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

Saime Paydas; Neşat Yücel; Ersin Nazlıcan; İlker Unal

doi:10.36516/jocass.1320561

Clinical Research

Böbrek Nakil Hastalarında Hiperürisemi ve Allopuirnol Tedavisinin Graft Sonlanımına Etkileri

Year 2023, Volume: 6 Issue: 3, 483 - 487, 31.12.2023

Saime Paydas , Neşat Yücel Ersin Nazlıcan , İlker Unal

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

Abstract

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.

Keywords

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

Supporting Institution

Herhangi bir destek alınmamıştır

Project Number

proje değildir

Thanks

Çalışmaya katılmayı kabul eden hastalar

References

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.

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

Year 2023, Volume: 6 Issue: 3, 483 - 487, 31.12.2023

Saime Paydas , Neşat Yücel Ersin Nazlıcan , İlker Unal

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

Abstract

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.

Keywords

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

Project Number

proje değildir

References

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.

There are 23 citations in total.

Details

Primary Language	English
Subjects	Transplantation, Internal Diseases, Nefroloji
Journal Section	Articles
Authors	Saime Paydas 0000-0001-6651-8265 Neşat Yücel This is me 0000-0002-6904-2263 Ersin Nazlıcan 0000-0002-1460-1996 İlker Unal 0000-0002-9485-3295
Project Number	proje değildir
Publication Date	December 31, 2023
Acceptance Date	December 14, 2023
Published in Issue	Year 2023 Volume: 6 Issue: 3

Cite

APA	Paydas, S., Yücel, N., Nazlıcan, E., Unal, İ. (2023). The Effect of Hyperuricemia and Allopurinol Treatment Outcome of Greft in Kidney Transplant Recipients. Journal of Cukurova Anesthesia and Surgical Sciences, 6(3), 483-487. https://doi.org/10.36516/jocass.1320561

Download Cover Image

Article Files

Full Text

download

You are free to:

Share — copy and redistribute the material in any medium or format The licensor cannot revoke these freedoms as long as you follow the license terms.

Under the following terms: Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use. NonCommercial — You may not use the material for commercial purposes. NoDerivatives — If you remix, transform, or build upon the material, you may not distribute the modified material. No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.