Treatment of Chronic Kidney Disease with Hyperuricemia：Current Situation and Challenges

doi:10.12114/j.issn.1007-9572.2019.00.028

Abstract

Abstract: Chronic kidney disease is commonly associated with hyperuricemia.Hyperuricemia is an independent risk factor for the progression of chronic kidney disease.Decreased glomerular filtration rate and increased adverse drug reactions can affect the choice of urate-lowering therapies for patients with chronic kidney disease.In this paper，with referencing to the related guidelines，we reviewed the current situation and progress of commonly used urate-lowering drugs，and put forward ways for overcoming the challenges in the application of new drugs for lowering uric acid and the management of uric acid，gout，tophus in chronic kidney disease with hyperuricemia.

Key words: Chronic kidney disease, Hyperuricemia, Uric acid, Gout, Glomerular filtration rate, Current situation, Challenges

摘要： 慢性肾脏病常合并高尿酸血症，高尿酸血症是慢性肾脏病进展的独立危险因素，由于肾小球滤过率下降、药物不良反应增加等因素将会影响慢性肾脏病患者降尿酸方案的选择。本文结合目前指南内容对常用药物的使用现状与进展进行综述，对新药物的应用、慢性肾脏病合并高尿酸血症的尿酸、痛风、痛风石的管理等挑战提出思考。

关键词: , 慢性肾脏病；高尿酸血症；尿酸；痛风；肾小球滤过率；现状；挑战

ZHANG Xiongfeng,LI Zhengsheng,ZHONG Qin, et al. Treatment of Chronic Kidney Disease with Hyperuricemia：Current Situation and Challenges　[J]. Chinese General Practice, 2019, 22(17): 2020-2024. DOI: 10.12114/j.issn.1007-9572.2019.00.028.
张雄峰,李正胜,钟琴等. 慢性肾脏病合并高尿酸血症治疗的现状与挑战[J]. 中国全科医学, 2019, 22(17): 2020-2024. DOI: 10.12114/j.issn.1007-9572.2019.00.028.

References

［1］中国慢性肾脏病患者合并高尿酸血症诊治共识专家组.中国慢性肾脏病患者合并高尿酸血症诊治专家共识［J］．中华肾脏病杂志，2017，33（6）：465．DOI：10.3760/cma.j.issn.1001-7097.2017.06.012.
Chinese Expert Consensus for Treatment of Chronic Kidney Disease with Hyperuricemia Group.Chinese expert consensus for treatment of chronic kidney disease with hyperuricemia［J］．Chinese Journal of Nephrology，2017，33（6）：465．DOI：10.3760/cma.j.issn.1001-7097.2017.06.012.
［2］中国医师协会肾脏内科医师分会.中国肾脏疾病高尿酸血症诊治的实践指南（2017版）［J］．中华医学杂志，2017，97（25）：1927-1936．DOI：10.3760/cma.j.issn.0376-2491.2017.25.003.
Chinese Nephrologist Association.Clinical practice guidelines for chronic kidney disease with hyperuricemia 2017［J］．National Medical Journal of China，2017，97（25）：1927-1936．DOI：10.3760/cma.j.issn.0376-2491.2017.25.003.
［3］NAGURA M，TAMURA Y，KUMAGAI T，et al．Uric acid metabolism of kidney and intestine in a rat model of chronic kidney disease［J］．Nucleosides Nucleotides Nucleic Asids，2016，35（10/12）：550-558．DOI：10.1080/15257770.2016.1163379.
［4］LI Z，LIU Q，MAO H，et al．Gender difference in the association of hyperuricemia with chronic kidney disease in southern China［J］．Kidney Blood Press Res，2012，36（1）：98-106．DOI：10.1159/000341486.
［5］ABDERRAMAN G M，HAMAT I，TONDI Z M M，et al．Hyperuricemia in patients with chronic renal failure in the General Hospital of National Reference of N'Djamena （Chad）［J］．Open J Nephrol，2017，7（1）：9-18．DOI：10.4236/ojneph.2017.71002.
［6］ADEEB F，UDAYAKUMAR A A，RYAN D，et al．SAT0689 prevalence of and temporal trends in hyperuricaemia among adult patients with chronic kidney disease in Ireland［J］．Ann Rheum Dis，2017，76（Suppl 2）：1036．DOI：10.1136/annrheumdis-2017-eular.5556.
［7］KORATALA A，SINGHANIA G，ALQUADAN K F，et al．Serum uric acid exhibits inverse relationship with estimated glomerular filtration rate［J］．Nephron，2016，134（4）：231-237．DOI：10.1159/000448629.
［8］XU Y，LIU X，SUN X，et al．The impact of serum uric acid on the natural history of glomerular filtration rate：a retrospective study in the general population［J］．Peer J，2016，4（10）：e1859．DOI：10.7717/peerj.1859.
［9］LI Z，SHENG Y，LIU C，et al．Nox4 has a crucial role in uric acid induced oxidative stress and apoptosis in renal tubular cells［J］．Mol Med Rep，2016，13（5）：4343-4348．DOI：10.3892/mmr.2016.5083.
［10］K?LSCH A I，KRüGER B.Asymptomatic hyperuricemia：risk factors for the development and progression of chronic kidney disease［J］．Dtsch Med Wochenschr，2017，142（20）：1526-1529．DOI：10.1055/s-0043-116919.
［11］TAKAE K，NAGATA M，HATA J，et al．Serum uric acid as a risk factor for chronic kidney disease in a Japanese community—the hisayama study［J］．Circ J，2016，80（8）：1857-1862．DOI：10.1253/circj.CJ-16-0030.
［12］ASAKAWA S，SHIBATA S，MORIMOTO C，et al．Podocyte injury and albuminuria in experimental hyperuricemic model rats［J］．Oxid Med Cell Longev，2017：3759153．DOI：10.1155/2017/3759153.
［13］XIA X，LUO Q，LI B，et al．Serum uric acid and mortality in chronic kidney disease：a systematic review and meta-analysis［J］．Metabolism，2016，65（9）：1326-1341．DOI：10.1016/j.metabol.2016.05.009.
［14］TSUJI T，OHISHI K，TAKEDA A，et al．The impact of serum uric acid reduction on renal function and blood pressure in chronic kidney disease patients with hyperuricemia［J］．Clin Exp Nephrol，2018，22（6）：1300-1308．DOI：10.1007/s10157-018-1580-4.
［15］ANWAR A T，CHOWDHURY M N，ISLAM M N，et al．Effect of allopurinol in chronic kidney disease progression in asymptomatic hyperuricaemic subjects［J］．J Dhaka Med Coll，2017，25（1）：5．
DOI：10.3329/jdmc.v25i1.33949.
［16］高尿酸血症相关疾病诊疗多学科共识专家组.中国高尿酸血症相关疾病诊疗多学科专家共识［J］．中华内科杂志，2017，56（3）：235-248．DOI：10.3760/cma.j.issn.0578-1426.2017.03.021.
Multi-disciplinary Expert Task Force on Hyperurice.Chinese multi-disciplinary consensus on the diagnosis and treatment of hyperuricemia and its related diseases［J］．Chinese Journal of Internal Medicine，2017，56（3）：235-248．DOI：10.3760/cma.j.issn.0578-1426.2017.03.021.
［17］KHANNA D，KHANNA P P，FITZGERALD J D，et al．2012 American College of Rheumatology guidelines for management of gout.Part 2：therapy and antiinflammatory prophylaxis of acute gouty arthritis［J］．Arthritis Care Res（Hoboken），2012，64（10）：1447-1461．DOI：10.1002/acr.21773.
［18］QASEEM A，HARRIS R P，FORCIEA M A.Management of acute and recurrent gout：a clinical practice guideline from the American College of Physicians［J］．Ann Intern Med，2017，166（1）：58-68．DOI：10.7326/M16-0570.
［19］中华医学会风湿病学分会.2016中国痛风诊疗指南［J］．中华内科杂志，2016，55（11）：892-899．DOI：10.3760/cma.j.issn.0578-1426.2016.11.019.
Chinese Rheumatology Association.Chinese guideline for the management for gout in 2016［J］．Chinese Journal of Internal Medicine，2016，55（11）：892-899．DOI：10.3760/cma.j.issn.0578-1426.2016.11.019.
［20］CHUNG W H，CHANG W C，STOCKER S L，et al．Insights into the poor prognosis of allopurinol-induced severe cutaneous adverse reactions：the impact of renal insufficiency，high plasma levels of oxypurinol and granulysin［J］．Ann Rheum Dis，2015，74（12）：2157-2164．DOI：10.1136/annrheumdis-2014-205577.
［21］JUTKOWITZ E，DUBREUIL M，LU N，et al．The cost-effectiveness of HLA-b*5801 screening to guide initial urate-lowering therapy for gout in the United States［J］．Semin Arthritis Rheum，2017，46（5）：594-600．DOI：10.1016/j.semarthrit.2016.10.009.
［22］杨丹.别嘌醇降尿酸治疗效益及药物经济学评价［D］．北京：北京协和医学院，2016：21-26.
YANG D.Efficiency and pharmacoeconomic evaluation of allopurinol in the treatment of uric acid reduction［D］．Beijing：Peking Union Medical College，2016：21-26.
［23］CHENG H，YAN D，ZUO X，et al．A retrospective investigation of HLA-B*5801 in hyperuricemia patients in a Han population of China［J］．Pharmacogenet Genomics，2018，28（5）：117-124．DOI：10.1097/FPC.0000000000000334.
［24］KIM S，KIM H J，AHN H S，et al．Renoprotective effects of febuxostat compared with allopurinol in patients with hyperuricemia：a systematic review and meta-analysis［J］．Kidney Res Clin Pract，2017，36（3）：274-281．DOI：10.23876/j.krcp.2017.36.3.274.
［25］LIM D H，OH J S，AHN S M，et al．The efficacy and tolerability of febuxostat in hyperuricemic patients undergoing dialysis［J］．Ann Rheum Dis，2016，75（Suppl 2）：1178-1179．DOI：10.1136/annrheumdis-2016-eular.3054.
［26］BARDIN T，CHALèS G，PASCART T，et al．Risk of cutaneous adverse events with febuxostat treatment in patients with skin reaction to allopurinol.A retrospective，hospital-based study of 101 patients with consecutive allopurinol and febuxostat treatment［J］．Joint Bone Spine，2016，83（3）：314-317．DOI：10.1016/j.jbspin.2015.07.011.
［27］NAKAYA I，NAMIKOSHI T，TSURUTA Y，et al．Management of asymptomatic hyperuricaemia in patients with chronic kidney disease by Japanese nephrologists：a questionnaire survey［J］．Nephrology（Carlton），2011，16（5）：518-521．DOI：10.1111/j.1440-1797.2011.01446.x.
［28］YU H，LIU X，SONG Y，et al．Safety and efficacy of benzbromarone and febuxostat in hyperuricemia patients with chronic kidney disease：a prospective pilot study［J］．Clin Exp Nephrol，2018，22（6）：1324-1330．DOI：10.1007/s10157-018-1586-y.
［29］国家食品药品监督管理局.警惕苯溴马隆的肝损害风险［J］．中国乡村医药，2015，22（2）：72．DOI：10.3969/j.issn.1006-5180.2015.02.041.
China Food and Drug Administration.Beware of the risk of liver damage caused by benzbromarone［J］．Chinese Journal of Rural Medicine and Pharmacy，2015，22（2）：72．DOI：10.3969/j.issn.1006-5180.2015.02.041.
［30］TAN P K，FARRAR J E，GAUCHER E A，et al．Coevolution of URAT1 and uricase during primate evolution：implications for serum urate homeostasis and gout［J］．Mol Biol Evol，2016，33（9）：2193-2200．DOI：10.1093/molbev/msw116.
［31］CALABRESE L H，KAVANAUGH A，YEO A E，et al．Frequency，distribution and immunologic nature of infusion reactions in subjects receiving pegloticase for chronic refractory gout［J］．Arthritis Res Ther，2017，19（1）：191．DOI：10.1186/s13075-017-1396-8.
［32］YOOD R A，OTTERY F D，IRISH W，et al．Effect of chronic kidney disease status on pegloticase treatment response［J］．Ann Rheum Dis，2013，71（Suppl 3）：87．DOI：10.1136/annrheumdis-2012-eular.1784.
［33］HOSOYA T，OGAWA Y，HASHIMOTO H，et al．Comparison of topiroxostat and allopurinol in Japanese hyperuricemic patients with or without gout：a phase 3，multicentre，randomized，double-blind，double-dummy，active-controlled，parallel-group study［J］．J Clin Pharm Ther，2016，41（3）：290-297．DOI：10.1111/jcpt.12391.
［34］MINER J N，TAN P K，HYNDMAN D，et al．Lesinurad，a novel，oral compound for gout，acts to decrease serum uric acid through inhibition of urate transporters in the kidney［J］．Arthritis Res Ther，2016，18（1）：214．DOI：10.1186/s13075-016-1107-x.
［35］刘正奇，钟琴.苗药痛风停汤对人肾小管上皮细胞hUAT、hURAT1基因表达的影响［J］．湖南中医杂志，2016，32（2）：167-169．DOI：10.16808/j.cnki.issn1003-7705.2016.02.086.
LIU Z Q，ZHONG Q.Effects of Miao medicine Tongfengting decoction on gene expression of hUAT and hURAT1 in human renal tubular epithelial cells［J］．Hunan Journal of Traditional Chinese Medicine，2016，32（2）：167-169．DOI：10.16808/j.cnki.issn1003-7705.2016.02.086.
［36］LI X X，HAN M，WANG Y Y，et al．Chinese herbal medicine for gout：a systematic review of randomized clinical trials［J］．Clin Rheum，2013，32（7）：943-959．DOI：10.1007/s10067-013-2274-7.
［37］SHIOZAWA A，SZABO S M，BOLZANI A，et al．Serum uric acid and the risk of incident and recurrent gout：a systematic review［J］．J Rheumatol，2017，44（3）：388-396．DOI：10.3899/jrheum.160452.
［38］RUOFF G，EDWARDS N L.Overview of serum uric acid treatment targets in gout：why less than 6 mg/dl？［J］．Postgrad Med，2016，128（7）：706-715．DOI：10.1080/00325481.2016.1221732.
［39］张雄峰，李正胜，刘正奇.难治性痛风性关节炎的临床分析［J］．中国骨与关节杂志，2017，6（8）：611-614．DOI：10.3969/j.issn.2095-252X.2017.08.010.
ZHANG X F，LI Z S，LIU Z Q.Clinical analysis of refractory gout arthritis［J］．Chinese Journal of Bone and Joint，2017，6（8）：611-614．DOI：10.3969/j.issn.2095-252X.2017.08.010.

[1]	ZHANG Peng, GAO Ying, YANG Hongxi, WAN Chunxiao. Association between Serum Uric Acid Level and the Risk of Chronic Kidney Disease among the Elderly in Longevity Areas of China [J]. Chinese General Practice, 2023, 26(31): 3884-3889.
[2]	HE Yingmei, JIA Xue, ZHU Guojun, LIU Bing. Effect of Serum Uric Acid Longitudinal Trajectory on New-onset Hypertriglyceridemia: a Prospective Cohort Study [J]. Chinese General Practice, 2023, 26(29): 3636-3639.
[3]	ZHANG Yunsheng, ZHANG Peng, JIN Yujing, GAO Ying. Association of Blood Pressure Level with the Risk of Chronic Kidney Disease among the Elderly in Longevity Areas of China [J]. Chinese General Practice, 2023, 26(28): 3502-3506.
[4]	SU Guobin, LING Xitao, DUAN Ruolan, ZHANG La, XU Yuan, PENG Yu, HOU Haijing, LIU Xusheng, LU Fuhua. Selection of Therapeutic Drugs for COVID-19 Infection in Adults with Chronic Kidney Disease Based on Medical Evidence [J]. Chinese General Practice, 2023, 26(26): 3220-3229.
[5]	FENG Xiaoling, YIN Wenqing, WANG Ying, HOU Lihui. Correlation Analysis between Different Free Testosterone Index Levels and Clinical Characteristics of Patients with Polycystic Ovary Syndrome [J]. Chinese General Practice, 2023, 26(24): 3005-3009.
[6]	ZHU Danmeng, HUANG Yuying, LUO Tong'an, HE Changyuan, CHEN Rilan. Effect of Pricking-bloodletting Therapy Combined with Zhuang-medicine-thread Moxibustion on TLRs/MyD88 Signal Pathway in a Rat Model of Acute Gouty Arthritis [J]. Chinese General Practice, 2023, 26(20): 2525-2531.
[7]	XIN Jiadong, ZHOU Jiabao, WU Zhiyuan, ZHANG Xuming, GAO Jiandong. Advances in Urate Excretion and Urate Transporters in Hyperuricemia [J]. Chinese General Practice, 2023, 26(15): 1916-1922.
[8]	SONG Hualong, GAO Ying. Association between Serum Uric Acid and the Risk of Type 2 Diabetes Mellitus: a Population-based Prospective Cohort Study [J]. Chinese General Practice, 2023, 26(15): 1831-1839.
[9]	SHU Tao, GUO Zheng, WANG Fei, CHEN Shuyan. Analysis of the Correlation between Time in Range and Diabetic Kidney Disease [J]. Chinese General Practice, 2023, 26(15): 1873-1879.
[10]	WANG Junwei, LIN Lingjun, SONG Linling, CHENG Xiaocui, NIE Xiuling. Association between Serum Potassium and Metabolic-associated Fatty Liver Disease in Patients with Primary Gout [J]. Chinese General Practice, 2023, 26(12): 1479-1484.
[11]	YAO Huijuan, YANG Yu, XU Ajing. Interpretation of Diabetes Management in Chronic Kidney Disease: a Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) [J]. Chinese General Practice, 2023, 26(12): 1415-1421.
[12]	YAN Peng, SONG Jianling, FANG Xiangdong. Recent Developments in Parathyroid Hormone Type 1 Receptor and Kidney Disease [J]. Chinese General Practice, 2023, 26(11): 1398-1403.
[13]	WANG Yingjie, CHENG Haoran, ZHOU Weihong. Correlation of Body Fat Composition and Metabolic Indicators with Metabolic-associated Fatty Liver Disease in a Non-obese Population [J]. Chinese General Practice, 2023, 26(06): 672-680.
[14]	YAO Huihui, SHU Lin, YAO Linli, LI Sha, YANG Xiaotong, LI Yunchun. Sex-specific Analysis of Influencing Factors for the Association between Baseline Serum Uric Acid and Two-year Outcome after First Acute Ischemic Stroke [J]. Chinese General Practice, 2023, 26(05): 557-562.
[15]	LIU Linhua, ZHAN Jinfeng, XIA Zhongbin. Effect of Impaired Fasting Glucose on Estimated Glomerular Filtration Rate [J]. Chinese General Practice, 2023, 26(03): 304-307.