Uricosuric Agents Reduce the Risk of Long-Term Dialysis in Hyperuricemic Patients with Advanced Chronic Kidney Disease: A Nationwide Cohort Study

Yung-Tai Chen ； Chao-Fu Chang ； Yu-Wen Chao ； Wei-Cheng Tseng

《Acta Nephrologica》 30卷4期 (2016/12) Pp. 203-212

https://doi.org/10.6221/AN.2016018

摘要

BACKGROUND: Hyperuricemia links to higher morbidity and mortality of chronic kidney disease (CKD). Uricosuric agents are recently reported to confer a better survival than allopurinol in hyperuricemic subjects without CKD. Nonetheless, the therapeutic role of uricosuric agents and allopurinol in hyperuricemic patients with advanced CKD remains unclear. METHODS: From January 1, 2000 to December 31, 2012, we selected 9,668 pre-dialysis stage 5 CKD patients receiving urate-lowering agents from the Taiwan's National Health Insurance Research Database as the study cohort, in whom 8,035 were treated with allopurinol and 1,633 were treated with uricosuric agents. Allopurinol and uricosuric agent users were propensity score-matched (1:1). Outcomes were all-cause mortality, myocardial infarction, stroke and long-term dialysis. RESULTS: Over a median follow-up of 3.2 years, a total of 1,210 deaths, 184 myocardial infarction, 426 stroke and 2,745 long-term dialysis events occurred. Cox models showed that the risks of all-cause mortality, myocardial infarction and stroke were similar between allopurinol and uricosuric agent users. Notably, competing risk analysis showed allopurinol use was associated with a significantly higher risk for long-term dialysis (adjusted HR 1.08, 95% CI 1.00 ～ 1.16) than uricosuric agents. The renoprotective effect of uricosuric agents was consistent across all subgroups in our study. CONCLUSIONS: Uricosuric agent may be associated with a lower risk for long-term dialysis in hyperuricemic patients with advanced CKD. Further studies are needed to confirm this association.

關鍵字

advanced CKD ； allopurinol ； dialysis ； uricosuric agents