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Hyperuricemia, urine uric excretion, and associated complications in thalassemia patients

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Abstract

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.

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Acknowledgements

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.

Funding

This study was supported by a research grant from the Faculty of Medicine, Chiang Mai University. Grant number: FUND-25591019-08194.

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Authors and Affiliations

  1. Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand

    Juthatip Chaloemwong, Adisak Tantiworawit, Thanawat Rattanathammethee, Chatree Chai-Adisaksopha, Ekarat Rattarittamrong & Lalita Norasetthada

  2. Nakhonping Hospital, Chiang Mai, Thailand

    Juthatip Chaloemwong

  3. Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand

    Pimlak Charoenkwan

  4. Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand

    Worawit Louthrenoo

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  1. Juthatip Chaloemwong
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Contributions

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.

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Correspondence to Adisak Tantiworawit.

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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.

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Chaloemwong, J., Tantiworawit, A., Rattanathammethee, T. et al. Hyperuricemia, urine uric excretion, and associated complications in thalassemia patients. Ann Hematol 98, 1101–1110 (2019). https://doi.org/10.1007/s00277-019-03630-0

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