Hyperuricemia, urine uric excretion, and associated complications in thalassemia patients
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Thalassemia patients have a high cell turnover rate due to chronic hemolysis and ineffective erythropoiesis; therefore, hyperuricemia is anticipated. This study aimed to identify the prevalence of hyperuricemia, gout and nephrolithiasis, conditions associated with serum uric acid (SUA), and urine uric acid excretion (UUA) in thalassemia patients. This was a cross-sectional study in patients aged 15 years or older at Chiang Mai University Hospital. All patients had blood and 24-h urine collection test. We enrolled 112 thalassemia patients in which 67.0% were female, 64.3% had beta thalassemia/Hb E, 76.8% were transfusion dependent, and 59.8% were post splenectomy. The median age was 29 (16–58) years. Mean SUA was 6.7 ± 2.0 mg/dl and hyperuricemia (SUA > 6.8 mg/dl) was found in 47 cases (45.2%). Intact spleen (ORs 4.3, 95%CI 1.55–12.50, p = 0.01) and lower FEuric (ORs 2.08, 95%CI 1.35–3.33, p < 0.01) were associated with hyperuricemia significantly. Seven (6.3%) had gouty arthritis and nine (8%) had microscopic hematuria, one case being confirmed nephrolithiasis. The mean UUA excretion was 981.3 ± 335.0 mg/day and UUA hyperexcretion (> 700 mg/24 h) was found in 83.3%. UUA hyperexcretion patients had renal hyperfiltration 46%, glomerular dysfunction 84%, and tubular dysfunction 7.7%. From our study, hyperuricemia was found in approximately 40% of thalassemia patients but gouty arthritis occurred only in few patients (6%). This may be explained by urinary uric hyperexcretion which is found in over 80%. The significant risk factors for hyperuricemia were intact spleen and lower fraction excretion of uric acid.
KeywordsHyperuricemia Uric excretion Gout Thalassemia
I would like to sincerely thank Ms. Antika Wongthani, Head of Analytical & Statistical data unit, Research Institute for Health Sciences, Chiang Mai University for suggestion in statistics of this study.
J.C. designed the research, collected, summarized, analyzed clinical data, and wrote the paper; A.T. designed the research, obtained researched grant, analyzed data, wrote the paper, and corresponding author; T.R., E.R.,C.C., L.N., P.C. wrote, revised, and approved the final manuscript. W.L designed the research, wrote, revised manuscript, approved the final manuscript, and gave critical comment.
This study was supported by a research grant from the Faculty of Medicine, Chiang Mai University. Grant number: FUND-25591019-08194.
Compliance with ethical standards
This study was approved by the ethical research committee, Faculty of Medicine, Chiang Mai University. Study code: MED-2559-04246 and have been performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.
Conflict of interest
The authors declare that they have no conflict of interest.
- 4.Fucharoen S (2013) Anemia, thalassemia and hemogloboinopathies in Northeast Thailand, Lao PDR and Vietnam. Srinagarind med J 25Google Scholar
- 5.Abdelmotaleb GAM, Abdelmonaem E, Ahmed E, Aboelsoued A et al (2017) Comparative study between measurements of serum cholesterol, uric acid and glucose in children with β-thalassemia by laboratory and bedside methods. Int J Adv Res [internet] Int J Adv Res 5(6):963–973. https://doi.org/10.21474/ijar01/4498 CrossRefGoogle Scholar
- 7.Kumar V, Gruber B (2003) Tophaceous gout in a patient with thalassemia. J Clin Rheumatol : Pract Rep Rheumatic Musculoskelet Dis 9(6):380–384. https://doi.org/10.1097/01.rhu.0000099746.74211.78 CrossRefGoogle Scholar
- 8.Ricchi P, Ammirabile M, Costantini S, Di Matola T, Spasiano A, Genna ML, Cinque P, Prossomariti L (2012) Splenectomy is a risk factor for developing hyperuricemia and nephrolithiasis in patients with thalassemia intermedia: a retrospective study. Blood Cells Mol Dis 49(3–4):133–135. https://doi.org/10.1016/j.bcmd.2012.05.012 CrossRefPubMedGoogle Scholar
- 9.Davis R, Jones JS, Barocas DA, Castle EP, Lang EK, Leveillee RJ, Messing EM, Miller SD, Peterson AC, Turk TM, Weitzel W (2012) Diagnosis, evaluation and follow-up of asymptomatic microhematuria (AMH) in adults: AUA guideline. J Urol 188(6 Suppl):2473–2481. https://doi.org/10.1016/j.juro.2012.09.078 CrossRefPubMedGoogle Scholar
- 14.KDIGO (2012) Clinical practice guideline for the evaluation and Management of Chronic Kidney Disease (2013). Off J Int Soc Nephrol 3(1)Google Scholar
- 20.Melo TRFD, Ercolin LDR, Chelucci RC, Melchior ACB, Lanaro C, Chin CM, Santos JLD (2015) Sickle Cell Disease – Current Treatment and New Therapeutical Approaches. In: Munshi A (ed) Inherited Hemoglobin Disorders. InTech, Rijeka, p Ch. 09. doi: https://doi.org/10.5772/60515
- 23.Inthawong K, Charoenkwan P, Silvilairat S, Tantiworawit A, Phrommintikul A, Choeyprasert W, Natesirinilkul R, Siwasomboon C, Visrutaratna P, Srichairatanakool S, Chattipakorn N, Sanguansermsri T (2015) Pulmonary hypertension in non-transfusion-dependent thalassemia: correlation with clinical parameters, liver iron concentration, and non-transferrin-bound iron. Hematology (Amsterdam, Netherlands) 20(10):610–617. https://doi.org/10.1179/1607845415y.0000000014 Google Scholar
- 24.Caspi D, Lubart E, Graff E, Habot B, Yaron M, Segal R (2000) The effect of mini-dose aspirin on renal function and uric acid handling in elderly patients. Arthritis Rheum 43:13–108. https://doi.org/10.1002/1529-0131(200001)43:1<103::AID-ANR13>3.0.CO;2-C CrossRefGoogle Scholar
- 25.Louthrenoo W, Kasitanon N, Wichainun R, Sukitawut W (2003) Effect of Minidose Aspirin on Renal Function and Renal Uric Acid Handling in Healthy Young Adults, vol 8. doi: https://doi.org/10.1097/00124743-200212000-00003,
- 26.Hyo Jin C, Yun Jong L, Jeong Jin P, Jung Chan L, Eun Young L, Eun Bong L, Yeong Wook S (2006) The effect of low dose aspirin on serum and urinary uric acid level in gouty arthritis patients. J Korean Rheum Assoc 13(3):203–208Google Scholar
- 27.Ali D, Mehran K, Moghaddam AG (2008) Comparative evaluation of renal findings in Beta-thalassemia major and intermedia. Saudi J Kidney Dis Transpl : Off Publ Saudi Center Organ Transplant, Saudi Arabia 19(2):206–209Google Scholar
- 30.Molazem Z, Noormohammadi R, Dokouhaki R, Zakerinia M, Bagheri Z (2016) The effects of nutrition, exercise, and a praying program on reducing Iron overload in patients with Beta-thalassemia major: a randomized clinical trial. Iran J Pediatr 26(5):e3869. https://doi.org/10.5812/ijp.3869 PubMedGoogle Scholar
- 34.Holzscheiter L, Beck C, Rutz S, Manuilova E, Domke I, Guder Walter G, Hofmann W (2014) NGAL, L-FABP, and KIM-1 in comparison to established markers of renal dysfunction. Clin Chem Lab Med 52. https://doi.org/10.1515/cclm-2013-0693
- 35.Thanakitcharu P, Jirajan B (2014) Determination of urinary neutrophil gelatinase-associated lipocalin (NGAL) cut-off level for early detection of acute kidney injury in Thai adult patients undergoing open cardiac surgery. J Med Assoc Thailand = Chotmaihet thangphaet 97(Suppl 11):S48–S55Google Scholar
- 40.Bjornstad P, Roncal C, Harra T, Pyle L, Lanaspa MA, Bishop FK, Snell-Bergeon JK, Johnson RJ, Wadwa RP, Maahs DM (2016) Hyperfiltration and uricosuria in adolescents with type 1 diabetes. Pediatric Nephrology (Berlin, Germany) 31(5):787–793. https://doi.org/10.1007/s00467-015-3299-8 CrossRefGoogle Scholar
- 42.Helal I, Brosnahan G, Gitomer B, Schrier R (2012) Glomerular hyperfiltration: Definitions, mechanisms and clinical implications, vol 8. doi: https://doi.org/10.1038/nrneph.2012.19
- 47.ชัยอำนวย พ ระบาดวิทยาของโรครูมาติค. Thai arthritis foundation. https://www.thaiarthritis.org/people23.php. Accessed 27 Sept 2018
- 49.Efthimia V, Neokleous N, Agapidou A, Economou M, Vetsiou E, Teli A, Perifanis V (2013) Nephrolithiasis in beta thalassemia major patients treated with deferasirox: an advent or an adverse event? A single Greek center experience. Ann Hematol 92(2):263–265. https://doi.org/10.1007/s00277-012-1558-3 CrossRefPubMedGoogle Scholar
- 50.Ricchi PAM, Costantini S, Spasiano A, Di Matola T, Cinque P et al (2013) Nephrolithiasis in patients exposed to deferasirox and desferioxamine: probably an age-linked event with different effects on some renal parameters. Ann Hematol 93(3):525–527. https://doi.org/10.1007/s00277-013-1833-y CrossRefPubMedGoogle Scholar