Avaliação do uso de alopurinol em pacientes com doença renal crônica e hiperuricemia assintomática.

Abstract

Introduction: Chronic kidney disease (CKD) is an important public health problem due to its high prevalence, with consequent impact on morbidity and mortality and high consumption of public resources in substitution therapy (dialysis and kidney transplantation). CKD treatment is based on intervention strategies for its risk factors, but the clinical management of currently known risk factors has not been sufficient to prevent the progression of CKD to its terminal stage. In the last two decades, asymptomatic hyperuricemia (AH) has been identified as a modifiable condition, the approach of which could increase the possibilities of prevention and treatment of CKD, decreasing the cost for patients, families and health systems. Objective: To assess whether the drug allopurinol decreases serum uric acid values and protects renal function in patients with CKD and AH. This dissertation consists of two articles: Article I: EVALUATION OF ALLOPURINOL USE IN PATIENTS WITH CHRONIC KIDNEY DISEASE AND ASYMPTOMATIC HYPERURICEMIA. INTRODUCTION: Asymptomatic hyperuricemia (AH) is common in patients with chronic kidney disease (CKD) and may be a risk for kidney injury. OBJECTIVE: To evaluate the use of allopurinol in the progression of chronic kidney disease and asymptomatic hyperuricemia. METHODS: retrospective case control study with data collection from medical records in a specialized center from 2006 to 2020. Eighty patients, in stages 3 and 4 of CKD, with HA, were separated into two groups. Case group included 40 patients who received allopurinol and control group included 40 patients who did not receive medication. Follow-up for 24 months and with 4 semiannual review consultations. The serum uric acid level and the glomerular filtration rate, estimated by the CKD-EPI formula, were compared at each visit within the group and between groups using mean, standard deviation and analysis of variance (ANOVA). RESULTS: the mean serum uric acid decreased in all revision visits in the allopurinol group, and there was a significant increase in the mean eGFR after allopurinol onset (p<0.001). No patient in the allopurinol group evolved to Chronic Kidney Disease (ESRD) in 24 months (p<0.001) while 4 patients in the control group evolved to ESRD. CONCLUSION: allopurinol was useful to reduce serum uric acid levels, improve renal function and delay the progression to ESRD in patients with asymptomatic hyperuricemia. Article II: PATIENT WITH CHRONIC KIDNEY DISEASE AND ASYMPTOMATIC HYPERURICEMIA: sociodemographic and health profile. INTRODUCTION: Asymptomatic hyperuricemia (AH) can be a risk for chronic kidney disease. OBJECTIVE: To characterize the clinical and sociodemographic profile of patients with chronic kidney disease (CKD) and AH treated at the outpatient clinic of a specialized center. METHODS: Retrospective cohort study with data collection from medical records, between the years 2006 and 2020. 80 patients with AH grouped in stages 3 and 4 of CKD were included. The variables were analyzed using a sociodemographic and health questionnaire in the first consultation with a 24-month follow-up. RESULTS: Forty-one men and 39 women with a mean age of 64.36 years. There was a predominance of patients in CKD stage 3 (72.5%), men were classified in stages 3a and 3b, while women were classified in stages 3b and 4 (p = 0.002). The serum uric acid (AU) and SD in men was 8.38 ± 1.462 and in women 7.59 ± 1.065 (p = 0.008). Men ate less of a purine-restricted diet compared to women (p<0.001). The underlying diseases that predominated were hypertension and diabetes (p = 0.064). The average proteinuria was 287 mg / 24 hours in men and 762 mg / 24 hours in women (p = 0.079). CONCLUSION: The patient profile of the study is predominantly elderly and middle-aged, in stage 3 of CKD and with AU on average 7.99 mg / dL. With some gender differences, men who are mostly hypertensive, do not follow a restrictive diet, with a higher AU value and with moderate kidney disease. Already, women have more diabetes, relatively more intense proteinuria and are classified in the most severe stages of CKD. Final considerations: In view of the results of this study, we hope to have drawn a clinical profile that helps to identify the chronic renal patient with asymptomatic hyperuricemia and to have contributed to the clear visualization of ULT results with allopurinol as a strategy to control serum uric acid levels, protect kidney function and reduce the population burden of ESRD, preventing disease and promoting health.