
- No. 425 Hospital of PLA; Sanya China
| | - Jiebin Hou
- Changhai Hospital; Second Military Medical University; Shanghai China
| | - Weiye Zhu
- Changhai Hospital; Second Military Medical University; Shanghai China
| | - Shuyue Zhang
- Cadets Brigade; Second Military Medical University; Shanghai China
| | - Keda Shao
- Cadets Brigade; Second Military Medical University; Shanghai China
| | | | - Wei Chen
- Changhai Hospital; Second Military Medical University; Shanghai China
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156
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Lekawanvijit S. Cardiotoxicity of Uremic Toxins: A Driver of Cardiorenal Syndrome. Toxins (Basel) 2018; 10:toxins10090352. [PMID: 30200452 PMCID: PMC6162485 DOI: 10.3390/toxins10090352] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 08/19/2018] [Accepted: 08/30/2018] [Indexed: 02/07/2023] Open
Abstract
Cardiovascular disease (CVD) is highly prevalent in the setting of chronic kidney disease (CKD). Such coexistence of CVD and CKD—the so-called “cardiorenal or renocardiac syndrome”—contributes to exponentially increased risk of cardiovascular (CV) mortality. Uremic cardiomyopathy is a characteristic cardiac pathology commonly found in CKD. CKD patients are also predisposed to heart rhythm disorders especially atrial fibrillation. Traditional CV risk factors as well as known CKD-associated CV risk factors such as anemia are insufficient to explain CV complications in the CKD population. Accumulation of uremic retention solutes is a hallmark of impaired renal excretory function. Many of them have been considered inert solutes until their biological toxicity is unraveled and they become accepted as “uremic toxins”. Direct cardiotoxicity of uremic toxins has been increasingly demonstrated in recent years. This review offers a mechanistic insight into the pathological cardiac remodeling and dysfunction contributed by uremic toxins with a main focus on fibroblastic growth factor-23, an emerging toxin playing a central role in the chronic kidney disease–mineral bone disorder, and the two most investigated non-dialyzable protein-bound uremic toxins, indoxyl sulfate and p-cresyl sulfate. Potential therapeutic strategies that could address these toxins and their relevant mediated pathways since pre-dialysis stages are also discussed.
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Affiliation(s)
- Suree Lekawanvijit
- Department of Pathology, Faculty of Medicine, Chiang Mai University, 110 Intawaroros Rd, Sribhoom, Chiang Mai 50200, Thailand.
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Safety and Efficacy of Benzbromarone and Febuxostat in Hyperuricemia Patients with Chronic Kidney Disease: A Prospective Pilot Study. Clin Exp Nephrol 2018; 22:1324-1330. [DOI: 10.1007/s10157-018-1586-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 04/28/2018] [Indexed: 01/22/2023]
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158
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Li C, Tang Q, Jiang H, Wu J, Zhang J, Yuan F, Du Y, Du H. Single Nucleotide Polymorphisms (SNPs) of URAT1 (rs7932775) and ABCG2 (rs3825016) on Chronic Kidney Disease Patients with Hyperuricemia. Chin Med 2018. [DOI: 10.4236/cm.2018.93007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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