Analysis Of Related Factors Of Renal Damage In Patients With Hyperuricemia And Comparison Of Uric Acid Lowering Treatment Efficacy In Patients With The Type Of Reduced Uric Acid Excretion

ObjectivesIn recent years,a large number of studies have shown that hyperuricemia?HUA?is closely related to renal damage,and renal damage is mainly manifested by decreased glomerular filtration rate?GFR?and proteinuria?including glomerular proteinuria and tubulin proteinuria and so on?.Literatures have confirmed that there are links between hyperuricemia and GFR or albuminuria in populations of physical examination,diabetes,and hypertension.However,there is no literature discussing the factors affecting GFR or albuminuria in hyperuricemia population,and no association has been reported between hyperuricemia and markers of tubuloproteinuria in the literature.The deposition of urate in renal interstitial is the main cause of renal damage caused by hyperuricemia,and no association has been reported between urine uric acid,an indirect marker of renal uric acid load,and GFR or proteinuria.Studies have shown that uric acid treatment could alleviate the development of renal damage in patients with hyperuricemia,but there is no unified view on the difference of efficacy and renal function recovery between febuxostat and benzbromarone currently.And there is no literature discussing the difference in efficacy of different drugs in hyperuricemia patients with different types of excretion.The objectives of this study:1.To investigate the factors affecting eGFR in male hyperuricemia patients;2.To investigate the factors affecting albuminuria and?1 microglobulinuria in male hyperuricemia patients and the relationship between the excretion of uric acid and proteinuria;3.To investigate differences in the efficacy of febuxostat and benzbromarone in patients with excretion-reduced type of hyperuricemia.Subjects and MethodsThe study consists of three parts:A cross-sectional study of men with hyperuricemia attending the Department of Endocrinology at Shanghai Sixth People's Hospital from April 2015 to October 2017 in accordance with the conditions?Parts 1 and 2?.A follow-up observation of the effectiveness of treatment in male patients with hyperuricemia treated with febuxostat or benzbromarone in the Department of Endocrinology at Shanghai Sixth People's Hospital from February 2017to January 2018?Part 3?.Logistic regression analysis was used to find risk factors,and investigate the effect of factors on the risk of disease after correcting confounding factors.ResultsPart ?:A total of 733 patients were included,and there were 62 male HUA patients with eGFR<60 ml/min/1.73 m².After correcting for related factors,age?OR:1.074,95%CI:1.046-1.103,P<0.0001?,tophus?OR:2.638,95%CI:1.312-5.301,P=0.006?and kidney stones?OR:2.120,95%CI:1.084-4.145,P=0.028?were associated with eGFR<60 ml/min/1.73m² in male HUA patients independently.Tophus,kidney stones,age were all related with eGFR<60 ml/min/1.73 m² in male HUA patients independently.Part ?:A total of 733 patients were included,132 had albuminuria,and 60 had?1 microglobulinuria.1)After correcting for related factors,urinary acid excretion?OR:9.165,95%CI:1.641-51.193,P=0.012?,systolic blood pressure?OR:1.024,95%CI:1.010-1.037,P<0.0001?,previous highest value of serum uric acid?OR:1.003,95%CI:1.000-1.005,P=0.023?,glycosylated hemoglobin?OR:1.484,95%CI:1.079-2.042,P=0.015?,and kidney stones?OR:1.829,95%CI:1.116-2.997,P=0.017?were associated with albuminuria in male HUA patients independently.The presence of kidney stones were associated with albuminuria in male HUA patients independently,the levels of uric acid excretion,systolic blood pressure,previous highest value of serum uric acid,and glycosylated hemoglobin were positively correlated with albuminuria in male HUA patients independently.2)After correcting for related factors,age?OR:1.054,95%CI:1.026-1.083,P<0.0001?,systolic blood pressure?OR:1.031,95%CI:1.012-1.051,P=0.001?,glycosylated hemoglobin?OR:1.629,95%CI:1.090-2.433,P=0.017?,urine pH?OR:0.592,95%CI:0.369-0.951,P=0.030?and erythrocyte sedimentation rate?OR:1.018,95%CI:1.001-1.035,P=0.033?were associated with?1 microglobulinuria in male HUA patients independently.Urinary pH was negatively correlated with?1 microglobulinuria in male HUA patients independently,levels of age,systolic blood pressure,glycosylated hemoglobin,erythrocyte sedimentation rate were positively correlated with?1 microglobulinuria in male HUA patients independently.Uric acid clearance was related to?1 microglobulinuria in male HUA patients dependently.Part ?:A total of 110 patients were included.After correction for related factors,both of the use of benzbromarone?OR:0.200,95%CI:0.077-0.520,P=0.001?and baseline blood uric acid?OR:1.008,95%CI:1.002-1.014,P=0.006?were independent influencing factors for serum uric acid reach the standard?serum uric acid<360?mol/L?at 6^th weeks of follow-up in male excretion-reduced HUA patients.The use of benzbromarone and low baseline blood uric acid level were independent factors for satisfactory serum uric acid at 6^th weeks of follow-up in male excretion-reduced HUA patients.The result of a further stratified analysis of different drug categories showed that the uric acid clearance rate was an independent factor affecting the level of uric acid in patients using benzbromarone.Conclusions1.The large amount of uric acid deposition in the body,kidney stones,and old age were all independent risk factors for renal insufficiency in male HUA patients.2.Uric acid excretion is an independent factor influencing albuminuria in male HUA patients.Uric acid clearance is associated with?1 microglobulinuria,but it is not an independent factor.3.The efficacy of benzbromarone is significantly higher than that of febuxostat in excretion-reduced male HUA patients.