Case Control Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Nephrol. May 6, 2017; 6(3): 132-142
Published online May 6, 2017. doi: 10.5527/wjn.v6.i3.132
Any link of gout disease control among hypertensive patients and onset of end-stage renal disease? Results from a population-based study
Sylvie Perreault, Javier Nuevo, Scott Baumgartner, Robert Morlock
Sylvie Perreault, Faculty of Pharmacy, University of Montreal, Montreal, QC H3C 3J7, Canada
Javier Nuevo, AstraZeneca, Calle de Serrano Galvache 56, 28033 Madrid, Spain
Scott Baumgartner, Robert Morlock, Ardea Biosciences, 9390 Towne Centre Dr, San Diego, CA 92121, United States
Author contributions: All authors are collectively responsible for the data and conclusions of this work.
Institutional review board statement: NA.
Informed consent statement: NA.
Conflict-of-interest statement: Perreault S holds the Sanofi Canada endowment Research Chair in Optimal Drug Use; Morlock R and Baumgartner S were employees of Ardea Biosciences, Inc., a member of the AstraZeneca Group, at the time of the study; Nuevo J is an employee of AstraZeneca.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Sylvie Perreault, BPharm, PhD, Full Professor, Faculty of Pharmacy, University of Montreal, Case Postale 6128, Succursale Centre-Ville, Montreal, QC H3C 3J7, Canada. sylvie.perreault@umontreal.ca
Telephone: +1-514-3436111 Fax: +1-514-3436120
Received: May 10, 2016
Peer-review started: May 11, 2016
First decision: June 14, 2016
Revised: October 17, 2016
Accepted: October 25, 2016
Article in press: October 27, 2016
Published online: May 6, 2017
Abstract
AIM

To determine the impact of allopurinol non-adherence as a proxy for uncontrolled disease on primary prevention of end-stage renal disease (ESRD).

METHODS

A cohort of 2752 patients with gout diagnosis was reconstructed using the Québec Régie de l’assurance maladie du Québec and MedEcho administrative databases. Eligible patients were new users of allopurinol, aged 45-85, with a diagnosis of hypertension, and treated with an antihypertensive drug between 1997 and 2007.

RESULTS

Major risk factor for ESRD onset was chronic kidney disease at stages 1 to 3 [rate ratio (RR) = 8.00; 95% confidence interval (CI): 3.16-22.3 and the severity of hypertension (≥ 3 vs < 3 antihypertensives)] was a trending risk factor as a crude estimate (RR = 1.94; 95%CI: 0.68-5.51). Of 341 patients, cases (n = 22) and controls (n = 319), high adherence level (≥ 80%) to allopurinol therapy, compared with lower adherence level (< 80%), was associated with a lower rate of ESRD onset (RR = 0.35; 95%CI: 0.13-0.91).

CONCLUSION

Gout control seem to be associated with a significant decreased risk of ESRD onset in hypertensive populations, further research should be conducted confirming this potential associated risk.

Keywords: Allopurinol, End-stage renal disease, Gout, Hyperuricemia, Medication adherence, Serum uric acid

Core tip: The question of whether serum uric acid has a pathogenic role in the onset and progression of chronic kidney disease (CKD) remains unanswered. Hyperuricemia and gout is common in CKD, and treatment adherence in gout patients is suboptimal and therefore a therapeutic challenge. Our population-based study assessed the impact of gout disease control on the risk of end stage renal disease (ESRD). Our study suggest that adherence to allopurinol of ≥ 80% as a proxy for gout control is associated with a significant, 65% reduction in the risk of ESRD onset.