Risk of chronic kidney disease in patients with gout and the impact of urate lowering therapy: a population-based cohort study.
Risk of chronic kidney disease in patients with gout and the impact of urate lowering therapy: a population-based cohort study.
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DOI：
10.1186/s13075-018-1746-1
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发表时间：
2018-10-30
影响因子：
4.9
通讯作者：
Roddy E
中科院分区：
文献类型：
--
作者：
Roughley M;Sultan AA;Clarson L;Muller S;Whittle R;Belcher J;Mallen CD;Roddy E
痛风和肾脏疾病之间的联系已经得到了很好的认识，但很少有研究研究痛风是否是随后发生慢性肾脏疾病(CKD)的危险因素。此外，降低尿酸治疗(ULT)对痛风患者慢性肾脏病发展的影响尚不清楚。这项研究的目的是量化痛风患者慢性肾脏病≥ 3期的风险以及ULT的影响。这是一项使用临床实践研究数据链(CPRD)数据的回溯性队列研究。从1998年至2016年的全科医疗记录中确定了痛风事件患者，并根据年龄、性别、可用随访时间和实践将其与未被诊断为痛风的患者随机进行1：1匹配。主要结果是根据估计的肾小球滤过率或有记录的诊断结果发展为慢性肾功能衰竭≥ 3级。用COX回归模型计算绝对危险比(ARs)和调整后危险比(HR)。对那些在痛风诊断后1年和3年内开出ULT处方的患者进行了CKD风险评估。有痛风事件的患者(n=41,446)与没有痛风的患者相匹配。暴露组的慢性肾脏病分期≥ -3比未暴露组大(AR 28.6比15.8/10,000人年)。痛风与发生CKD的风险增加相关(调整后的HR为1.78，95%CI为1.70至1.85)。那些接触ULT的人发生CKD的风险更大，但调整后，这在所有分析中都减弱到不显著(除了对女性的3年分析(调整后的HR为1.31，95%CI为1.09至1.59))。本研究已证实痛风是发生慢性肾脏病≥ 3期的危险因素。建议进一步研究痛风可能增加慢性肾脏病风险的机制，以及合理使用ULT是否可以降低痛风患者慢性肾脏病的风险或进展。本文的在线版本(10.1186/s13075-0181746-1)包含补充材料，可供授权用户使用。
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. 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. 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)). 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. 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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影响因子：
168.9
作者：
Matsushita, Kunihiro;van der Velde, Marije;Astor, Brad C.;Woodward, Mark;Levey, Andrew S.;de Jong, Paul E.;Coresh, Josef;Gansevoort, Ron T.
通讯作者：
Gansevoort, Ron T.
影响因子：
5.9
作者：
BERGER, L;YU, TF
通讯作者：
YU, TF
影响因子：
--
作者：
Krishnan, Eswar
通讯作者：
Krishnan, Eswar
影响因子：
5.5
作者：
Kuo, Chang-Fu;Grainge, Matthew J.;Doherty, Michael
通讯作者：
Doherty, Michael
DOI：
10.1053/j.ajkd.2017.12.009
发表时间：
2018-06
期刊：
American journal of kidney diseases : the official journal of the National Kidney Foundation
影响因子：
--
作者：
Johnson RJ;Bakris GL;Borghi C;Chonchol MB;Feldman D;Lanaspa MA;Merriman TR;Moe OW;Mount DB;Sanchez Lozada LG;Stahl E;Weiner DE;Chertow GM
通讯作者：
Chertow GM