The Role of a "Treat-to-Target" Approach in the Long-Term Renal Outcomes of Patients with Gout

초록

Background: Although gout is accompanied by the substantial burden of kidney disease, there are limited data to assess renal function as a therapeutic target. This study evaluated the importance of implementing a treat-to-target approach in relation to renal outcomes. Methods: Patients with gout who underwent continuous urate-lowering therapy (ULT) for at least 12 months were included. The effect of ULT on renal function was investigated by means of a sequential comparison of the estimated glomerular filtration rate (eGFR). Results: Improvement in renal function was only demonstrated in subjects in whom the serum urate target of <6 mg/dL was achieved (76.40 +/- 18.81 mL/min/1.73 m(2) vs. 80.30 +/- 20.41 mL/min/1.73 m(2), p < 0.001). A significant difference in the mean change in eGFR with respect to serum urate target achievement was shown in individuals with chronic kidney disease stage 3 (-0.35 +/- 3.87 mL/min/1.73 m(2) vs. 5.33 +/- 11.64 mL/min/1.73 m(2), p = 0.019). Multivariable analysis predicted that patients >= 65 years old had a decreased likelihood of improvement (OR 0.31, 95% CI 0.13-0.75, p = 0.009). Conclusions: The treat-to-target approach in the long-term management of gout is associated with better renal outcomes, with a greater impact on those with impaired renal function.

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