Correction of Hyperurecemia in Preserving Kidney Function in Adolescents
Introduction. Risk factors leading to the development of chronic kidney disease (CKD) in children are now well understood. Among them are metabolic disorders, including purine, which is accompanied by an increase in the likelihood of renal function decline and the development of gouty nephropathy in adulthood. Purpose. To study the impact hyperuricaemia on the filtration function of the kidneys in adolescents. Materials and methods. A 4-year multicenter, open-label, initiative, randomized, parallel- group prospective study as a pediatric part of The Impact of Urate-lowering therapy on kidney function (IMPULsKF): SCREEN TO MANAGE, registered with ClinicalTrials.gov under number NCT03336203, conducted in Ukraine. In 18 children with hyperuricemia without any diagnoses and 16 children with chronic kidney disease, the natural dynamics of hyperuricemia and its correction in kidney disease with febuxostat were studied after reaching the age of 18. The parameters of the estimated glomerular filtration rate, the urine albumin/creatinine ratio, depending on the level of uricemia, were studied. Results. A tendency towards an increase in the values of hyperuricemia with increasing age was established, regardless of the presence of renal disease. There were significant differences (P≤0.05) in a decrease in the urine albumin/creatinine ratio during hypouricemic therapy, a tendency to an increase in the glomerular filtration rate and a decrease in the risk of developing end-stage renal failure. By the end of the 4-year follow-up, 4 (22%) of 18 children had documented prehypertension, which is possibly associated with the presence of asymptomatic hyperuricemia. In children with CKD, a decrease in urecemia correlated with an increase in eGFR, although no strong correlation was obtained in this sample and within 2 years of therapy. Correction of hyperuricemia to target values was characterized by a significant decrease in albumin/creatinin ratio and by a half - in the risk of developing end-stage renal disease. The correlation coefficient (r) between the decrease in the value of hyperuricemia and the decrease in albumin/creatinine ratio was 0.968, thus the relationship between the studied signs is direct, the strength of the relationship according to the Chaddock scale is very high. Conclusions. In children, initially having higher rates of hyperuricemia, has been shown the tendency to a further increase in hyperuricemia in adulthood. Its correction leads to a decrease in albumin/creatinine ratio and a decrease in the risks of developing end-stage renal disease in adolescents with CKD stages 1-3. It was hypothesized about a possible higher effect of drug correction of asymptomatic hyperuricemia with febuxostat at stage 1 of chronic kidney disease in comparison with stages 2-3.