Böbrek Nakil Hastalarında Hiperürisemi ve Allopuirnol Tedavisinin Graft Sonlanımına Etkileri

Yıl 2023, Cilt: 6 Sayı: 3, 483 - 487, 31.12.2023

Saime Paydas , Neşat Yücel Ersin Nazlıcan , İlker Unal

https://doi.org/10.36516/jocass.1320561

Öz

Giriş: Böbrek nakli alıcılarında; greft disfonksiyonu ve kullanılan immünsüpresifler nedeniyle serum ürik asit(SUA) seviyesi artabilir. Çalışmamızda, böbrek nakli alıcılarında yüksek SUA düzeyleri ve allopurinol tedavisinin böbrek fonksiyonları üzerindeki etkileri değerlendirildi.
Hastalar ve Yöntemler: Çalışmaya alınan 233 böbrek nakli alıcılarından 113’ünde SUA düzeyi yüksek idi (G1). G1'de allopurinol tedavisini 57 hasta(G1A+) aldı ve 56 hasta(G1A-) almadı. Beş yıl takip edilen (G5) 118 hastanın 56'sında hiperürisemi (G5-1) saptandı. G5-1'de 26 hasta allopurinol (G5-1A+) ile tedavi edildi, 30 hastada allopurinol verilmemiş idi (G5-1A-). G5’de 62 hasta normourisemikti (G5-2). Glomerül filtrasyon hızı<10ml/dk greft kaybı olarak kabul edildi.
Bulgular: 233 hastanın yaş ortalaması 42,8±11,6 (17-76), 164'ü erkekti (%70,0). 2.yılda G2 ve G1'de sırasıyla 9 (%7,5) ve 18 (%15,9) greft kaybı gelişti (p=0,045). Allopurinol tedavisine göre greft kaybının 10'u G1A+'da, 8'i G1A-'de meydana geldi (p=0,330). G5-1 ve G5-2'de sırasıyla 12 (%21) ve 9 (%14) greft kaybı meydana geldi (p= 0,62). G5-1A+ ve G5-1A-'da 7 (%23) ve 5'te (%19) greft kaybı meydana geldi (p = 0.71). İlk iki yıl dikkate alındığında, G5-1'deki greft kaybı G5-2'dekinden daha yüksekti (p = 0,023). Yüksek SUA seviyeleri, normal SUA seviyelerine göre greft kaybını 3,6 kat arttırdı (%95 güven aralığı:(1,2-12.70).
Sonuç: Böbrek nakli alıcılarında 2. yıl ve 5. yılda yüksek SUA düzeyleri ile graf kaybı arasında anlamlı bir ilişki vardı. Yüksek SUA'nın allopurinol tedavisi ile böbrek fonksiyonlarını koruyucu etki göstermiştir. Bu nedenle, allopurinol gibi hiperürisemi tedavisi, böbrek nakli alıcılarında böbrek fonksiyonunu korumak için iyi bir seçenek olabilir.

Anahtar Kelimeler

Ürik asit,, böbrek nakli alıcısı, böbrek fonksiyon bozukluğu, allopurinol

Destekleyen Kurum

Herhangi bir destek alınmamıştır

Proje Numarası

proje değildir

Teşekkür

Çalışmaya katılmayı kabul eden hastalar

The Effect of Hyperuricemia and Allopurinol Treatment Outcome of Greft in Kidney Transplant Recipients

Öz

Introduction: Kidney transplant recipients(KTRs) may have high level of serum uric acid(SUA) due to greft dysfunction and immunosuppressives. In this study, we evaluated effect of high SUA levels and allopurinol therapy in KTRs on renal functions.
Patients and Methods: 113 of 233 KTRs had elevated SUA level(G1). Fiftyseven of G1 received allopurinol treatment(G1A+) and 56 patients G1A-) did not. 56 of 118 patients who were followed for five years(G5) were hyperuricemic(G5-1) and 26 of G5-1 treated with allopurinol(G5-1A+) and 30 of them did not(G5-1A-). 62 patients were normourisemic(G5-2). GFR<10 ml/min was considered as graft loss.
Results: Of the 233 patients the mean age was 42.8±11.6(17-76), 164 were male(70.0%). In 2.year graft loss developed in 9(7.5 %) and 18(15.9%) of G2 and G1 respectively(p=0.045). According to allopurinol therapy 10 of the graft loss occurred in the G1A+ and 8 in the G1A-(p=0,330). Graft loss occurred in 12(21%) and 9(14%) in G5-1 and G5-2 respectively(p=0.62). Graft loss occurred in 7(23%) and 5(19%) in G5-1A+ and G5-1A- respectively(p=0.71). Considering the first two years graft loss in G5-1 was higher than in the G5-2(p=0.023), and higher SUA levels increased the graft loss by 3.6 times compared to normal SUA levels(95% confidence interval(1,2-12.70).
Conclusion: There was a significant relationship between high SUA levels and graf loss in KTRs in 2 years and 5 years. Treatment of high SUA with alIopurinol therapy had protective effect on renal functions. So that tretment of hyperuricemia such as allopurinol can be good option to preserve kidney function in KTRs.

Anahtar Kelimeler

: Uric acid, renal dysfunction, allopurinol, kidney transplant recipient

Proje Numarası

proje değildir

Kaynakça

• 1. Clive DM. Renal transplant-associated hyperuricemia and gout. J Am Soc Nephrol. 2000; 11(5): 974-9. https://doi.org/10.1681/ASN.V115974
• 2. Weiner DE, Tighiouart H, Elsayed EF, et al. Uric acid and incident kidney disease in the community. J Am Soc Nephrol. 2008; 19(6): 1204-11. https://doi.org/10.1681/ASN.2007101075
• 3. Obermayr RP, Temml C, Gutjahr G, et al. Elevated uric acid increases the risk of kidney disease. J Am Soc Nephrol. 2008; 19(12): 2407-13. https://doi.org/10.1681/ASN.2008010080
• 4. Han M, Lee JP, Park S, et al. Early onset hyperuricemia is a prognostic marker for kidney graft failure: Propensity score matching analysis in a Korean multicenter cohort. PLoS One. 2017;12(5):e0176786. https://doi.org/10.1371/journal.pone.0176786
• 5. Kim KM, Kim SS, Han DJ, et al. Hyperuricemia in kidney transplant recip-ients with intact graft function. Transplant Proc. 2010; 42(9): 3562-7. https://doi.org/10.1016/j.transproceed.2010.07.104
• 6. Saglam F, Celik A, Sarioglu S, et al. Hyperuricemia influences chronic cyclosporine nephropathy. Transplant Proc. 2008; 40(1): 167-70. https://doi.org/10.1016/j.transproceed.2007.11.013
• 7. Armstrong KA, Johnson DW, Campbell SB, et al. Does uric acid have a pathogenetic role in graft dysfunction and hypertension in renal trans-plant recipients? Transplantation. 2005; 80(11): 1565-71. https://doi.org/10.1097/01.tp.0000183895.88572.13
• 8. Kanbay M, Huddam B, Azak A, et al. A randomized study of allopurinol on endothelial function and estimated glomerular filtration rate in asymp-tomatic hyperuricemic subjects with normal renal function. Clin J Am Soc Nephrol. 2011; 6(8): 1887-94. https://doi.org/10.2215/CJN.11451210
• 9. Akgul A, Bilgic A, Ibis A, et al. Is uric acid a predictive factor for graft dysfunction in renal transplant recipients? Transplant Proc. 2007; 39(4): 1023-6. https://doi.org/10.1016/j.transproceed.2007.03.028
• 10. Malheiro J, Almeida M, Fonseca I, et al. Hyperuricemia in adult renal allograft recipients: prevalence and predictors. Transplant Proc. 2012; 44(8): 2369-72. https://doi.org/10.1016/j.transproceed.2012.07.033
• 11. Lin HY, Rocher LL, McQuillan MA, et al. Cyclosporine-induced hyperu-ricemia and gout. N Engl J Med. 1989; 321(5): 287-92. https://doi.org/10.1056/NEJM198908033210504
• 12. Numakura K, Satoh S, Tsuchiya N, et al. Hyperuricemia at 1 year after renal transplantation, its prevalence, associated factors, and graft survival. Transplantation. 2012; 94(2): 145-51. https://doi.org/10.1097/TP.0b013e318254391b
• 13. Gerhardt U, Grosse Hüttmann M, Hohage H. Influence of hyperglycemia and hyperuricemia on long-term transplant survival in kidney transplant recipients. Clin Transplant. 1999; 13(5): 375-9. https://doi.org/10.1034/j.1399-0012.1999.130502.x
• 14. Iseki K, Ikemiya Y, Inoue T, et al. Significance of hyperuricemia as a risk factor for developing ESRD in a screened cohort. Am J Kidney Dis. 2004; 44(4): 642-50. https://doi.org/10.1016/S0272-6386(04)00934-5
• 15. Hart A, Jackson S, Kasiske BL, et al. Uric acid and allograft loss from interstitial fibrosis/tubular atrophy: post hoc analysis from the angioten-sin II blockade in chronic allograft nephropathy trial. Transplantation. 2014; 97(10): 1066-71. https://doi.org/10.1097/01.TP.0000440952.29757.66
• 16. Min SI, Yun IJ, Kang JM, et al. Moderate-to-severe early-onset hyperu-ricemia: a prognostic marker of long-term kidney transplant outcome. Nephrol Dial Transplant. 2009; 24(8): 2584-90. https://doi.org/10.1093/ndt/gfp192
• 17. Akalin E, Ganeshan SV, Winston J, Muntner P. Hyperuricemia is associ-ated with developing the composite outcomes of new cardiovascular events and chronic allograft nephropathy. Transplantation. 2008; 86(5): 652-8. https://doi.org/10.1097/TP.0b013e3181814f5b
• 18. Meier-Kriesche HU, Schold JD, Vanrenterghem Y, et al. Uric acid levels have no significant effect on renal function in adult renal transplant recipi-ents: evidence from the symphony study. Clin J Am Soc Nephrol. 2009; 4(10): 1655-60. https://doi.org/10.2215/CJN.02700409
• 19. Kim ED, Famure O, Li Y, et al. Uric acid and the risk of graft failure in kidney transplant recipients: a re-assessment. Am J Transplant. 2015; 15(2): 482-8. https://doi.org/10.1111/ajt.13000
• 20. Liu X, Zhai T, Ma R, et al. Effects of uric acid-lowering therapy on the progression of chronic kidney disease: a systematic review and meta-analysis. Ren Fail. 2018; 40(1): 289-97. https://doi.org/10.1080/0886022X.2018.1456463
• 21. Yang H, Li R, Li Q, et al. Effects of febuxostat on delaying chronic kidney disease progression: a randomized trial in China. Int Urol Nephrol. 2023; 55(5): 1343-52. https://doi.org/10.1007/s11255-022-03437-5
• 22. Bandukwala F, Huang M, Zaltzman JS, et al. Association of uric acid with inflammation, progressive renal allograft dysfunction and post-transplant cardiovascular risk. Am J Cardiol. 2009; 103(6): 867-71. https://doi.org/10.1016/j.amjcard.2008.11.042
• 23. Osadchuk L, Bashir MH, Tangirala B, et al. Effect of allopurinol on slow-ing allograft functional decline in kidney transplant recipients. Exp Clin Transplant. 2014; 12(3): 190-4.