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A treat-to-target approach for gout confers renoprotective effect in patients with chronic kidney disease stage 3

  • Observational Research
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Abstract

The aim of this study was to assess changes in the estimated glomerular filtration rate (eGFR) in gouty patients with chronic kidney disease (CKD) using a “treat-to-target” (T2T) approach in gout. This multicenter observational retrospective study included patients diagnosed with gout and CKD stage 3 taking xanthine oxidase inhibitors (XOIs) (allopurinol or febuxostat) for at least 12 months. All patients were treated using a T2T strategy according to national gout guidelines to achieve the target levels of serum uric acid (sUA; < 5–6 mg/dl) within 6 months of the first visit. The primary outcome was to assess changes in eGFR. The effects of independent variables were analyzed over eGFR in a linear mixed-effects (LME) model. Fifty patients with gout and CKD stage 3 treated with XOIs with a T2T strategy for 12 months were included. Eighty-two percent of the patients achieved the sUA target during the study period. The improvement seen in eGFR was higher during the first 6 months, showing a median increase of 7.54 ml/min/m2 (SE = 1.25) and trending towards stability over 12 months. For every 1 mg/dl of decrease in sUA, an improvement of 1.5 ml/min/m2 in eGFR was observed (coefficient ± SE: − 1.58 ± 0.26) (p < 0.001) with no differences between type and dosage of XOIs treatment, colchicine administration, age, sex, and smoking status. A reduction in sUA levels using a T2T approach with XOIs at an optimal dose is possible and could help conserve and improve renal function in gouty patients with CKD stage 3.

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Acknowledgements

Authors acknowledge the language editing support by J. Moore, from Spanish Society of Rheumatology (Sociedad Española de Reumatología)

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No funding was received.

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Authors and Affiliations

  1. Rheumatology Department, Hospital Universitario Torrejon de Ardoz, Madrid, Spain

    Marta Novella-Navarro, Alejandro Prada-Ojeda & Luis Sala-Icardo

  2. Bioinformatic Unit/GENOXPHOS-Group, Centro Nacional Investigaciones Cardiovasculares (CNIC), Madrid, Spain

    Jose Luis Cabrera-Alarcon

  3. Rheumatology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain

    Cesar Diaz-Torne

  4. Rheumatology Department, Hospital Universitario HM Sanchinarro, Madrid, Spain

    Francisco Aramburu-Muñoz & Paloma García de la Peña Lefebvre

  5. Rheumatology Department, Hospital General Universitario Gregorio Marañon, Madrid, Spain

    Iustina Janta

  6. Rheumatology Department, Hospital Universitario Infanta Elena, Madrid, Spain

    Maria Carmen Ortega de la O

  7. Rheumatology Department, Hospital Can Misses, Ibiza, Spain

    Ana Urruticoechea-Arana

  8. Rheumatology Department, Hospital Universitario Infanta Leonor, Avenida Gran Via del Este, 80, 28031, Madrid, Spain

    Enrique Calvo-Aranda

  9. Crystal-induced Arthritis Study Group, Spanish Society of Rheumatology (GEACSER), Madrid, Spain

    Marta Novella-Navarro, Cesar Diaz-Torne, Iustina Janta, Maria Carmen Ortega de la O, Alejandro Prada-Ojeda & Enrique Calvo-Aranda

Authors
  1. Marta Novella-Navarro
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  2. Jose Luis Cabrera-Alarcon
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  3. Cesar Diaz-Torne
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  4. Francisco Aramburu-Muñoz
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  7. Alejandro Prada-Ojeda
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  8. Luis Sala-Icardo
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  9. Ana Urruticoechea-Arana
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  10. Paloma García de la Peña Lefebvre
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  11. Enrique Calvo-Aranda
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Contributions

MN, JLC, and EC designed and drafted the work, with analysis and interpretation of data; CD made substantial contributions to the interpretation of data, revising it critically for important intellectual content. All co-authors made substantial contributions to the acquisition of data. All co-authors revised and approved the version to be published, agreeing to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. All co-authors take full responsibility for the integrity of the study and the final manuscript.

Corresponding author

Correspondence to Enrique Calvo-Aranda.

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Conflict of interest

Dr. Novella-Navarro reports non-financial support from Sociedad Española de Reumatología during the conduct of the study; Dr. Cabrera-Alarcon has nothing to disclose; Dr. Diaz-Torne reports personal fees from Menarini and Grünenthal, outside the submitted work; Dr. Aramburu-Muñoz has nothing to disclose; Dr. Calvo-Aranda reports non-financial support from Sociedad Española de Reumatología, during the conduct of the study; personal fees from Menarini, Grünenthal and SOBI, outside the submitted work; Dr. García de la Peña Lefebvre has nothing to disclose; Dr. Janta reports personal fees from MENARINI and Grünenthal, outside the submitted work; Dr. Ortega de la O reports personal fees from Grünenthal, outside the submitted work; Dr. Prada-Ojeda reports personal fees from Menarini and Grünenthal, outside the submitted work; Dr. Sala-Icardo has nothing to disclose; Dr. Urruticoechea-Arana reports personal fees from GRÜNENTHAL and MENARINI, outside the submitted work.

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Novella-Navarro, M., Cabrera-Alarcon, J.L., Diaz-Torne, C. et al. A treat-to-target approach for gout confers renoprotective effect in patients with chronic kidney disease stage 3. Rheumatol Int 40, 1081–1087 (2020). https://doi.org/10.1007/s00296-020-04517-4

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