Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.
The Impact On Renal Function of Quantitative Serum Urate Reduction In Gout Patients.
Whelton1, Andrew, MacDonald2, Patricia A., Hunt2, Barbara, Gunawardhana2, Lhanoo
Gout may lead to deterioration of renal function beyond that which can be attributed to aging. This analysis evaluated the effects of urate-lowering therapy (ULT) on renal function in hyperuricemic gout subjects with baseline (BL) estimated glomerular filtration rates (eGFR) of < or >=60 mL/min.
Subjects (1086) completing 2 phase 3 trials (FACT and APEX) were enrolled in the long-term EXCEL study and received daily ULT (febuxostat 80 or 120 mg or allopurinol 300 mg) for <=4 years. eGFR was calculated using the Modification of Diet in Renal Disease (MDRD) equation. A repeated-measures linear model was used to assess the relationship between eGFR change and sUA change, with factors for year of treatment and BL renal function (eGFR <60 vs >=60 mL/min).
Among this mostly male (96%), Caucasian (79%), and obese (63%) cohort, 7% (n=77) had BL eGFR <60 mL/min. Long-term ULT appeared to provide greater stabilization of renal function in subjects with BL eGFR <60 (Figure 1) than for those with BL eGFR >=60 (Figure 2). Overall, greater sustained sUA decreases were associated with less renal function deterioration (p<0.001). The model projects that, overall, every 1 mg/dL sUA reduction from BL will yield 1.25 mL/min less of a decrease in eGFR compared with no sUA reduction. The impact of BL renal impairment was significant (p<0.05): given the same treatment duration and sUA change, subjects with renal impairment (BL eGFR <60 mL/min) had 4.7 mL/min less of an eGFR decrease compared to those with BL eGFR >60 mL/min.
In treated gout subjects, the magnitude of treatment-induced persistent decreases in sUA is correlated with reduced deterioration of renal function, especially in patients with baseline eGFR <60 mL/min. These findings have important clinical implications in the management of gout in patients with renal impairment.
To cite this abstract, please use the following information:
Whelton, Andrew, MacDonald, Patricia A., Hunt, Barbara, Gunawardhana, Lhanoo; The Impact On Renal Function of Quantitative Serum Urate Reduction In Gout Patients. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :1031