非布司他对腹膜透析患者高尿酸血症的疗效及其与残肾功能的关系

The urate-lowering efficacy of febuxostat and its relationship with residual renal function in peritoneal dialysis patients with hyperuricemia

目的探讨非布司他对腹膜透析患者高尿酸血症的疗效及其与残肾功能的关系。方法本研究为回顾性队列研究。纳入2018年1月至2021年10月在宁波市第一医院行腹膜透析伴高尿酸血症的患者,根据是否使用非布司他分为观察组和对照组。收集两组患者治疗前临床基线资料和治疗后1~12个月期间的临床指标,并记录非布司他使用期间的不良反应。比较两组患者随访期间的血尿酸水平、达标率及残肾功能变化。结果共纳入105例患者,观察组55例,男27例,女28例,年龄(54.5±14.8)岁;对照组50例,男32例,女18例,年龄(53.8±15.2)岁。两组间年龄、性别、体质指数、原发疾病等基线资料差异均无统计学意义(均P>0.05)。观察组和对照组患者在治疗1、3、6和12个月时[观察组分别为(311±69)、(286±61)、(307±65)、(312±57)μmol/L,对照组分别为(454±71)、(453±76)、(463±70)、(459±76)μmol/L]血尿酸水平均低于基线值[观察组和对照分别为(479±77)和(486±59)μmol/L](均P<0.05),且观察组血尿酸水平低于对照组(均P<0.05)。观察组在治疗1、3、6和12个月时血尿酸达标率均高于对照组(均P<0.05),12个月时残肾估算肾小球滤过率(eGFR)和残肾尿素清除指数(Kt/V)的下降幅度均小于对照组(均P<0.05)。在随访期间,观察组不良反应发生率为9.09%(5/55)。结论非布司他可有效治疗腹膜透析患者合并的高尿酸血症,安全性较好,且可能有助于延缓其残肾功能的丢失。

Objective To investigate the urate-lowering efficacy of febuxostat in peritoneal dialysis(PD)patients with hyperuricemia(HUA)and its relationship with residual renal function.Methods Patients with HUA who underwent PD in Ningbo First Hospital from January 2018 to October 2021 were enrolled and divided into experimental group and control group according to whether to use febuxostat.The clinical baseline data before treatment and clinical indicators during 1-12 months after treatment were collected in two groups,and the adverse reactions during the use of febuxostat were also recorded.The changes of serum uric acid,standard-reaching rate and residual renal function were compared between the two groups during the follow-up.Results A total of 105 patients were included in the study.There were 55 patients in the experimental group[27 males and 28 females,with a mean age of(54.5±14.8)years]and 50 patients in the control group[32 males and 18 females,with a mean age of(53.8±15.2)years].No statistically significant difference was detected in clinical baseline data between the two groups(all P>0.05).The serum uric acid of the experimental group[(479±77),(311±69),(286±61),(307±65),(312±57)μmol/L]and control group[(486±59),(454±71),(453±76),(463±70),(459±76)μmol/L]were lower than baseline values at 1,3,6 and 12 months after treatment and the differences of two groups were statistically significant(all P<0.05).The serum uric acid in experimental group was significantly lower than that of control group(P<0.05).At 1,3,6 and 12 months after treatment,the standard-reaching rate of serum uric acid in the experimental group was significantly higher than that of the control group(all P<0.05).The decrease of residual estimated glomerular filtration rate(eGFR)and residual renal urea clearance index(Kt/V)in the experimental group were significantly lower than those in the control group at 12 months after treatment(all P<0.05).During the follow-up,the incidence of adverse reactions in the experimental group was 9.09%(5/55).Conclusions Febuxostat can effectively treat PD patients with hyperuricemia and has a high safety profile.Moreover,it may delay the loss of residual renal function.