Asymptomatic Hyperuricemia with CKD (To Treat or Not To Treat) - Dr. Gawad
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Asymptomatic Hyperuricemia with CKD (To Treat or Not To Treat) - Dr. Gawad
- 1. Asymptomatic Hyperuricemia with CKD To Treat or Not To Treat Mohammed Abdel Gawad MD Neph, ESENeph Lecturer of Nephrology, School of Medicine, New Giza University Nephrology Consultant, Alexandria Founder of NephroTube.com Co-chair of AFRAN Web/Media Committee ISN Education SoMe Team Member drgawad@gmail.com @Gawad_Nephro
- 3. Chronic symptomatic hyperuricemia / Gout / Nephrolithiasis CKD ND Treat hyperuricemia: life style + urate lowering therapy (ULT) CKD Chronic symptomatic hyperuricemia / Gout / Nephrolithiasis Treat hyperuricemia: life style + urate lowering therapy (ULT) Chronic symptomatic hyperuricemia Asymptomatic hyperuricemia ?? ULT: to use or not to use CKD ND life style
- 4. Chronic symptomatic hyperuricemia Asymptomatic hyperuricemia ?? ULT: to use or not to use CKD ND • Available evidence and its appraisal: • Guidelines • Trials / Studies • Special situations • Proposed approach Conflicting and contradictory results
- 5. Chronic symptomatic hyperuricemia Asymptomatic hyperuricemia ?? ULT: to use or not to use CKD ND • Available evidence and its appraisal: • Guidelines • Trials / Studies • Special situations • Proposed approach Conflicting and contradictory results
- 8. Available online 15 May 2020
- 10. Chronic symptomatic hyperuricemia Asymptomatic hyperuricemia ?? ULT: to use or not to use CKD ND • Available evidence and its appraisal: • Guidelines • Trials / Studies • Special situations • Proposed approach Conflicting and contradictory results
- 13. no evidence of clinically meaningful benefits of serum urate reduction with allopurinol on kidney outcomes among patients with type 1 diabetes and early-to-moderate diabetic kidney disease
- 14. no evidence of clinically meaningful benefits of serum urate reduction with allopurinol on kidney outcomes among patients with type 1 diabetes and early-to-moderate diabetic kidney disease Can PERL study result be generalized to all type 1 DM CKD patients?
- 19. Can CKD-FIX study result be generalized to all CKD with albuminuric or high risk of progression?
- 22. stage 3 or 4 CKD
- 23. Patients with progressing CKD (decrease in eGFR by >4 ml/min/1.73m2 per year) over 1–2 years, empiric allopurinol may be appropriate
- 25. Chronic symptomatic hyperuricemia Asymptomatic hyperuricemia ?? ULT: to use or not to use CKD ND • Available evidence and its appraisal: • Guidelines • Trials / Studies • Special situations • Proposed approach
- 26. PERL trial and CKD-FIX Young age
- 27. Non proteinuric, mild to moderate renal impairment
- 28. The association between the pre-donation serum UA and residual renal function at 6 months and 1 year after nephrectomy 291 live kidney donors Volume 49, Issue 5, June 2017 Solitary kidney
- 29. Chronic symptomatic hyperuricemia Asymptomatic hyperuricemia ?? ULT: to use or not to use CKD ND • Available evidence and its appraisal: • Guidelines • Trials / Studies • Special situations • Proposed approach
- 31. Home Messages - Asymptomatic hyperuricemia in CKD • Debatable evidence to treat or not treat • Scale arm is more toward not to treat • ?! CKD progression (especially after controlling all other factors/early CKD), non proteinuric, mild to moderate CKD, young age, solitary kidney • Individualization according to step wise approach may be reasonable.
- 32. Thank You
Editor's Notes
- The Voting Panel felt that, on average, for the majority of patients with asymptomatic hyperuricemia (including those with comorbid CKD, CVD, urolithiasis, or hypertension), the benefits of ULT would not outweigh potential treatment costs or risks for the large number of patients unlikely to progress to gout.
- eGFR was determined by the CKD-EPI creatinine equation. Sensitivity analyses were conducted with the use of the CKD-EPI equation, based on cystatin C alone and in combination with creatinine, and the Modification of Diet in Renal Disease equation
- eGFR was determined by the CKD-EPI creatinine equation. Sensitivity analyses were conducted with the use of the CKD-EPI equation, based on cystatin C alone and in combination with creatinine, and the Modification of Diet in Renal Disease equation
- Nevertheless, too many data support the concept that interventions on risk factors may be ineffective once progression of kidney damage is under way and earlier intervention could be advisable in the course of disease.