PT - JOURNAL ARTICLE AU - Gerald D. Levy AU - Nazia Rashid AU - Fang Niu AU - T. Craig Cheetham TI - Effect of Urate-lowering Therapies on Renal Disease Progression in Patients with Hyperuricemia AID - 10.3899/jrheum.131159 DP - 2014 Apr 01 TA - The Journal of Rheumatology PG - jrheum.131159 4099 - http://www.jrheum.org/content/early/2014/03/26/jrheum.131159.short 4100 - http://www.jrheum.org/content/early/2014/03/26/jrheum.131159.full AB - Objective To evaluate the association between hyperuricemia and renal disease progression in a real-world, large observational database study. Methods We conducted a population-based retrospective cohort study identifying 111,992 patients with hyperuricemia (> 7 mg/dl) from a large medical group. The final cohort were ≥ 18 years old, urate-lowering therapy (ULT)-naïve, and had the following laboratory results available: at least 1 glomerular filtration rate (GFR) level before the index date and at least 1 serum uric acid (sUA) level and GFR in the followup 36-month period. The cohort was categorized into 3 groups: never treated (NoTx), ULT time receiving therapy of < 80% (< 80%), and ULT time receiving therapy of ≥ 80% (≥ 80%). Outcomes were defined as a ≥ 30% reduction in GFR from baseline, dialysis, or GFR of ≤ 15 ml/min. A subanalysis of patients with sUA < 6 mg/dl at study conclusion was performed. Cox proportional hazards regression model determined factors associated with renal function decline. Results A total of 16,186 patients met inclusion criteria. There were 11,192 NoTx patients, 3902 with < 80% time receiving ULT, and 1092 with ≥ 80% time receiving ULT. Factors associated with renal disease progression were age, sex, hypertension, diabetes, congestive heart failure, hospitalizations, rheumatoid arthritis, and higher sUA at baseline. Time receiving therapy was not associated with renal outcomes. Patients who achieved sUA < 6 mg/dl had a 37% reduction in outcome events (p < 0.0001; HR 0.63, 95% CI: 0.5-0.78). Conclusion Hyperuricemia is an independent risk factor for renal function decline. Patients treated with ULT who achieved sUA < 6 mg/dl on ULT showed a 37% reduction in outcome events.