ABSTRACT
Objective To investigate the effect of urate-lowering therapy on renal function in chronic kidney disease (CKD) stages 2-5 patients with hyperuricemia (HUA).Methods A total of 132 patients of CKD stages 2-5 with HUA between July 2016 and December 2017 in Department of Nephrology of the Second Affiliated Hospital of Anhui Medical University were prospectively and self-controlled analyzed.Serum uric acid (SUA),estimated glomerular filtration rate (eGFR) and other clinical parameters were measured at baseline and after 1-6 months treatment.The patients were divided into group A (CKD stages 2-3a) and group B (CKD stages 3b-5) on the baseline value of eGFR.The changes of SUA and eGFR before and after treatment were compared.According to the level of SUA after 6 months treatment,patients were divided into attainment group (SUA ＜ 360 μmol/L) and nonattainment group (SUA ≥ 360 μmol/L).The difference of renal function in pre-treatment and post-treatment was compared.Multiple stepwise linear regression was used to analyze the relationship among the change of eGFR after receiving 6 months' treatment (deGFR) and SUA level,baseline eGFR and other indexes.Results After 1,3,6 months treatment,the average levels of SUA,Scr and urea nitrogen of all patients were decreased significantly while eGFR value was increased significantly (all P ＜ 0.050) than those in pre-treatment period.After six-month-therapy,proteinuria and hematuria were improved significantly in all patients (P ＜ 0.001,P=0.001).Compared with pre-treatment period,both the SUA levels of group A and group B were declined significantly while eGFR had a significant rise after treatment (P ＜ 0.001).The change of eGFR post-treatment in group A was significantly higher than that of group B [(13.64±15.35) vs (8.97±9.79) ml· min-1· (1.73 m2)-1,P=0.044].At 6 months after treatment,the eGFR value increased markedly in both attainment group and nonattainment group compared with pre-treatment period (P ＜ 0.001).After six-month-therapy,the eGFR value in attainment group was increased more obviously than that of nonattainment group [(13.96 ± 14.64) vs (8.03±9.69) ml· min-1· (1.73 m2)-1,P=0.021].Multiple stepwise linear regression analysis showed that the baseline eGFR value was an influencing factor of deGFR (b=0.161,P=0.020).Conclusions The renal function of CKD stages 2-5 patients with HUA can be significantly improved by urate-lowering therapy,which can effectively reduce proteinuria and hematuria.