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Management of asymptomatic hyperuricaemia in patients with chronic kidney disease by Japanese nephrologists: A questionnaire survey
Author(s) -
NAKAYA IZAYA,
NAMIKOSHI TAMEHACHI,
TSURUTA YUKI,
NAKATA TAKESHI,
SHIBAGAKI YUGO,
ONISHI YOSHIHIRO,
FUKUHARA SHUNICHI
Publication year - 2011
Publication title -
nephrology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.752
H-Index - 61
eISSN - 1440-1797
pISSN - 1320-5358
DOI - 10.1111/j.1440-1797.2011.01446.x
Subject(s) - medicine , benzbromarone , kidney disease , asymptomatic , allopurinol , gout , nephrology , hyperuricemia , stage (stratigraphy) , physical therapy , uric acid , paleontology , biology
Aim: Hyperuricaemia is associated with chronic kidney disease (CKD) progression and cardiovascular events (CVE). In a US study, only 4% of rheumatologists initiated urate‐lowering therapy in patients with asymptomatic hyperuricaemia (AHU). The present study aimed to clarify how Japanese board‐certified nephrologists manage AHU in CKD patients. Methods: Questionnaires on management of AHU in CKD stage 3 or more were mailed to 1500 Japanese board‐certified nephrologists, excluding paediatricians and urologists, randomly selected from the directory of the Japanese Society of Nephrology ( n = 2976). Results: Five hundred and ninety‐five nephrologists (40%) responded. Most nephrologists (84–89%) recommended that AHU in patients in CKD stages 3–5 should be treated, but fewer nephrologists (63%) recommended that AHU in patients of CKD stage 5D should be treated. The serum urate level to start urate‐lowering therapy and the target serum urate level to be achieved (mg/dL) were 8.2 ± 0.9 and 6.9 ± 0.9, 8.4 ± 0.9 and 7.0 ± 1.0, 8.6 ± 1.0 and 7.3 ± 1.1, and 9.1 ± 1.2 and 7.8 ± 1.3 at stages 3, 4, 5 and 5D, respectively. The most frequently used maximal dosage of allopurinol was 100 mg/day at each stage. Benzbromarone was used in 52% of patients at stage 3, but only in 29%, 13% and 5% of patients at stages 4, 5 and 5D, respectively. The most important reasons to treat AHU at CKD stages 3–5 were prevention of CKD progression (45%), CVE (33%), gout (18%) and urolithiasis (3%). Conclusion: Most Japanese nephrologists treat AHU in pre‐dialysis CKD with an aim to prevent CKD progression or CVE mainly by allopurinol.