Association between urate-lowering therapy and kidney failure in patients with chronic kidney disease

• DOI: 10.1007/s40620-024-02179-0
• Publication Date: 2025-01-08T12:09:57Z
• Authors: Agathe Mouheb; Oriane Lambert; Natalia Alencar d...; Christian Jacquel...; Maurice Laville; Christian Combe; Denis Fouque; Luc Frimat; Ziad A. Massy; Solène M. Laville; Sophie Liabeuf; ; Natalia Alencar d...; Dorothée Cannet; Christian Combe; Denis Fouque; Luc Frimat; Aghilès Hamroun; Yves-Edouard Herpe; Christian Jacquel...; Oriane Lambert; Céline Lange; Maurice Laville; Sophie Liabeuf; Ziad A. Massy; Marie Metzger; Pascal Morel; Christophe Pascal; Roberto Pecoits-F...; Joost Schantsra; Bénédicte Stengel; Thierry Hannedouche; Bruno Moulin; Sébastien Mailliez; Gaétan Lebrun; Éric Magnant; Gabriel Choukroun; Benjamin Deroure; Adeline Lacraz; Guy Lambrey; Jean Philippe Bou...; Marie Essig; Thierry Lobbedez; Raymond Azar; Hacène Sekhri; Mustafa Smati; Mohamed Jamali; Alexandre Klein; Michel Delahousse; Christian Combe; Séverine Martin; Isabelle Landru; Eric Thervet; Ziad Massy; Philippe Lang; Xavier Belenfant; Pablo Urena; Carlos Vela; Luc Frimat; Dominique Chauveau; Viktor Panescu; Christian Noel; François Glowacki; Maxime Hoffmann; Maryvonne Hourmant; Dominique Besnier; Angelo Testa; F. Kuentz; Philippe Zaoui; Charles Chazot; Laurent Juillard; Stéphane Burtey; Adrien Keller; N. Kamar; Denis Fouque; Maurice Laville
• Keywords: Disease progression; Chronic kidney disease; Pharmacoepidemiology; Inappropriate prescribing; 610; Drug use; Urate-lowering therapy; [SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology

International audience ; 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 on CKD progression is subject to debate. The objective of the present study was to describe the prevalence of inappropriate urate-lowering therapy prescriptions and evaluate the association between urate-lowering therapy 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 CKD (eGFR < 60 mL/min/1.73 m2). Prescriptions of urate-lowering therapy drugs (allopurinol or febuxostat) were recorded prospectively. The appropriateness of each prescription was evaluated according to the patient's kidney function at baseline and during follow-up. Propensity score-matched, cause-specific Cox proportional hazards regression models were used to assess the association between incident urate-lowering therapy use and CKD progression (defined as the initiation of kidney replacement therapy (KRT) but also in other ways).Results: At baseline, 987 of the 3009 patients included in this study (median age: 69; men: 66%) were receiving urate-lowering therapy; 396 of these 987 patients were receiving an inappropriate prescription with regard to their kidney function. During a 5-year follow-up period, 70% of the 396 urate-lowering therapy prescriptions remained inappropriate. In the propensity score-matched cohort (n = 674), 136 patients started KRT. Compared with non- urate-lowering therapy use, urate-lowering therapy use was not significantly associated with a slowing in CKD progression, regardless of the definition used (HRKRT 0.89, 95% CI 0.67-1.20).Conclusions: Our real-world data emphasized the lack of reassessment of urate-lowering therapy prescriptions in patients with CKD. Urate-lowering therapy was not associated with a slowing of CKD progression.