Nephroprotective potential of urate reducing therapy

Introduction. Assessment of serum uricemia is currently becoming an available laboratory marker of metabolic distress associated with an increased risk of a wide range of comorbid conditions and diseases, from gout and urate nephrolithiasis to cardiovascular pathology and type 2 diabetes mellitus.

Aim. To analyze the interrelationships of hyperuricemia and gout with impaired renal function and nephrolithiasis in dynamic follow-up over three years in real outpatient practice.

Materials and methods. The retrospective observational study included 324 patients (121 men and 203 women) who sought medical help in 2021–2024. The presence of concomitant pathology, the dynamics of UA levels, creatinine, and estimated (CKD EPI) glomerular filtration rate were analyzed in subgroups of men and women with UA levels < 360 μmol/l (normouricemia) and ≥ 360 μmol/l (GU).

Results. An increase in the prevalence of hyperuricemia by 15% among men and 10% among women over three years is determined. The increase in the number of gout patients over the same period was 7% and 3%, respectively. A statistically significant relationship between the presence of hyperuricemia (uric acid ≥ 360 μmol/l) and impaired renal function was determined only in women (χ2 = 15.4; p = 0.00046). In the presence of GU, there were no patients with normal glomerular filtration rate, either initially or during dynamic follow-up, and CKD of advanced stages (3b-5) was observed in them 6.8 times more frequently initially and 4 times more frequently after 3 years of follow-up.

Conclusion. A significant inverse correlation (-0.25; p < 0.05) was found between an increase in serum uricemia and a decrease in glomerular filtration rate, regardless of gender differences. The use of urate-lowering therapy with the achievement of a target uric acid level of less than 300 mmol/l demonstrated the possibility of stabilization of renal function and resorption of tophi in a patient with gout.

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