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Albert J, Broadwell A, Padnick-Silver L, Marder B, LaMoreaux B. Intensive urate-lowering with pegloticase plus methotrexate co-therapy in uncontrolled gout patients with and without chronic kidney disease: A retrospective case series. Medicine (Baltimore) 2024; 103:e37424. [PMID: 38457582 PMCID: PMC10919538 DOI: 10.1097/md.0000000000037424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 02/06/2024] [Accepted: 02/07/2024] [Indexed: 03/10/2024] Open
Abstract
Chronic kidney disease (CKD) and gout commonly co-occur. Pegloticase lowers serum urate (SU) in uncontrolled gout patients but antidrug antibodies limit urate-lowering response and increase infusion reaction (IR) risk. Methotrexate (MTX) co-administration increases pegloticase response rate and mitigates IR risk but CKD limits MTX use. This pooled case series examined pegloticase + MTX co-therapy in uncontrolled gout patients with and without CKD. Cases of pegloticase + MTX co-therapy in existing datasets were retrospectively examined. Baseline eGFR classified patients as CKD (eGFR < 60 mL/min/1.73 m2) or non-CKD (eGFR ≥ 60 mL/min/1.73 m2). Patient characteristics, treatment parameters, laboratory values, urate-lowering response rate (≥12 pegloticase infusions received and SU < 6 mg/dL just before infusion 12), and AEs were examined. Fifteen CKD (eGFR: 43.2 ± 11.3 mL/min/1.73 m2; SU: 8.6 ± 2.2 mg/dL), 27 non-CKD (eGFR: 82.9 ± 19.0 mL/min/1.73 m2; SU: 9.5 ± 1.7 mg/dL) patients were included. Comorbidity profiles were similar, but CKD patients were older (72.0 ± 9.9 vs 52.3 ± 14.3 years) and more often female (33.3% vs 7.4%). Treatment parameters were similar with 4-week MTX Run-in followed by mean of 14.7 ± 8.1 [CKD] vs 14.1 ± 7.1 [non-CKD] pegloticase infusions. However, CKD patients had lower MTX dose (14.8 ± 5.8 vs 19.3 ± 4.9 mg/week). Urate-lowering response was similar (92% vs 86%). eGFR increased during treatment in 60% of CKD (+11.5 ± 20.9 mL/min/1.73 m2, 87% stable/improved CKD-stage) and 44% of non-CKD (+4.2 ± 15.0 mL/min/1.73 m2) patients. AEs were similar (≥1 AE CKD: 53%, non-CKD: 67%; gout flare most-reported). One case each of pancytopenia and IR (mild) occurred in non-CKD patients. These real-world data show similar pegloticase + MTX efficacy in CKD and non-CKD patients. No new safety signals were identified, with most CKD patients showing renal function stability or improvement during therapy.
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Affiliation(s)
| | | | | | - Brad Marder
- Horizon Therapeutics plc (now Amgen, Inc.), Deerfield, IL
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Kim YE, Ahn SM, Oh JS, Kim YG, Lee CK, Yoo B, Hong S. Febuxostat dose requirement according to renal function in patients who achieve target serum urate levels: A retrospective cohort study. Joint Bone Spine 2024; 91:105668. [PMID: 38036062 DOI: 10.1016/j.jbspin.2023.105668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 10/18/2023] [Accepted: 11/24/2023] [Indexed: 12/02/2023]
Abstract
OBJECTIVES To determine the febuxostat dose requirement according to renal function in patients who achieve target serum urate (SU) levels. METHODS Of 3153 gout patients who underwent febuxostat treatment, 873 patients with an initial SU level>6mg/dL were included and categorized by the estimated glomerular filtration rate: normal, chronic kidney disease (CKD) stage 3, and stages 4-5. Ninety-five patients with insufficient follow-up were further excluded. The dose of febuxostat in patients who achieved the SU target (< 6mg/dL) was defined as the average daily dosage at the time of SU target achievement. RESULTS The cohort of 778 gout patients had a median age of 52.0 years (IQR, 41.0-63.0) and comprised 711 (91.4%) men. The mean SU at febuxostat initiation was higher in the CKD 4-5 (9.6 [± 3.1] mg/dL) than in the other groups (CKD 3, 8.7 [± 1.7]; normal, 8.4 [± 1.7]; P<0.001). Patients achieved target SU at a median of 4.0 (1.9-9.6) months and in those who achieved target SU, the dose of febuxostat at the time of SU target achievement was significantly lower in the CKD 4-5 group (50.0 [± 16.5] mg) than in the other groups (vs. CKD stage 3, 60.0 [± 19.5] mg; P<0.01, vs. normal, 60.0 [± 19.8] mg; P<0.01). Furthermore, CKD stage 4-5 had a negative correlation with the febuxostat dose requirement (Beta: -2.334, P<0.05). CONCLUSION Among patients who achieved SU target, those with severely decreased renal function (CKD 4-5) required a lower febuxostat dose to achieve the target SU level compared to patients with normal or mild renal impairment.
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Affiliation(s)
- Young-Eun Kim
- Department of Rheumatology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, 05505 Seoul, Republic of Korea
| | - Soo Min Ahn
- Department of Rheumatology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, 05505 Seoul, Republic of Korea
| | - Ji Seon Oh
- Information Medicine, Big Data Research Center, Asan Medical Center, Seoul, Republic of Korea
| | - Yong-Gil Kim
- Department of Rheumatology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, 05505 Seoul, Republic of Korea
| | - Chang-Keun Lee
- Department of Rheumatology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, 05505 Seoul, Republic of Korea
| | - Bin Yoo
- Department of Rheumatology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, 05505 Seoul, Republic of Korea
| | - Seokchan Hong
- Department of Rheumatology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, 05505 Seoul, Republic of Korea.
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Zhang L, Zhang F, Bai Y, Huang L, Zhong Y, Zhang X. Effects of sodium-glucose cotransporter-2 (SGLT-2) inhibitors on serum uric acid levels in patients with chronic kidney disease: a systematic review and network meta-analysis. BMJ Open Diabetes Res Care 2024; 12:e003836. [PMID: 38238025 PMCID: PMC10807021 DOI: 10.1136/bmjdrc-2023-003836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 12/19/2023] [Indexed: 01/23/2024] Open
Abstract
Elevated serum uric acid levels are an independent predictor of occurrence and development of chronic kidney disease (CKD) and are strongly associated with prognosis. Several clinical trials have demonstrated the benefits of sodium-glucose cotransporter-2 (SGLT-2) inhibitors. To evaluate and rank the effects and safety of various SGLT-2 for serum uric acid levels in patients with CKD. We performed a systematic PubMed, Embase, Scopus, and Web of Science search, including studies published before July 1, 2023. Two researchers independently extracted data on study characteristics and outcomes and assessed study quality using the Cochrane Collaboration's risk of bias tool 2. The gemtc package of R software was used to perform network meta-analysis within a Bayesian framework. The primary outcome was serum uric acid levels, and the secondary outcome was adverse events. Effect sizes are reported as standardized mean differences (SMDs), risk ratio (RR), and 95% CI, respectively. The certainty of evidence was evaluated using Grading of Recommendations, Assessment, Development and Evaluations (GRADE) criteria. Eight RCTs (9367 participants) were included in this meta-analysis. The results of the paired meta-analysis showed that SGLT-2 inhibitors significantly reduced serum uric acid levels in patients with CKD compared with the placebo group (SMD -0.22; 95% CI -0.42 to -0.03; GRADE: low). Pooled analysis of any adverse events reported in the included studies showed similar incidence rates in the SGLT-2 inhibitor and placebo groups (RR: 0.99; 95% CI 0.97 to 1.00; p=0.147; GRADE: high). Subgroup analysis showed a statistically significant difference only for tofogliflozin. Further network meta-analysis showed that dapagliflozin 10 mg and ipragliflozin 50 mg may be the most effective in reducing uric acid levels. SGLT-2 inhibitors significantly reduced serum uric acid levels in patients with CKD, and dapagliflozin 10 mg and ipragliflozin 50 mg may be the optimal dosages. SGLT-2 inhibitors hold great promise as an antidiabetic therapeutic option for patients with CKD who have elevated serum uric acid levels. PROSPERO registration number: CRD42023456581.
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Affiliation(s)
- Linli Zhang
- Department of Nephrology A, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Xuhui, Shanghai, China
| | - Fan Zhang
- Department of Nephrology A, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Xuhui, Shanghai, China
| | - Yan Bai
- Department of Nephrology A, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Xuhui, Shanghai, China
| | - Liuyan Huang
- Department of Nephrology A, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Xuhui, Shanghai, China
| | - Yifei Zhong
- Department of Nephrology A, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Xuhui, Shanghai, China
| | - Xianwen Zhang
- Department of Nephrology A, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Xuhui, Shanghai, China
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Prest M. Nutrition Interventions for the Management of Gout. J Ren Nutr 2023; 33:e1-e3. [PMID: 36649831 DOI: 10.1053/j.jrn.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 01/11/2023] [Indexed: 01/15/2023] Open
Affiliation(s)
- Melissa Prest
- National Kidney Foundation of IL, Chicago, Illinois.
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Long T, Liu L. Research Progress on the Relationship between Dietary Patterns and Hyperuricemia. Appl Bionics Biomech 2022; 2022:5658423. [PMID: 36164548 PMCID: PMC9509246 DOI: 10.1155/2022/5658423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/18/2022] [Accepted: 08/23/2022] [Indexed: 11/18/2022] Open
Abstract
As the final metabolite of purine metabolism, uric acid is critically associated with human health. The serum uric acid level is regulated by diet and the metabolic capacity of the human body. The impaired control of uric acid metabolism and excretion is associated with the increased level of serum uric acid, which ultimately results in hyperuricemia. Hyperuricemia is the "fourth-highest" after hypertension, hyperglycemia, and hyperlipidemia. With progress made in the relationship between diet and hyperuricemia, different dietary patterns and lifestyles have been discussed, such as exercise, the amount intake of meat, seafood, supplements with omega-3 fatty acids, sugar-sweetened soft drinks and energy drinks, and lower-fat-containing foods as well as drinking beer, wine, and spirits in the present article. This study demonstrated that a lower risk of hyperuricemia is substantially correlated with higher baseline adherence to MeDiet, and plant polyphenols can combat hyperuricemia by blocking xanthine oxidase.
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Affiliation(s)
- Tian Long
- Department of Clinical Nutrition, Huangshi Central Hospital, Affiliated Hospital of Hubei Polytechnic University, Edong Healthcare Group, Huangshi, Hubei 435000, China
| | - Liang Liu
- Department of Clinical Nutrition, Huangshi Central Hospital, Affiliated Hospital of Hubei Polytechnic University, Edong Healthcare Group, Huangshi, Hubei 435000, China
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McCormick N, Lu N, Yokose C, Joshi AD, Sheehy S, Rosenberg L, Warner ET, Dalbeth N, Merriman TR, Saag KG, Zhang Y, Choi HK. Racial and Sex Disparities in Gout Prevalence Among US Adults. JAMA Netw Open 2022; 5:e2226804. [PMID: 35969396 PMCID: PMC9379746 DOI: 10.1001/jamanetworkopen.2022.26804] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
IMPORTANCE Emerging data suggest gout and hyperuricemia may now be more frequent among Black adults in the US than White adults, especially Black women. However, national-level, sex-specific general population data on racial differences in gout prevalence and potential socioclinical risk factors are lacking. OBJECTIVE To identify sex-specific factors driving disparities between Black and White adults in contemporary gout prevalence in the US general population. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional analysis used nationally representative, decadal survey data from successive cycles of the National Health and Nutrition Examination Survey from 2007 to 2016. Data were analyzed from November 1, 2019, through May 31, 2021. Participants included US adults self-reporting Black or White race. EXPOSURES Self-reported race, excess body mass index, chronic kidney disease (CKD; defined as estimated glomerular filtration rate <60 mL/min/1.73 m2, according to latest equations without race coefficient), poverty, poor-quality diet, low educational level, alcohol consumption, and diuretic use. MAIN OUTCOMES AND MEASURES Race- and sex-specific prevalence of physician- or clinician-diagnosed gout and hyperuricemia and their differences before and after adjusting for potential socioclinical risk factors. RESULTS A total of 18 693 participants were included in the analysis, consisting of 3304 Black women (mean [SD] age, 44.8 [0.4] years), 6195 White women (mean [SD] age, 49.8 [0.3] years), 3085 Black men (mean [SD] age, 43.6 [0.5] years]), and 6109 White men (mean [SD] age, 48.2 [0.3] years). Age-standardized prevalence of gout was 3.5% (95% CI, 2.7%-4.3%) in Black women and 2.0% (95% CI, 1.5%-2.5%) in White women (age-adjusted odds ratio [OR], 1.81 [95% CI, 1.29-2.53]); prevalence was 7.0% (95% CI, 6.2%-7.9%) in Black men and 5.4% (95% CI, 4.7%-6.2%) in White men (age-adjusted OR, 1.26 [95% CI, 1.02-1.55]). These associations attenuated after adjusting for poverty, diet, body mass index, and CKD among women and for diet and CKD among men but became null after adjusting for all risk factors (ORs, 1.05 [95% CI, 0.67-1.65] among women and 1.05 [95% CI, 0.80-1.35] among men). Hyperuricemia end point findings were similar. CONCLUSIONS AND RELEVANCE In this nationally representative race- and sex-specific cross-sectional study of US adults, gout was more prevalent in adults self-reporting Black race during a recent 10-year period compared with their White counterparts. These racial differences may be explained by sex-specific differences in diet and social determinants of health and clinical factors. Culturally informed efforts focusing on these factors could reduce current gout-related disparities.
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Affiliation(s)
- Natalie McCormick
- Clinical Epidemiology Program, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston
- Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Arthritis Research Canada, Vancouver, British Columbia
| | - Na Lu
- Arthritis Research Canada, Vancouver, British Columbia
| | - Chio Yokose
- Clinical Epidemiology Program, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston
- Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Amit D. Joshi
- Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston
| | - Shanshan Sheehy
- Slone Epidemiology Center at Boston University, Boston, Massachusetts
| | - Lynn Rosenberg
- Slone Epidemiology Center at Boston University, Boston, Massachusetts
| | - Erica T. Warner
- Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston
- Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Boston, Massachusetts
| | - Nicola Dalbeth
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Tony R. Merriman
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham
- Department of Biochemistry, University of Otago, Dunedin, New Zealand
| | - Kenneth G. Saag
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham
| | - Yuqing Zhang
- Clinical Epidemiology Program, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston
- Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Hyon K. Choi
- Clinical Epidemiology Program, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston
- Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Arthritis Research Canada, Vancouver, British Columbia
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7
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Zhang H, Li H, Green AP, Wang M, Yan F, Li M, He Y, Sun W, Yuan X, Lu J, Sun M, Merriman TR, Li C. Association of low-level environmental exposure to cadmium and lead with gout flare using a cohort study design. CHEMOSPHERE 2021; 280:130648. [PMID: 33932909 DOI: 10.1016/j.chemosphere.2021.130648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 04/18/2021] [Accepted: 04/20/2021] [Indexed: 06/12/2023]
Abstract
Cadmium (Cd) and lead (Pb) are toxic heavy metals with endocrine-disrupting properties. We investigated the associations of low-level environmental exposure to Cd/Pb and gout status (intercritical gout, gout flare and combined gout) in a cohort study. We measured by ICP-MS the levels of Cd and Pb in blood (Cd-B and Pb-B) and urine (Cd-U and Pb-U) from 408 participants with blood and 346 participants with urine samples recruited from a hospital gout clinic. The median levels of Cd-B and Pb-B (in μg/L) in the gout flare group were 0.87 (range 0.41-2.49) and 31.54 (25.38-41.46), respectively, and the median levels of Cd-U and Pb-U in the gout flare group were 1.05 (0.69-1.91) and 3.86 (3.49-4.44), respectively. These medians were significantly higher than those in the control or intercritical groups (P < 0.05). For Cd-B in tertile 2 (T2) and Cd-U in tertile 3, Cd levels were significantly associated with gout flare status compared to the reference tertile 1 (OR = 4.3, P = 0.041 and OR = 25.1, P = 0.002, respectively) after adjustment under Model 3. For Pb-U, the risk of gout flare status was significantly higher in T2 (OR = 51.0, P = 0.002) compared to the T1 under Model 3. Our results show that median levels of Cd-B, Pb-B, Cd-U and Pb-U in the gout flare group were significantly higher than participants without gout or with gout but in the intercritical period. We provide evidence that the risk of gout flare status is associated with increased Cd levels, and that blood and urine levels of Cd are a risk factor for gout flare status.
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Affiliation(s)
- Hui Zhang
- Institute of Metabolic Diseases, Qingdao University, Qingdao, 266071, China; Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, the Affiliated Hospital of Qingdao University, China; Medical Research Center, The Affiliated Hospital of Qingdao University, China.
| | - Hailong Li
- Institute of Metabolic Diseases, Qingdao University, Qingdao, 266071, China; Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, the Affiliated Hospital of Qingdao University, China; Medical Research Center, The Affiliated Hospital of Qingdao University, China.
| | | | - Ming Wang
- Institute of Metabolic Diseases, Qingdao University, Qingdao, 266071, China; Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, the Affiliated Hospital of Qingdao University, China; Medical Research Center, The Affiliated Hospital of Qingdao University, China.
| | - Fei Yan
- Institute of Metabolic Diseases, Qingdao University, Qingdao, 266071, China; Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, the Affiliated Hospital of Qingdao University, China; Medical Research Center, The Affiliated Hospital of Qingdao University, China.
| | - Maichao Li
- Institute of Metabolic Diseases, Qingdao University, Qingdao, 266071, China; Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, the Affiliated Hospital of Qingdao University, China; Medical Research Center, The Affiliated Hospital of Qingdao University, China.
| | - Yuwei He
- Institute of Metabolic Diseases, Qingdao University, Qingdao, 266071, China; Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, the Affiliated Hospital of Qingdao University, China; Medical Research Center, The Affiliated Hospital of Qingdao University, China.
| | - Wenyan Sun
- Institute of Metabolic Diseases, Qingdao University, Qingdao, 266071, China; Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, the Affiliated Hospital of Qingdao University, China; Medical Research Center, The Affiliated Hospital of Qingdao University, China.
| | - Xuan Yuan
- Institute of Metabolic Diseases, Qingdao University, Qingdao, 266071, China; Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, the Affiliated Hospital of Qingdao University, China; Medical Research Center, The Affiliated Hospital of Qingdao University, China.
| | - Jie Lu
- Institute of Metabolic Diseases, Qingdao University, Qingdao, 266071, China; Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, the Affiliated Hospital of Qingdao University, China; Medical Research Center, The Affiliated Hospital of Qingdao University, China.
| | - Mingshu Sun
- Department of Rheumatology and Clinical Immunology, The Affiliated Hospital of Qingdao University, China.
| | - Tony R Merriman
- Institute of Metabolic Diseases, Qingdao University, Qingdao, 266071, China; Department of Biochemistry, University of Otago, Dunedin, New Zealand; Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Alabama, USA.
| | - Changgui Li
- Institute of Metabolic Diseases, Qingdao University, Qingdao, 266071, China; Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, the Affiliated Hospital of Qingdao University, China; Medical Research Center, The Affiliated Hospital of Qingdao University, China; Department of Endocrinology and Metabolism, The Affiliated Hospital of Qingdao University, China.
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Dyah Kurniasari M, Karwur FF, Rayanti RE, Huruta AD, Lin YH, Weng SF, Tsai HT. Increased Systolic Blood Pressure Mediates the Relationship Between Urate and Gout Risk in Indonesia: A Novel Application of a Partial Least Squares-Structural Equation Model. Biol Res Nurs 2021; 24:40-47. [PMID: 34340595 DOI: 10.1177/10998004211029044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Most Indonesians with hyperuricemia are less than 40 years old, which suggests an increasing gout risk in the country. Meanwhile, untreated hyperuricemia was also suggested to lead to hypertension. Yet, it is unclear whether blood pressure (BP) plays a mediating role between urate and gout. OBJECTIVE We investigated the mediating effect of BP between urate and gout risk in Indonesians using a partial least squares-structural equation model. METHOD A community-based retrospective case-control study was conducted between July 1 and August 31, 2019 in Indonesia. We randomly recruited 397 participants, including 86 patients with gout and 311 healthy controls from seven community health service centers. Multivariate logistic regression was employed to analyze the adjusted odds ratios of the association between risk factors, such as urate level and BP, and gout risk after controlling for other covariates. A path analysis was utilized to analyze the mediating effect of systolic BP between urate and gout. The STROBE reporting guideline for the observational study is adopted in our reporting. RESULT We found that a 1 mg/dL increase of urate level significantly increased gout risk with an OR of 4.97 (95% CI: 3.48-7.09) and an AOR of 4.44 (95% CI: 3.07-6.42) after adjusting for covariates. The association between urate and gout was also significantly mediated by systolic BP (β = 0.05; 95% CI Bias Corrected [0.02-0.08], p < 0.001). CONCLUSION Urate was significantly associated with gout risk and was possibly mediated by increased systolic BP in Indonesians. Controlling systolic BP could be one of the strategies to decrease the risk of gout for individuals with hyperuricemia. Health education can be carried out by community health nurses to individuals on controlling their urate level and systolic BP to decrease the gout risk among Indonesian.
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Affiliation(s)
- Maria Dyah Kurniasari
- School of Nursing, College of Nursing, Taipei Medical University, Republic of China.,Faculty of Medicine and Health Sciences, Department of Nursing, Universitas Kristen Satya Wacana, Salatiga City, Indonesia
| | - Ferry Fredy Karwur
- Faculty of Medicine and Health Sciences, Department of Nutrition, Universitas Kristen Satya Wacana, Salatiga City, Indonesia
| | - Rosiana Eva Rayanti
- Faculty of Medicine and Health Sciences, Department of Nursing, Universitas Kristen Satya Wacana, Salatiga City, Indonesia
| | - Andrian Dolfriandra Huruta
- Faculty of Economics and Business, Universitas Kristen Satya Wacana, Salatiga, Indonesia.,PhD Program in Business, Chung Yuan Christian University, Zhongli District, Taoyuan, Republic of China
| | - Yu Huei Lin
- Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Republic of China
| | - Shuen Fu Weng
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Medical University Hospital, Republic of China.,Division of Endocrinology and Metabolism, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Republic of China
| | - Hsiu Ting Tsai
- School of Nursing, College of Nursing, Taipei Medical University, Republic of China.,Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Republic of China
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9
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Safiri S, Kolahi A, Cross M, Carson‐Chahhoud K, Hoy D, Almasi‐Hashiani A, Sepidarkish M, Ashrafi‐Asgarabad A, Moradi‐Lakeh M, Mansournia MA, Kaufman JS, Collins G, Woolf AD, March L, Smith E. Prevalence, Incidence, and Years Lived With Disability Due to Gout and Its Attributable Risk Factors for 195 Countries and Territories 1990–2017: A Systematic Analysis of the Global Burden of Disease Study 2017. Arthritis Rheumatol 2020; 72:1916-1927. [DOI: 10.1002/art.41404] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 05/19/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Saeid Safiri
- Aging Research Institute Tabriz University of Medical Sciences, Tabriz, Iran and Neuroscience Institute Tehran University of Medical Sciences Tehran Iran
| | - Ali‐Asghar Kolahi
- Social Determinants of Health Research Center Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Marita Cross
- Institute of Bone and Joint Research The University of Sydney Sydney New South Wales Australia
| | | | - Damian Hoy
- Institute of Bone and Joint Research The University of Sydney, Sydney, New South Wales, Australia, and Global Alliance for Musculoskeletal Health Royal Cornwall Hospital Truro UK
| | | | - Mahdi Sepidarkish
- School of Public Health Babol University of Medical Sciences Babol Iran
| | | | - Maziar Moradi‐Lakeh
- Preventive Medicine and Public Health Research Center Iran University of Medical Sciences Tehran Iran
| | | | - Jay S. Kaufman
- Faculty of Medicine McGill University Montreal Quebec Canada
| | - Gary Collins
- Botnar Research Centre University of Oxford NIHR Oxford Biomedical Research Centre Oxford University Hospitals NHS Foundation Trust Oxford UK
| | - Anthony D. Woolf
- Royal Cornwall Hospital and University of Exeter Medical School Truro UK
| | - Lyn March
- Institute of Bone and Joint Research The University of Sydney Royal North Shore Hospital, Sydney, New South Wales, Australia, and Global Alliance for Musculoskeletal Health Royal Cornwall Hospital Truro UK
| | - Emma Smith
- Institute of Bone and Joint Research The University of Sydney Sydney New South Wales Australia
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Bardin T, Nguyen QD, Tran KM, Le NH, Do MD, Richette P, Letavernier E, Correas JM, Resche-Rigon M. A cross-sectional study of 502 patients found a diffuse hyperechoic kidney medulla pattern in patients with severe gout. Kidney Int 2020; 99:218-226. [PMID: 32898570 DOI: 10.1016/j.kint.2020.08.024] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 08/18/2020] [Accepted: 08/27/2020] [Indexed: 12/27/2022]
Abstract
We have previously shown that ultrasonography can detect hyperechogenic crystal deposits in the kidney medulla of patients with gout. In this cross-sectional study we investigated the frequency and clinical correlates of hyperechogenic kidney medulla in 502 consecutive primary consultants for gout (ACR/EULAR criteria) at the Vien Gut medical center in Ho Chi Minh City, Vietnam. None of these patients received urate-lowering drugs. Kidney medulla echogenicity on B-mode ultrasonography was compared to that of the kidney cortex. Overall, 36% patients showed a hyperechoic pattern of Malpighi pyramids. On univariate analysis, the pattern was significantly associated with age, estimated gout duration, steroid-dependency, clinical tophi, urate arthropathy, double contour thickness at the scanned joints, coronary heart disease, arterial hypertension, hyperuricemia, proteinuria, leukocyturia, and decreased estimated glomerular filtration rate. On multivariable analysis, the hyperechoic pattern was associated with estimated disease duration, clinical tophi, urate arthropathy, double contour thickness and decreased estimated glomerular filtration rate. No hyperechoic pattern was observed in 515 consecutive consultants without gout. Thus, hyperechoic kidney medulla was frequently demonstrated in Vietnamese patients with tophaceous gout and associated with features of tubulointerstitial nephritis. This finding revives the hypothesis of microcrystalline nephropathy of gout, predominantly seen in untreated gouty patients, which could be an important target for urate-lowering therapy.
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Affiliation(s)
- Thomas Bardin
- French-Vietnamese Research Center on Gout and Chronic Diseases, Vien Gut Medical Center, Ho Chi Minh City, Vietnam; Department of Rheumatology, Hôpital Lariboisière APHP, Paris, France; Université de Paris, INSERM U1132, Paris, France.
| | - Quang D Nguyen
- French-Vietnamese Research Center on Gout and Chronic Diseases, Vien Gut Medical Center, Ho Chi Minh City, Vietnam
| | - Khoy M Tran
- French-Vietnamese Research Center on Gout and Chronic Diseases, Vien Gut Medical Center, Ho Chi Minh City, Vietnam
| | - Nghia H Le
- French-Vietnamese Research Center on Gout and Chronic Diseases, Vien Gut Medical Center, Ho Chi Minh City, Vietnam
| | - Minh D Do
- Center for Molecular Biomedicine, University of Medicine and Pharmacy at Ho Chi Min City, Vietnam
| | - Pascal Richette
- Department of Rheumatology, Hôpital Lariboisière APHP, Paris, France; Université de Paris, INSERM U1132, Paris, France
| | - Emmanuel Letavernier
- Department of Physiology, Hôpital Tenon, APHP, Paris, France; Sorbonne Université and INSERM, UMR S 1155, Hôpital Tenon, Paris, France
| | - Jean-Michel Correas
- Department of Radiology, Hôpital Necker, APHP, Paris, France; Université de Paris, Paris, France
| | - Mathieu Resche-Rigon
- French-Vietnamese Research Center on Gout and Chronic Diseases, Vien Gut Medical Center, Ho Chi Minh City, Vietnam; Department of Biostatistics, Hôpital Saint Louis, APHP, Paris, France; Université de Paris, UMR U1153 ECSTRA team INERM, Paris, France
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11
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Bikbov B, Purcell CA, Levey AS, Smith M, Abdoli A, Abebe M, Adebayo OM, Afarideh M, Agarwal SK, Agudelo-Botero M, Ahmadian E, Al-Aly Z, Alipour V, Almasi-Hashiani A, Al-Raddadi RM, Alvis-Guzman N, Amini S, Andrei T, Andrei CL, Andualem Z, Anjomshoa M, Arabloo J, Ashagre AF, Asmelash D, Ataro Z, Atout MMW, Ayanore MA, Badawi A, Bakhtiari A, Ballew SH, Balouchi A, Banach M, Barquera S, Basu S, Bayih MT, Bedi N, Bello AK, Bensenor IM, Bijani A, Boloor A, Borzì AM, Cámera LA, Carrero JJ, Carvalho F, Castro F, Catalá-López F, Chang AR, Chin KL, Chung SC, Cirillo M, Cousin E, Dandona L, Dandona R, Daryani A, Das Gupta R, Demeke FM, Demoz GT, Desta DM, Do HP, Duncan BB, Eftekhari A, Esteghamati A, Fatima SS, Fernandes JC, Fernandes E, Fischer F, Freitas M, Gad MM, Gebremeskel GG, Gebresillassie BM, Geta B, Ghafourifard M, Ghajar A, Ghith N, Gill PS, Ginawi IA, Gupta R, Hafezi-Nejad N, Haj-Mirzaian A, Haj-Mirzaian A, Hariyani N, Hasan M, Hasankhani M, Hasanzadeh A, Hassen HY, Hay SI, Heidari B, Herteliu C, Hoang CL, Hosseini M, Hostiuc M, Irvani SSN, Islam SMS, Jafari Balalami N, James SL, Jassal SK, Jha V, Jonas JB, Joukar F, Jozwiak JJ, Kabir A, Kahsay A, Kasaeian A, Kassa TD, Kassaye HG, Khader YS, Khalilov R, Khan EA, Khan MS, Khang YH, Kisa A, Kovesdy CP, Kuate Defo B, Kumar GA, Larsson AO, Lim LL, Lopez AD, Lotufo PA, Majeed A, Malekzadeh R, März W, Masaka A, Meheretu HAA, Miazgowski T, Mirica A, Mirrakhimov EM, Mithra P, Moazen B, Mohammad DK, Mohammadpourhodki R, Mohammed S, Mokdad AH, Morales L, Moreno Velasquez I, Mousavi SM, Mukhopadhyay S, Nachega JB, Nadkarni GN, Nansseu JR, Natarajan G, Nazari J, Neal B, Negoi RI, Nguyen CT, Nikbakhsh R, Noubiap JJ, Nowak C, Olagunju AT, Ortiz A, Owolabi MO, Palladino R, Pathak M, Poustchi H, Prakash S, Prasad N, Rafiei A, Raju SB, Ramezanzadeh K, Rawaf S, Rawaf DL, Rawal L, Reiner RC, Rezapour A, Ribeiro DC, Roever L, Rothenbacher D, Rwegerera GM, Saadatagah S, Safari S, Sahle BW, Salem H, Sanabria J, Santos IS, Sarveazad A, Sawhney M, Schaeffner E, Schmidt MI, Schutte AE, Sepanlou SG, Shaikh MA, Sharafi Z, Sharif M, Sharifi A, Silva DAS, Singh JA, Singh NP, Sisay MMM, Soheili A, Sutradhar I, Teklehaimanot BF, Tesfay BE, Teshome GF, Thakur JS, Tonelli M, Tran KB, Tran BX, Tran Ngoc C, Ullah I, Valdez PR, Varughese S, Vos T, Vu LG, Waheed Y, Werdecker A, Wolde HF, Wondmieneh AB, Wulf Hanson S, Yamada T, Yeshaw Y, Yonemoto N, Yusefzadeh H, Zaidi Z, Zaki L, Zaman SB, Zamora N, Zarghi A, Zewdie KA, Ärnlöv J, Coresh J, Perico N, Remuzzi G, Murray CJL, Vos T. Global, regional, and national burden of chronic kidney disease, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2020; 395:709-733. [PMID: 32061315 PMCID: PMC7049905 DOI: 10.1016/s0140-6736(20)30045-3] [Citation(s) in RCA: 2881] [Impact Index Per Article: 720.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 09/16/2019] [Accepted: 01/06/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Health system planning requires careful assessment of chronic kidney disease (CKD) epidemiology, but data for morbidity and mortality of this disease are scarce or non-existent in many countries. We estimated the global, regional, and national burden of CKD, as well as the burden of cardiovascular disease and gout attributable to impaired kidney function, for the Global Burden of Diseases, Injuries, and Risk Factors Study 2017. We use the term CKD to refer to the morbidity and mortality that can be directly attributed to all stages of CKD, and we use the term impaired kidney function to refer to the additional risk of CKD from cardiovascular disease and gout. METHODS The main data sources we used were published literature, vital registration systems, end-stage kidney disease registries, and household surveys. Estimates of CKD burden were produced using a Cause of Death Ensemble model and a Bayesian meta-regression analytical tool, and included incidence, prevalence, years lived with disability, mortality, years of life lost, and disability-adjusted life-years (DALYs). A comparative risk assessment approach was used to estimate the proportion of cardiovascular diseases and gout burden attributable to impaired kidney function. FINDINGS Globally, in 2017, 1·2 million (95% uncertainty interval [UI] 1·2 to 1·3) people died from CKD. The global all-age mortality rate from CKD increased 41·5% (95% UI 35·2 to 46·5) between 1990 and 2017, although there was no significant change in the age-standardised mortality rate (2·8%, -1·5 to 6·3). In 2017, 697·5 million (95% UI 649·2 to 752·0) cases of all-stage CKD were recorded, for a global prevalence of 9·1% (8·5 to 9·8). The global all-age prevalence of CKD increased 29·3% (95% UI 26·4 to 32·6) since 1990, whereas the age-standardised prevalence remained stable (1·2%, -1·1 to 3·5). CKD resulted in 35·8 million (95% UI 33·7 to 38·0) DALYs in 2017, with diabetic nephropathy accounting for almost a third of DALYs. Most of the burden of CKD was concentrated in the three lowest quintiles of Socio-demographic Index (SDI). In several regions, particularly Oceania, sub-Saharan Africa, and Latin America, the burden of CKD was much higher than expected for the level of development, whereas the disease burden in western, eastern, and central sub-Saharan Africa, east Asia, south Asia, central and eastern Europe, Australasia, and western Europe was lower than expected. 1·4 million (95% UI 1·2 to 1·6) cardiovascular disease-related deaths and 25·3 million (22·2 to 28·9) cardiovascular disease DALYs were attributable to impaired kidney function. INTERPRETATION Kidney disease has a major effect on global health, both as a direct cause of global morbidity and mortality and as an important risk factor for cardiovascular disease. CKD is largely preventable and treatable and deserves greater attention in global health policy decision making, particularly in locations with low and middle SDI. FUNDING Bill & Melinda Gates Foundation.
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Mohammed E, Browne LD, Kumar A. U. A, Adeeb F, Fraser AD, Stack AG. Prevalence and treatment of gout among patients with chronic kidney disease in the Irish health system: A national study. PLoS One 2019; 14:e0210487. [PMID: 30682034 PMCID: PMC6347136 DOI: 10.1371/journal.pone.0210487] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 12/23/2018] [Indexed: 01/18/2023] Open
Abstract
Background Gout is a common inflammatory arthritis associated with adverse clinical outcomes. Under treatment is common in the general population. The aim of this study was to determine the prevalence of gout and its treatment among patients with chronic kidney disease (CKD). Methods We conducted a multi-centre cross sectional study of patients (n = 522) who attended specialist nephrology clinics in Ireland. Standardized data collection tool recorded clinical characteristics and medication use at clinic visits and kidney function was assessed with standardised creatinine measurements and Estimated Glomerular Filtration Rate (eGFR). The prevalence of gout and the corresponding use of urate lowering therapies (ULT) were determined. Multivariate logistic regression explored correlates of gout expressed as Odds Ratios (OR) and 95% Confidence Intervals (CI) adjusting for demographic and clinical characteristics. Results Overall prevalence of gout was 16.6% and increased significantly from 7.5% in Stage 1–2 CKD to 22.8% in stage 4–5 CKD, P< 0.005. Prevalence increased with age (P < 0.005) and was higher in men than women (19.1% versus 10.3% P< 0.005). Overall, 67.9% of gout patients with CKD were treated with ULT, and the percentage increased with advancing stage of CKD from 55.6% in Stage 1–2 to 77.4% in Stage 4–5, P<0.005. Multivariable modelling identified men (vs women), OR, 1.95 (0.95–4.03), serum albumin, OR 1.09 (1.02–1.16) per 1 g/L lower, poorer kidney function, OR 1.11 (1.01–1.22) per 5 ml/min/1.73m2 lower, and rising parathyroid hormone levels, OR 1.38 (1.08–1.77) per 50 pg/ml higher as disease correlates. Conclusions Gout is common in CKD and increases with worsening kidney function in the Irish health system. Over two thirds of patients with gout were receiving ULT, increasing to 77% of patients with advanced CKD. Greater awareness of gout in CKD, its treatment and the effectiveness of treatment strategies should be vigorously monitored to improve patient outcomes.
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Affiliation(s)
- Elshaeima Mohammed
- Division of Nephrology, Department of Medicine, University Hospital Limerick, Limerick, Ireland
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Leonard D. Browne
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Arun Kumar A. U.
- Division of Nephrology, Department of Medicine, University Hospital Limerick, Limerick, Ireland
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Fahd Adeeb
- Department of Rheumatology, University Hospital Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
| | - Alexander D. Fraser
- Department of Rheumatology, University Hospital Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
| | - Austin G. Stack
- Division of Nephrology, Department of Medicine, University Hospital Limerick, Limerick, Ireland
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
- * E-mail:
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13
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Lin TM, Chi JE, Chang CC, Kang YN. Do etoricoxib and indometacin have similar effects and safety for gouty arthritis? A meta-analysis of randomized controlled trials. J Pain Res 2018; 12:83-91. [PMID: 30588082 PMCID: PMC6305166 DOI: 10.2147/jpr.s186004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background Gout, a common medical condition that causes pain, can be treated by painkillers and anti-inflammatories. Indometacin and etoricoxib are two such drugs. However, no synthesized evidence exists comparing etoricoxib with indometacin in treating patients with gout. Methods We searched PubMed, Embase, Ovid MEDLINE, Web of Science, ScienceDirect, and the Cochrane Library without restrictions on language or publication date for potential randomized clinical trials comparing etoricoxib with indometacin for gout. The meta-analysis was conducted using a random-effects model. Results Search results yielded 313 references from six electronic databases, four of which met the eligibility criteria. These four were randomized clinical trials, and they involved a total of 609 patients with gouty arthritis. No significant differences were observed in pain score change, tenderness, or swelling between etoricoxib and indometacin; the mean differences were −0.05 (95% CI, −0.21 to 0.10), −0.06 (95% CI, −0.18 to 0.05), and −0.04 (95% CI, −0.17 to 0.09). However, the pooled data revealed that significantly fewer overall adverse events occurred in the etoricoxib group (n=105, 33.5%) than in the indometacin group (n=130, 44.1%) and the risk ratio was 0.77 (95% CI, 0.62–0.94). Conclusion Our meta-analysis revealed that etoricoxib and indometacin have similar effects on pain relief. However, etoricoxib has a significantly lower risk of adverse events than does indometacin, especially digestive system-related adverse events.
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Affiliation(s)
- Tzu-Min Lin
- Center for Evidence-Based Medicine, Department of Education, Taipei Medical University Hospital, Taipei, Taiwan, Republic of China, .,Division of Rheumatology, Immunology and Allergy, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan, Republic of China
| | - Jia-En Chi
- Center for Evidence-Based Medicine, Department of Education, Taipei Medical University Hospital, Taipei, Taiwan, Republic of China, .,School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, Republic of China
| | - Chi-Ching Chang
- Division of Rheumatology, Immunology and Allergy, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan, Republic of China.,Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, Republic of China
| | - Yi-No Kang
- Center for Evidence-Based Medicine, Department of Education, Taipei Medical University Hospital, Taipei, Taiwan, Republic of China,
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14
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Roughley M, Sultan AA, Clarson L, Muller S, Whittle R, Belcher J, Mallen CD, Roddy E. Risk of chronic kidney disease in patients with gout and the impact of urate lowering therapy: a population-based cohort study. Arthritis Res Ther 2018; 20:243. [PMID: 30376864 PMCID: PMC6235219 DOI: 10.1186/s13075-018-1746-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 10/15/2018] [Indexed: 01/10/2023] Open
Abstract
Background An association between gout and renal disease is well-recognised but few studies have examined whether gout is a risk factor for subsequent chronic kidney disease (CKD). Additionally, the impact of urate-lowering therapy (ULT) on development of CKD in gout is unclear. The objective of this study was to quantify the risk of CKD stage ≥ 3 in people with gout and the impact of ULT. Methods This was a retrospective cohort study using data from the Clinical Practice Research Datalink (CPRD). Patients with incident gout were identified from general practice medical records between 1998 and 2016 and randomly matched 1:1 to patients without a diagnosis of gout based on age, gender, available follow-up time and practice. Primary outcome was development of CKD stage ≥ 3 based on estimated glomerular filtration rate (eGFR) or recorded diagnosis. Absolute rates (ARs) and adjusted hazard ratios (HRs) were calculated using Cox regression models. Risk of developing CKD was assessed among those prescribed ULT within 1 and 3 years of gout diagnosis. Results Patients with incident gout (n = 41,446) were matched to patients without gout. Development of CKD stage ≥ 3 was greater in the exposed group than in the unexposed group (AR 28.6 versus 15.8 per 10,000 person-years). Gout was associated with an increased risk of incident CKD (adjusted HR 1.78 95% CI 1.70 to 1.85). Those exposed to ULT had a greater risk of incident CKD, but following adjustment this was attenuated to non-significance in all analyses (except on 3-year analysis of women (adjusted HR 1.31 95% CI 1.09 to 1.59)). Conclusions This study has demonstrated gout to be a risk factor for incident CKD stage ≥ 3. Further research examining the mechanisms by which gout may increase risk of CKD and whether optimal use of ULT can reduce the risk or progression of CKD in gout is suggested. Electronic supplementary material The online version of this article (10.1186/s13075-018-1746-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Matthew Roughley
- East London NHS Foundation Trust, Trust Headquarters, 9 Alie Street, London, E1 8DE, UK.
| | - Alyshah Abdul Sultan
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Lorna Clarson
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Sara Muller
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Rebecca Whittle
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - John Belcher
- School of Computing and Mathematics, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Christian D Mallen
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Edward Roddy
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK.,Haywood Academic Rheumatology Centre, Midland Partnership NHS Foundation Trust, Haywood Hospital, Burslem, Staffordshire, ST6 7AG, UK
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15
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García-Arroyo FE, Gonzaga G, Muñoz-Jiménez I, Blas-Marron MG, Silverio O, Tapia E, Soto V, Ranganathan N, Ranganathan P, Vyas U, Irvin A, Ir D, Robertson CE, Frank DN, Johnson RJ, Sánchez-Lozada LG. Probiotic supplements prevented oxonic acid-induced hyperuricemia and renal damage. PLoS One 2018; 13:e0202901. [PMID: 30142173 PMCID: PMC6108486 DOI: 10.1371/journal.pone.0202901] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 08/11/2018] [Indexed: 02/07/2023] Open
Abstract
Hyperuricemia is highly prevalent and especially common in subjects with metabolic, cardiovascular and renal diseases. In chronic kidney disease, hyperuricemia is extremely common, and uric acid (UA) excretion relies on gut uricolysis by gut microbiota. Current therapy for lowering serum UA includes drugs that may produce undesired secondary effects. Therefore, this pilot study was designed to evaluate the potential of two probiotic supplements to reduce systemic uric acid concentrations. Secondary objectives were to assess whether the hypouricemic effect related to a therapeutic benefit on the hyperuricemia-induced renal damage and hypertension. Analysis of fecal microbiota was also performed. Groups of 6 rats each were followed for 5 weeks and allocated in the following treatment groups: C = Control; HU-ND = Oxonic acid-induced hyperuricemia (HU) +regular diet; HU-P = HU+placebo; HU-F1 = HU+ probiotics formula 1 and HU-F2 = HU+ probiotics formula 2. We confirmed that oxonic acid-induced hyperuricemia produced hypertension and renal functional and structural changes, along with modest changes in the overall composition of fecal microbiota. Both probiotic-containing diets prevented HU, elevated UA urinary excretion and intrarenal UA accumulation induced by oxonic acid. The hypouricemic effect conferred by probiotic supplementation also prevented the renal changes and hypertension caused by hyperuricemia. However, probiotic treatment did not restore the fecal microbiota. In conclusion, we demonstrated for the first time the ability of probiotics containing uricolytic bacteria to lower serum uric acid in hyperuricemic animals with beneficial consequences on blood pressure and renal disease. As probiotics supplements are innocuous for human health, we recommend clinical studies to test if probiotic supplements could benefit hyperuricemic individuals.
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Affiliation(s)
| | - Guillermo Gonzaga
- Laboratory of Renal Physiopathology, INC Ignacio Chavez, Mexico City, Mexico
| | - Itzel Muñoz-Jiménez
- Laboratory of Renal Physiopathology, INC Ignacio Chavez, Mexico City, Mexico
| | | | - Octaviano Silverio
- Laboratory of Renal Physiopathology, INC Ignacio Chavez, Mexico City, Mexico
| | - Edilia Tapia
- Laboratory of Renal Physiopathology, INC Ignacio Chavez, Mexico City, Mexico
| | - Virgilia Soto
- Dept.of Pathology, INC Ignacio Chavez, Mexico City, Mexico
| | | | | | - Usha Vyas
- Kibow Biotech, Newtown Square, PA, United States of America
| | - Anthony Irvin
- Kibow Biotech, Newtown Square, PA, United States of America
| | - Diana Ir
- Division of Infectious Diseases, University of Colorado, Aurora, CO, United States of America
| | - Charles E. Robertson
- Division of Infectious Diseases, University of Colorado, Aurora, CO, United States of America
| | - Daniel N. Frank
- Division of Infectious Diseases, University of Colorado, Aurora, CO, United States of America
| | - Richard J. Johnson
- Renal Diseases and Hypertension, University of Colorado, Aurora, CO, United States of America
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16
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Mirkov S. Reducing clinical risks associated with the pharmacological treatment of acute gout attacks. DRUGS & THERAPY PERSPECTIVES 2018. [DOI: 10.1007/s40267-018-0519-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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17
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Eleftheriadis T, Golphinopoulos S, Pissas G, Stefanidis I. Asymptomatic hyperuricemia and chronic kidney disease: Narrative review of a treatment controversial. J Adv Res 2017; 8:555-560. [PMID: 28748122 PMCID: PMC5512148 DOI: 10.1016/j.jare.2017.05.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 04/23/2017] [Accepted: 05/01/2017] [Indexed: 02/07/2023] Open
Abstract
Today there is plausible evidence both on experimental and epidemiological basis, that hyperuricemia represents a risk factor for the development and progression of chronic kidney disease (CKD). Nevertheless, the role of serum uric acid lowering treatment in CKD is still a matter of serious controversy. Review of randomised controlled trials, suggests that there may be an improvement of renal function with allopurinol treatment in CKD stage 3-5. However, these studies have included a relatively limited number of participants and provide insufficient information on adverse events and on the incidence of the end stage renal disease. Therefore, before adequately powered randomised, placebo-controlled trials are completed we cannot recommend treating asymptomatic hyperuricemia in patients with CKD.
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Affiliation(s)
| | | | | | - Ioannis Stefanidis
- Department of Nephrology, University of Thessaly, School of Medicine, Mezourlo Hill, 41110 Larissa, Greece
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18
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Nguyen USDT, Zhang Y, Louie-Gao Q, Niu J, Felson DT, LaValley MP, Choi HK. Obesity Paradox in Recurrent Attacks of Gout in Observational Studies: Clarification and Remedy. Arthritis Care Res (Hoboken) 2017; 69:561-566. [PMID: 27331767 DOI: 10.1002/acr.22954] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 05/10/2016] [Accepted: 06/07/2016] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Obesity is strongly associated with incident gout risk, but its association with the risk of recurrent gout attacks has been null or weak, constituting an obesity paradox. We sought to demonstrate and overcome the methodologic issues associated with the obesity paradox for risk of recurrent gout attacks. METHODS Using the Multiple Risk Factor Intervention Trial database, we decomposed the total effect of obesity into its direct and indirect (i.e., mediated) effects using marginal structural models. We also estimated the total effect of body mass index (BMI) change from baseline among incident gout patients. RESULTS Of 11,816 gout-free subjects at baseline, we documented 408 incident gout cases, with 132 developing recurrent gout attacks over a 7-year followup period. The adjusted odds ratio (OR) for incident gout among obese individuals was 2.6, whereas that for recurrent gout attacks among gout patients was 0.98 (i.e., the obesity paradox). These ORs correlated well with the ORs for the indirect and direct effects of obesity on the risk of recurrent gout attacks (2.83 and 0.98, respectively). Compared with no BMI change, the OR of increasing versus decreasing >5% of baseline BMI was 0.61 and 1.60 for recurrent gout attacks, respectively (P for trend < 0.01), suggesting a dose-response association. CONCLUSION The obesity paradox for the risk of recurrent gout attacks is explained by the absence of the direct effect, which is often measured in conventional analyses and misinterpreted as the intended total effect of interest. In contrast, the BMI change analysis correctly estimated the intended total effect of BMI, and revealed a dose-response relationship.
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Affiliation(s)
- Uyen-Sa D T Nguyen
- University of Massachusetts Medical School, Worcester, and Boston University School of Medicine, Boston, Massachusetts
| | - Yuqing Zhang
- Boston University School of Medicine, Boston, Massachusetts
| | | | - Jingbo Niu
- Boston University School of Medicine, Boston, Massachusetts
| | - David T Felson
- Boston University School of Medicine, Boston, Massachusetts
| | | | - Hyon K Choi
- Boston University School of Medicine, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts
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19
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Tan VS, Garg AX, McArthur E, Lam NN, Sood MM, Naylor KL. The 3-Year Incidence of Gout in Elderly Patients with CKD. Clin J Am Soc Nephrol 2017; 12:577-584. [PMID: 28153936 PMCID: PMC5383383 DOI: 10.2215/cjn.06790616] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 12/12/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES The risk of gout across CKD stages is not well described. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We performed a retrospective cohort study using linked health care databases from Ontario, Canada from 2002 to 2010. The primary outcome was the 3-year cumulative incidence of gout, on the basis of diagnostic codes. We presented our results by level of kidney function (eGFR≥90 ml/min per 1.73 m2, 60-89, 45-59, 30-44, 15-29, and chronic dialysis) and by sex. Additional analyses examined the risk of gout adjusting for clinical characteristics, incidence of gout defined by the receipt of allopurinol or colchicine, and gout risk in a subpopulation stratified by the level of eGFR and albuminuria. RESULTS Of the 282,925 adults aged ≥66 years, the mean age was 75 years and 57.9% were women. The 3-year cumulative incidence of gout was higher in older adults with a lower level of eGFR. In women, the 3-year cumulative incidence of gout was 0.6%, 0.7%, 1.3%, 2.2%, and 3.4%, and in men the values were 0.8%, 1.2%, 2.5%, 3.7%, and 4.6%, respectively. However, patients on chronic dialysis had a lower 3-year cumulative incidence of gout (women 2.0%, men 2.9%) than those with more moderate reductions in kidney function (i.e., eGFR 15-44 ml/min per 1.73 m2). The association between a greater loss of kidney function and a higher risk of diagnosed gout was also evident after adjustment for clinical characteristics and in all additional analyses. CONCLUSIONS Patients with a lower level of eGFR had a higher 3-year cumulative incidence of gout, with the exception of patients receiving dialysis. Results can be used for risk stratification.
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Affiliation(s)
| | - Amit X Garg
- Division of Nephrology and
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Ontario, Canada
| | - Eric McArthur
- Institute for Clinical Evaluative Sciences, Ontario, Canada
| | - Ngan N Lam
- Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada
| | - Manish M Sood
- Institute for Clinical Evaluative Sciences, Ontario, Canada
- Division of Nephrology, University of Ottawa, Ottawa, Ontario, Canada; and
| | - Kyla L Naylor
- Institute for Clinical Evaluative Sciences, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Abstract
BACKGROUND Few studies have evaluated whether patients with a diagnosis of gout adhere to alcohol use recommendations and the relationship between adherence and activity limitations. PURPOSE The purpose of this study was to determine adherence to American College of Rheumatology (ACR) alcohol use recommendations and evaluate the relationship between alcohol use and activity limitations in persons with gout. METHOD A secondary analysis was performed with a sample of 298 persons with gout from the 2008 National Health Interview Survey. RESULTS In all, 22.8% of persons with gout were nonadherent to alcohol use recommendations. Males, those aged 41-60 years, and those not receiving healthcare for joint symptoms were most likely to be nonadherent. In all, 39.9% reported that joint symptoms interfered with activity in the preceding 30 days. Those who were adherent were more likely to report limitations (χ = 6.788, p = .03). CONCLUSIONS To promote optimal patient outcomes, more attention needs to be devoted to individualized patient education and self-management interventions that follow ACR recommendations.
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Abstract
Hyperuricemia (elevated serum uric acid) is prevalent, and an important mediator of gout, an increasingly common condition. In addition, hyperuricemia is associated with metabolic syndrome, diabetes, hypertension, and kidney and cardiovascular diseases. Although it remains controversial whether hyperuricemia is a causal factor for kidney disease, the kidneys play a major role in the regulation of serum uric acid levels. Approximately two-thirds of the uric acid produced in humans is excreted by the kidneys. The handling of urate in the renal proximal tubule is extensive, as uric acid undergoes filtration, reabsorption, and secretion. Variations in renal urate handling have been shown to influence the risk of gout. In observational studies, hyperuricemia has been shown to predict kidney disease onset and progression, with a variety of mechanisms implicated. Because of this close association between hyperuricemia and kidney disease, and due to limited studies on the topic, it is important to conduct future studies on the treatment of hyperuricemia to slow kidney disease progression and improve cardiovascular survival in patients with chronic kidney disease. Furthermore, it is important to monitor for gout in patients with kidney disease and to follow the guidelines for treatment of hyperuricemia in this group of patients. This narrative review provides an in-depth discussion of the link between serum uric acid levels, renal handling of uric acid, and diseases associated with dysfunction in uric acid homeostasis.
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Gout characteristics associate with depression, but not anxiety, in primary care: Baseline findings from a prospective cohort study. Joint Bone Spine 2016; 83:553-8. [DOI: 10.1016/j.jbspin.2015.10.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 10/19/2015] [Indexed: 11/20/2022]
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Jalal DI, Decker E, Perrenoud L, Nowak KL, Bispham N, Mehta T, Smits G, You Z, Seals D, Chonchol M, Johnson RJ. Vascular Function and Uric Acid-Lowering in Stage 3 CKD. J Am Soc Nephrol 2016; 28:943-952. [PMID: 27620990 DOI: 10.1681/asn.2016050521] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 07/20/2016] [Indexed: 01/14/2023] Open
Abstract
Hyperuricemia may contribute to endothelial dysfunction in CKD. We evaluated whether lowering serum uric acid levels with allopurinol improves endothelial dysfunction in 80 participants ≥18 years of age with stage 3 CKD and asymptomatic hyperuricemia (≥7 mg/dl in men and ≥6 mg/dl in women) randomized in a double-blinded manner to receive placebo or allopurinol for 12 weeks. Randomization was stratified according to presence or absence of diabetes mellitus. We measured vascular endothelial function by brachial artery flow-mediated dilation. No significant differences existed between groups at baseline; 61% of the participants had diabetes mellitus in both groups. The placebo and the allopurinol groups had baseline serum uric acid levels (SDs) of 8.7 (1.6) mg/dl and 8.3 (1.4) mg/dl, respectively, and baseline flow-mediated dilation values (SDs) of 6.0% (5.0%) and 4.8% (5.0%), respectively. Compared with placebo, allopurinol lowered serum uric acid significantly but did not improve endothelial function. In participants without diabetes mellitus, allopurinol associated with a trend toward improved flow-mediated dilation (+1.4% [3.9%] versus -0.7% [4.1%] with placebo), but this was not statistically significant (P=0.26). Furthermore, we did not detect significant differences between groups in BP or serum levels of markers of inflammation and oxidative stress. In conclusion, allopurinol effectively and safely lowered serum uric acid levels in adults with stage 3 CKD and asymptomatic hyperuricemia but did not improve endothelial function in this sample of patients.
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Affiliation(s)
- Diana I Jalal
- Division of Renal Diseases and Hypertension, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado,VA Eastern Colorado Health Care System, Denver, Colorado
| | - Emily Decker
- Division of Renal Diseases and Hypertension, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Loni Perrenoud
- Division of Renal Diseases and Hypertension, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Kristen L Nowak
- Division of Renal Diseases and Hypertension, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Nina Bispham
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado
| | - Tapan Mehta
- Division of Renal Diseases and Hypertension, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Gerard Smits
- Division of Renal Diseases and Hypertension, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Zhiying You
- Division of Renal Diseases and Hypertension, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Douglas Seals
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado
| | - Michel Chonchol
- Division of Renal Diseases and Hypertension, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Richard J Johnson
- Division of Renal Diseases and Hypertension, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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Matsuo H, Tsunoda T, Ooyama K, Sakiyama M, Sogo T, Takada T, Nakashima A, Nakayama A, Kawaguchi M, Higashino T, Wakai K, Ooyama H, Hokari R, Suzuki H, Ichida K, Inui A, Fujimori S, Shinomiya N. Hyperuricemia in acute gastroenteritis is caused by decreased urate excretion via ABCG2. Sci Rep 2016; 6:31003. [PMID: 27571712 PMCID: PMC5004129 DOI: 10.1038/srep31003] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 07/11/2016] [Indexed: 01/02/2023] Open
Abstract
To clarify the physiological and pathophysiological roles of intestinal urate excretion via ABCG2 in humans, we genotyped ABCG2 dysfunctional common variants, Q126X (rs72552713) and Q141K (rs2231142), in end-stage renal disease (hemodialysis) and acute gastroenteritis patients, respectively. ABCG2 dysfunction markedly increased serum uric acid (SUA) levels in 106 hemodialysis patients (P = 1.1 × 10(-4)), which demonstrated the physiological role of ABCG2 for intestinal urate excretion because their urate excretion almost depends on intestinal excretion via ABCG2. Also, ABCG2 dysfunction significantly elevated SUA in 67 acute gastroenteritis patients (P = 6.3 × 10(-3)) regardless of the degree of dehydration, which demonstrated the pathophysiological role of ABCG2 in acute gastroenteritis. These findings for the first time show ABCG2-mediated intestinal urate excretion in humans, and indicates the physiological and pathophysiological importance of intestinal epithelium as an excretion pathway besides an absorption pathway. Furthermore, increased SUA could be a useful marker not only for dehydration but also epithelial impairment of intestine.
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Affiliation(s)
- Hirotaka Matsuo
- Department of Integrative Physiology and Bio-Nano Medicine, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan
| | - Tomoyuki Tsunoda
- Department of Pediatric Hepatology and Gastroenterology, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Kanagawa 230-0012, Japan
| | - Keiko Ooyama
- Ryougoku East Gate Clinic, Sumida-ku, Tokyo 130-0026, Japan
| | - Masayuki Sakiyama
- Department of Integrative Physiology and Bio-Nano Medicine, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan.,Department of Dermatology, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan
| | - Tsuyoshi Sogo
- Department of Pediatric Hepatology and Gastroenterology, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Kanagawa 230-0012, Japan
| | - Tappei Takada
- Department of Pharmacy, The University of Tokyo Hospital, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Akio Nakashima
- Division of Kidney and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Minato-ku, Tokyo 105-8471, Japan
| | - Akiyoshi Nakayama
- Department of Integrative Physiology and Bio-Nano Medicine, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan
| | - Makoto Kawaguchi
- Department of Integrative Physiology and Bio-Nano Medicine, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan.,Department of Urology, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan
| | - Toshihide Higashino
- Department of Integrative Physiology and Bio-Nano Medicine, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan
| | - Kenji Wakai
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Aichi 461-8673, Japan
| | - Hiroshi Ooyama
- Ryougoku East Gate Clinic, Sumida-ku, Tokyo 130-0026, Japan
| | - Ryota Hokari
- Department of Internal Medicine, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan
| | - Hiroshi Suzuki
- Department of Pharmacy, The University of Tokyo Hospital, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Kimiyoshi Ichida
- Division of Kidney and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Minato-ku, Tokyo 105-8471, Japan.,Department of Pathophysiology, Tokyo University of Pharmacy and Life Sciences, Hachioji, Tokyo 192-0392, Japan
| | - Ayano Inui
- Department of Pediatric Hepatology and Gastroenterology, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Kanagawa 230-0012, Japan
| | - Shin Fujimori
- Department of Internal Medicine, Teikyo University School of Medicine, Itabashi-ku, Tokyo 173-8605, Japan
| | - Nariyoshi Shinomiya
- Department of Integrative Physiology and Bio-Nano Medicine, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan
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Harding M. An update on gout for primary care providers. Nurse Pract 2016; 41:14-22. [PMID: 26974048 DOI: 10.1097/01.npr.0000481510.32360.fa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This article discusses the current beliefs regarding the pathogenesis of gout and reviews the 2012 guidelines from the American College of Rheumatology regarding diagnostic testing, optimal treatments, and lifestyle modifications. Implementing these guidelines will assist clinicians in resolving acute episodes and managing gout long term, improving outcomes and quality of life.
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Affiliation(s)
- Mariann Harding
- Mariann Harding is an associate professor of nursing at Kent State University, Tuscarawas, New Philadelphia, Ohio
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27
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Kuo CF, Grainge MJ, Zhang W, Doherty M. Global epidemiology of gout: prevalence, incidence and risk factors. Nat Rev Rheumatol 2015; 11:649-62. [PMID: 26150127 DOI: 10.1038/nrrheum.2015.91] [Citation(s) in RCA: 732] [Impact Index Per Article: 81.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Gout is a crystal-deposition disease that results from chronic elevation of uric acid levels above the saturation point for monosodium urate (MSU) crystal formation. Initial presentation is mainly severely painful episodes of peripheral joint synovitis (acute self-limiting 'attacks') but joint damage and deformity, chronic usage-related pain and subcutaneous tophus deposition can eventually develop. The global burden of gout is substantial and seems to be increasing in many parts of the world over the past 50 years. However, methodological differences impair the comparison of gout epidemiology between countries. In this comprehensive Review, data from epidemiological studies from diverse regions of the world are synthesized to depict the geographic variation in gout prevalence and incidence. Key advances in the understanding of factors associated with increased risk of gout are also summarized. The collected data indicate that the distribution of gout is uneven across the globe, with prevalence being highest in Pacific countries. Developed countries tend to have a higher burden of gout than developing countries, and seem to have increasing prevalence and incidence of the disease. Some ethnic groups are particularly susceptible to gout, supporting the importance of genetic predisposition. Socioeconomic and dietary factors, as well as comorbidities and medications that can influence uric acid levels and/or facilitate MSU crystal formation, are also important in determining the risk of developing clinically evident gout.
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Affiliation(s)
- Chang-Fu Kuo
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, 5, Fu-Hsing Street, Taoyuan 333, Taiwan
| | - Matthew J Grainge
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Clinical Sciences Building, City Hospital, Nottingham NG5 1PB, UK
| | - Weiya Zhang
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Clinical Sciences Building, City Hospital, Nottingham NG5 1PB, UK
| | - Michael Doherty
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Clinical Sciences Building, City Hospital, Nottingham NG5 1PB, UK
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Lam NN, Garg AX, Segev DL, Schnitzler MA, Xiao H, Axelrod D, Brennan DC, Kasiske BL, Tuttle-Newhall JE, Lentine KL. Gout after living kidney donation: correlations with demographic traits and renal complications. Am J Nephrol 2015; 41:231-40. [PMID: 25896309 DOI: 10.1159/000381291] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Accepted: 02/24/2015] [Indexed: 01/07/2023]
Abstract
BACKGROUND The demographic and clinical correlates of gout after living kidney donation are not well described. METHODS Using a unique database that integrates national registry identifiers of U.S. living kidney donors (1987-2007) with billing claims from a private health insurer (2000-2007), we identified post-donation gout based on medical diagnosis codes or pharmacy fills for gout therapies. The frequencies and demographic correlates of gout after donation were estimated by Cox regression with left- and right-censoring. We also compared the rates of renal diagnoses among donors with and without gout, matched in the ratio 1:3 by age, sex, and race. RESULTS The study sample of 4,650 donors included 13.1% African Americans. By seven years, African Americans were almost twice as likely to develop gout as Caucasian donors (4.4 vs. 2.4%; adjusted hazard ratio, aHR, 1.8; 95% confidence interval (CI) 1.0-3.2). Post-donation gout risk also increased with older age at donation (aHR per year 1.05) and was higher in men (aHR 2.80). Gout rates were similar in donors and age- and sex-matched general non-donors (rate ratio 0.86; 95% CI 0.66-1.13). Compared to matched donors without gout, donors with gout had more frequent renal diagnoses, reaching significance for acute kidney failure (rate ratio 12.5; 95% CI 1.5-107.0), chronic kidney disease (rate ratio 5.0; 95% CI 2.1-11.7), and other disorders of the kidney (rate ratio 2.2; 95% CI 1.2-4.2). CONCLUSION Donor subgroups at increased risk of gout include African Americans, older donors, and men. Donors with gout have a higher burden of renal complications after demographic adjustment.
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Affiliation(s)
- Ngan N Lam
- Division of Nephrology, Western University, London, Ont., Canada
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Wang W, Bhole VM, Krishnan E. Chronic kidney disease as a risk factor for incident gout among men and women: retrospective cohort study using data from the Framingham Heart Study. BMJ Open 2015; 5:e006843. [PMID: 25869687 PMCID: PMC4401834 DOI: 10.1136/bmjopen-2014-006843] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Historically, the nature of association between chronic kidney disease (CKD) and gouty arthritis has been unclear. The goal of the present study was to test the hypothesis that CKD is an independent risk factor for developing incident gout. DESIGN Patients were from the original Framingham Heart Study cohort. Using Cox proportional hazard models we estimated the HR of CKD to incident gout among men and women separately after adjusting for age, alcohol consumption, smoking, hypertension, diabetes and body mass index. SETTINGS Patients were all from Framingham, Massachusetts, USA. PARTICIPANTS Excluding patients who had CKD in the first visit from this study, 2159 men and 2558 women were selected covering a 54-year period (1948-2002). RESULTS There were 371 incident cases (231 men and 140 women) of gout over the follow-up of 140,421 person-years. Incidence rates of gout per 1000 person-years for participants with and without CKD were 6.82 (95% CI 5.10 to 9.10) and 2.43 (2.18 to 2.71), respectively. In multivariable Cox models, CKD was associated with gout, with a HR of 1.88 (1.13 to 3.13) among men and 2.31 (1.25 to 4.24) among women. Additional analyses using alternate definitions for CKD and cross-sectional study did not change the results. Sensitivity analysis suggested that the observed findings might be an underestimate of the true relative risk. CONCLUSIONS The present study provides epidemiological evidence to support the notion that CKD is a risk factor for gout.
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Affiliation(s)
- Weiqi Wang
- Stanford University School of Medicine, Palo Alto, California, USA
| | | | - Eswar Krishnan
- Stanford University School of Medicine, Palo Alto, California, USA
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Jing J, Kielstein JT, Schultheiss UT, Sitter T, Titze SI, Schaeffner ES, McAdams-DeMarco M, Kronenberg F, Eckardt KU, Kottgen A, for the GCKD Study Investigators, Eckardt KU, Titze S, Prokosch HU, Barthlein B, Reis A, Ekici AB, Gefeller O, Hilgers KF, Hubner S, Avendano S, Becker-Grosspitsch D, Hauck N, Seuchter SA, Hausknecht B, Rittmeier M, Weigel A, Beck A, Ganslandt T, Knispel S, Dressel T, Malzer M, Floege J, Eitner F, Schlieper G, Findeisen K, Arweiler E, Ernst S, Unger M, Lipski S, Schaeffner E, Baid-Agrawal S, Petzold K, Schindler R, Kottgen A, Schultheiss U, Meder S, Mitsch E, Reinhard U, Walz G, Haller H, Lorenzen J, Kielstein JT, Otto P, Sommerer C, Follinger C, Zeier M, Wolf G, Busch M, Paul K, Dittrich L, Sitter T, Hilge R, Blank C, Wanner C, Krane V, Schmiedeke D, Toncar S, Cavitt D, Schonowsky K, Borner-Klein A, Kronenberg F, Raschenberger J, Kollerits B, Forer L, Schonherr S, Weissensteiner H, Oefner P, Gronwald W, Zacharias H, Schmid M. Prevalence and correlates of gout in a large cohort of patients with chronic kidney disease: the German Chronic Kidney Disease (GCKD) study. Nephrol Dial Transplant 2014; 30:613-21. [DOI: 10.1093/ndt/gfu352] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
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Xing SC, Meng DM, Chen Y, Jiang G, Liu XS, Li N, Yan YY, Li CG. Study on the diversity of Bacteroides and Clostridium in patients with primary gout. Cell Biochem Biophys 2014; 71:707-15. [PMID: 25344643 DOI: 10.1007/s12013-014-0253-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
To analyze the diversity of both Bacteroides and Clostridium in patients with primary gout and the difference from that of normal individuals. And to investigate the relationship between the primary gout and the intestinal flora. Fecal samples of 90 cases with the primary gout and 94 cases normal comparison group were selected, together with the cases that match the filter criteria. The DNA is extracted from the feces. 16S rRNA specific primers of both Bacteroides and Clostridium were adopted for the PCR amplification. The molecular fingerprints of Bacteroides and Clostridium in both the primary gout group and the normal control group were obtained through DGGE and subjected for further analysis on both the diversity and the similarity. Compared with normal individuals, the number of bands and Shannon-Weaver (H') of Bacteroides in patients with primary gout was not reduced, but significantly decreased in Clostridium. Furthermore, the intra-group and inter-group similarity of both Bacteroides and Clostridium were lower. The primary gout has caused the structural change of both Bacteroides and Clostridium, inducing the low similarity, especially for Clostridium. It has statistic significance. The gut predominant flora may play an important role in the development of primary gout.
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Affiliation(s)
- Shi-Chao Xing
- The Affiliated Hospital of Qingdao University, Qingdao, 266003, Shandong, China,
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Wang W, Krishnan E. Cigarette smoking is associated with a reduction in the risk of incident gout: results from the Framingham Heart Study original cohort. Rheumatology (Oxford) 2014; 54:91-5. [PMID: 25086327 DOI: 10.1093/rheumatology/keu304] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Cigarette smoking is correlated with other risk factors for gout such as adiposity and alcohol intake. The goal of this study was to study the direction and magnitude of association between cigarette smoking and risk for gout. METHODS We analysed 54-year follow-up data (1948-2002) for 2279 men and 2785 women who were gout-free at their first assessment as a part of the Framingham Heart Study. Using Cox proportional hazards models we estimated the association between cigarette smoking and incident gout among men and women separately after adjusting for age, BMI, alcohol intake, hypertension, kidney disease and diabetes. RESULTS There were 399 incident cases (249 men and 150 women) of gout over 151 058 person-years of observation. Incidence rates of gout per 1000 person-years for smokers and non-smokers were 2.13 (95% CI 1.79, 2.53) and 3.04 (95% CI 2.70, 3.42), respectively. In multivariable Cox models, cigarette smoking was associated with gout with a hazard ratio of 0.76 (95% CI 0.59, 0.98) overall, 0.68 (95% CI 0.49, 0.93) among men and 0.92 (95% CI 0.60, 1.41) among women. Lower risk for smokers was evident among all obesity categories, but not among women. Sensitivity analysis suggested that the magnitude of the true odds ratio might be lower than our calculations. CONCLUSION Cigarette smoking is associated with lower incidence of gout and this is not explained by differences in the prevalence of risk factors. The mechanistic underpinnings of this epidemiological finding merits further study.
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Affiliation(s)
- Weiqi Wang
- Department of Immunology and Rheumatology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Eswar Krishnan
- Department of Immunology and Rheumatology, Stanford University School of Medicine, Palo Alto, CA, USA.
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Bitik B, Öztürk MA. An old disease with new insights: Update on diagnosis and treatment of gout. Eur J Rheumatol 2014; 1:72-77. [PMID: 27708879 DOI: 10.5152/eurjrheumatol.2014.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 04/21/2014] [Indexed: 12/20/2022] Open
Abstract
Gout is an acute and chronic inflammatory disorder associated with high morbidity and impaired quality of life. There has been a substantial increase in the prevalence and incidence of gout in recent years. Novel diagnostic and therapeutic options have provided new insights into the pathogenesis and management of hyperuricemia and gout in the last decade. This clinical review aims to summarize the diagnostic process and management of acute and chronic gout.
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Affiliation(s)
- Berivan Bitik
- Department of Rheumatology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - M Akif Öztürk
- Department of Rheumatology, Gazi University Faculty of Medicine, Ankara, Turkey
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34
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Lu N. Standardized incidence ratios for gout: comment on the article by Krishnan. Arthritis Rheumatol 2014; 66:1685-6. [PMID: 24497483 DOI: 10.1002/art.38387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Na Lu
- Boston University School of Public Health, Boston, MA
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