Kidney Week

Abstract: TH-PO1074

Association between Urate-Lowering Therapy and Kidney Failure in Patients with CKD

Session Information

• CKD: Therapeutic Advances
  October 24, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2302 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

• Mouheb, Agathe, Centre Hospitalier Universitaire Amiens-Picardie, Amiens, Hauts-de-France, France

Agathe Mouheb, MPH

• Lambert, Oriane, Centre de Recherche en Epidemiologie et Sante des Populations, Villejuif, Île-de-France, France

Oriane Lambert, MPH

• Alencar de Pinho, Natalia, Centre de Recherche en Epidemiologie et Sante des Populations, Villejuif, Île-de-France, France

Natalia Alencar de Pinho, PhD

• Jacquelinet, Christian, Agence de la biomedecine, La Plaine Saint-Denis, France

Christian Jacquelinet, MD, PhD

• Laville, Maurice, Université de Lyon, CarMeN INSERM1060, Lyon, Auvergne-Rhône-Alpes , France

Maurice Laville

• Combe, Christian, Centre Hospitalier Universitaire de Bordeaux Groupe hospitalier Sud, Bordeaux, Nouvelle-Aquitaine, France

Christian Combe, MD, PhD

• Fouque, Denis, Nephrology department, Lyon South Medical Center, Lyon, Auvergne-Rhône-Alpes , France

Denis Fouque, MD, PhD

• Frimat, Luc, Centre Hospitalier Regional Universitaire de Nancy, Nancy, Grand Est, France

Luc Frimat, MD, PhD

• Massy, Ziad, Association pour l’Utilisation du Rein Artificiel dans la région parisienne (AURA), Paris, Ile-De-France, France

Ziad Massy, MD, PhD

• Laville, Solene M., Centre Hospitalier Universitaire Amiens-Picardie, Amiens, Hauts-de-France, France

Solene M. Laville, PharmD, PhD

• Liabeuf, Sophie, Centre Hospitalier Universitaire Amiens-Picardie, Amiens, Hauts-de-France, France

Sophie Liabeuf, PharmD, PhD

Background

Hyperuricemia is a hallmark of gout and a suspected risk factor for the progression of chronic kidney disease (CKD). However, the impact of urate-lowering therapy (ULT) on CKD progression is subject to debate. The objective of the present study was to evaluate the association between ULT prescription and the progression of kidney disease in patients with CKD.

Methods

CKD-REIN is a French, nationwide, prospective cohort of 3,033 nephrology outpatients with a confirmed diagnosis of CKD (eGFR<60 mL/min/1.73 m²). Prescriptions of ULT drugs (allopurinol or febuxostat), and patient's characteristics were recorded prospectively during follow-up. Propensity score-matched, cause-specific Cox proportional hazards regression models were used to assess the association between incident ULT use and CKD progression (defined primarily as the initiation of kidney replacement therapy (KRT) but also in other ways).

Results

Among the patients included in the cohort, 337 started ULT and were matched with a ULT non-user. The characteristics of the matched patients were balanced. The median age of the patients was 71 years, the mean eGFR was 30 mL/min/1.73 m², the mean uricemia was 494 µmol/L, and 65% were receiving diuretics.
Over a median follow-up of 3.2 [1.9-4.2] years, 136 patients started KRT (incidence rate [95% confidence interval (CI)]: 7.6 [6.3–8.8] per 100 person-years), among whom 66 patients initiated ULT.
Our analysis did not reveal a significant association between ULT prescription and the occurrence of KRT (HR [95%CI]: 0.89 [0.67 – 1.20]). Regardless of the definition considered, CKD progression was not significantly associated with ULT prescription.

Conclusion

Real-world data from the CKD-REIN cohort show that ULTs do not slow the progression of CKD. Thus, in patients with asymptomatic hyperuricemia, ULT should not be prescribed for the purpose of slowing down CKD progression.