Penatalaksanaan Hiperurisemia Pada Penyakit Ginjal Kronik (CKD)

Authors

DOI:

https://doi.org/10.30595/hmj.v4i1.5805

Keywords:

hyperuricemia, CKD, soursop, allopurinol, febuxostat

Abstract

Management of hyperuricemia in CKD includes non pharmacology and pharmacology. Non-pharmacological with lifestyle change interventions such as exercise, weight loss, low purine meat consumption, avoid high fructose, reduce alcohol and herbs. The treatment of asymptomatic hyperuricemia in CKD is still controversial. In Japan and Korea given uric acid-lowering drugs when the serum uric acid level (SUA)> 8 mg / dl but in America and Europe are not given drugs for fear of side effects. Soursop fruit consumption can be an alternative treatment for hyperuricemia in CKD both asymptomatic and symptomatic. The recommended drugs for hyperuricemia in CKD are allopurinol and febuxostat. Allopurinol is excreted through the kidneys so it is necessary to adjust the dose in CKD, starting from 50-100 mg / day, increasing it to 200-300 mg / day every 2-5 weeks until SUA <6 mg / dl. The dose may be> 300 mg / day if the patient is notified and the monitor may be toxic. In America, Europe and Japan recommend febuxostat only for the treatment of hyperuricemia.

Author Biography

Haidar Alatas, Gadjah Mada University, Departemen Ilmu Penyakit Dalam, Divisi Nefrologi-Hipertensi, RSUD Banyumas

Internal Medicine, Nephrology-Hypertension Departement, RSUD Banyumas.

References

1. Liu B, Wang T, Zhao H, Yue W, Yu Y, Liu C, et al. The prevalence of hyperuricemia in China: a meta-analysis. BMC Public Health. 2011 Oct 27;11:832.

2. Liu R, Han C, Wu D, Xia X, Gu J, Guan H, et al. Prevalence of Hyperuricemia and Gout in Mainland China from 2000 to 2014: A Systematic Review and Meta-Analysis. Biomed Res Int [Internet]. 2015 [cited 2019 Aug 13];2015. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4657091/

3. Vargas-Santos AB, Neogi T. Management of Gout and Hyperuricemia in CKD. American Journal of Kidney Diseases. 2017 Sep 1;70(3):422–39.

4. Zhu Y, Pandya BJ, Choi HK. Prevalence of gout and hyperuricemia in the US general population: The National Health and Nutrition Examination Survey 2007-2008: Prevalence of Gout and Hyperuricemia in the US. Arthritis & Rheumatism. 2011;63(10):3136–41.

5. Sharaf El Din UAA, Salem MM, Abdulazim DO. Uric acid in the pathogenesis of metabolic, renal, and cardiovascular diseases: A review. Journal of Advanced Research. 2017;8(5):537–48.

6. Burns CM, Wortmann RL. Disorders of Purine and Pyrimidine Metabolism. In: Kasper D, Fauci A, Hauser S, Longo D, Jameson JL, Loscalzo J, editors. Harrison’s Principles of Internal Medicine [Internet]. 19th ed. New York, NY: McGraw-Hill Education; 2014 [cited 2019 Oct 30]. Available from: accessmedicine.mhmedical.com/content.aspx?aid=1120817634

7. Burns C, Wortmann RL. Chapter 44. Gout. In: Imboden JB, Hellmann DB, Stone JH, editors. CURRENT Diagnosis & Treatment: Rheumatology [Internet]. 3rd ed. New York, NY: The McGraw-Hill Companies; 2013 [cited 2019 Oct 30]. Available from: accessmedicine.mhmedical.com/content.aspx?aid=57273972

8. Johnson RJ, Sanchez-Lozada LG, Mazzali M, Feig DI, Kanbay M, Sautin YY. What Are the Key Arguments Against Uric Acid as a True Risk Factor for Hypertension? Hypertension. 2013;61(5):948–51.

9. Brown L, Luciano A, Pendergast J, Khairallah P, Anderson CAM, Sondheimer J, et al. Predictors of Net Acid Excretion in the Chronic Renal Insufficiency Cohort (CRIC) Study. Am J Kidney Dis. 2019 Aug 1;74(2):203–12.

10. Sato Y, Feig DI, Stack AG, Kang D-H, Lanaspa MA, Ejaz AA, et al. The Case for Uric Acid-Lowering Treatment in Patients with Hyperuricaemia and CKD. Nat Rev Nephrol. 2019 Jul 11;1–9.

11. Kim SY, Guevara JP, Kim KM, Choi HK, Heitjan DF, Albert DA. Hyperuricemia and Risk of Stroke: A Systematic Review and Meta-analysis. Arthritis Rheum. 2009;61(7):885–92.

12. Shin DH. To Treat or Not To Treat Asymptomatic Hyperuricemia In Chronic Kidney Disease. Kidney Res Clin Pract. 2019 Sep;38(3):257–9.

13. Ramirez-Sandoval JC, Madero M. Treatment of Hyperuricemia in Chronic Kidney Disease. Uric Acid in Chronic Kidney Disease. 2018;192:135–46.

14. Langlois M, De Bacquer D, Duprez D, De Buyzere M, Delanghe J, Blaton V. Serum uric acid in hypertensive patients with and without peripheral arterial disease. Atherosclerosis. 2003;168(1):163–8.

15. Maiuolo J, Oppedisano F, Gratteri S, Muscoli C, Mollace V. Regulation of uric acid metabolism and excretion. Int J Cardiol. 2016 Jun 15;213(Supplement C):8–14.

16. Barrett KE, Barman SM, Boitano S, Brooks H. Ganong’s Review of Medical Physiology, 23rd Edition. 23 edition. New York: McGraw-Hill Medical; 2009. 726 p.

17. Roy D, Perreault M, Marette A. Insulin stimulation of glucose uptake in skeletal muscles and adipose tissues in vivo is NO dependent. Am J Physiol. 1998 Apr 1;274(4):E692–9.

18. Kaplan NM, Victor RG, Flynn JT. Kaplan’s clinical hypertension. Eleventh edition. Philadelphia: Wolters Kluwer; 2015. 461 p.

19. Xu W, Huang Y, Li L, Sun Z, Shen Y, Xing J, et al. Hyperuricemia Induces Hypertension Through Activation Of Renal Epithelial Sodium Channel (ENaC). Metabolism. 2016;65(3):73–83.

20. Choi HK, Ford ES. Prevalence of the Metabolic Syndrome in Individuals with Hyperuricemia. The American Journal of Medicine. 2007;120(5):442–7.

21. Yuan H, Yu C, Li X, Sun L, Zhu X, Zhao C, et al. Serum Uric Acid Levels and Risk of Metabolic Syndrome: A Dose-Response Meta-Analysis of Prospective Studies. J Clin Endocrinol Metab. 2015;100(11):4198–207.

22. Chiu HK, Tsai EC, Juneja R, Stoever J, Brooks-Worrell B, Goel A, et al. Equivalent Insulin Resistance In Latent Autoimmune Diabetes In Adults (Lada) And Type 2 Diabetic Patients. Diabetes Res Clin Pract. 2007;77(2):237–44.

23. Jalal DI, Rivard CJ, Johnson RJ, Maahs DM, McFann K, Rewers M, et al. Serum Uric Acid Levels Predict The Development Of Albuminuria Over 6 Years In Patients With Type 1 Diabetes: Findings From The Coronary Artery Calcifiscation In Type 1 Diabetes Study. Nephrol Dial Transplant. 2010;25(6):1865–9.

24. Li P, Zhang L, Zhang M, Zhou C, Lin N. Uric acid enhances PKC-dependent eNOS phosphorylation and mediates cellular ER stress: A mechanism for uric acid-induced endothelial dysfunction. Int J Mol Med. 2016 Apr;37(4):989–97.

25. Sánchez-Lozada LG, Soto V, Tapia E, Avila-Casado C, Sautin YY, Nakagawa T, et al. Role of oxidative stress in the renal abnormalities induced by experimental hyperuricemia. American Journal of Physiology - Renal Physiology. 2008;295(4):F1134–41.

26. Ejaz AA, Mu W, Kang D-H, Roncal C, Sautin YY, Henderson G, et al. Could Uric Acid Have a Role in Acute Renal Failure? Clinical Journal of the American Society of Nephrology. 2006;2(1):16–21.

27. Greenberg KI, McAdams-DeMarco MA, Kottgen A, Appel LJ, Coresh J, Grams ME. Plasma Urate and Risk of a Hospital Stay with AKI: The Atherosclerosis Risk in Communities Study. Clin J Am Soc Nephrol. 2015;10(5):776–83.

28. Nwokocha CR, Owu DU, Gordon A, Thaxter K, McCalla G, Ozolua RI, et al. Possible mechanisms of action of the hypotensive effect of Annona muricata (soursop) in normotensive Sprague–Dawley rats. Pharmaceutical Biology. 2012 Nov 1;50(11):1436–41.

29. Kırça M, Oğuz N, Çetin A, Uzuner F, Yeşilkaya A. Uric acid stimulates proliferative pathways in vascular smooth muscle cells through the activation of p38 MAPK, p44/42 MAPK and PDGFRβ. J Recept Sig Transd. 2017 Mar 4;37(2):167–73.

30. Nagayama D, Yamaguchi T, Saiki A, Imamura H, Sato Y, Ban N, et al. High serum uric acid is associated with increased cardio-ankle vascular index (CAVI) in healthy Japanese subjects: A cross-sectional study. Atherosclerosis. 2015 Mar 1;239(1):163–8.

31. Petreski T, Ekart R, Hojs R, Bevc S. Asymptomatic Hyperuricemia And Cardiovascular Mortality In Patients With Chronic Kidney Disease Who Progress To Hemodialysis. Int Urol Nephrol. 2019 Jun 1;51(6):1013–8.

32. Sánchez-Lozada LG, Lanaspa MA, Cristóbal-García M, García-Arroyo F, Soto V, Cruz-Robles D, et al. Uric acid-induced endothelial dysfunction is associated with mitochondrial alterations and decreased intracellular ATP concentrations. Nephron Exp Nephrol. 2012;121(0):e71–8.

33. Wu Y-Y, Qiu X-H, Ye Y, Gao C, Wu F, Xia G. Risk factors analysis for hyperuricemic nephropathy among CKD stages 3–4 patients: an epidemiological study of hyperuricemia in CKD stages 3–4 patients in Ningbo, China. Ren Fail. 2018 Nov 29;40(1):666–71.

34. Galán I, Goicoechea M, Quiroga B, Macías N, Santos A, García de Vinuesa MS, et al. Hyperuricemia is associated with progression of chronic kidney disease in patients with reduced functioning kidney mass. Nefrología. 2018 Jan 1;38(1):73–8.

35. Sturm G, Kollerits B, Neyer U, Ritz E, Kronenberg F. Uric acid as a risk factor for progression of non-diabetic chronic kidney disease? The Mild to Moderate Kidney Disease (MMKD) Study. Experimental Gerontology. 2008 Apr 1;43(4):347–52.

36. Feig DI, Kang D-H, Johnson RJ. Uric Acid and Cardiovascular Risk. New England Journal of Medicine. 2008;359(17):1811–21.

37. Fukui M, Tanaka M, Shiraishi E, Harusato I, Hosoda H, Asano M, et al. Serum uric acid is associated with microalbuminuria and subclinical atherosclerosis in men with type 2 diabetes mellitus. Metabolism - Clinical and Experimental. 2008 May 1;57(5):625–9.

38. Heinig M, Johnson RJ. Role of uric acid in hypertension, renal disease, and metabolic syndrome. Cleve Clin J Med. 2006 Dec;73(12):1059–64.

39. Kaewput W, Thongprayoon C, Rangsin R, Ruangkanchanasetr P, Bathini T, Mao MA, et al. Association Between Serum Uric Acid And Chronic Kidney Disease In Patients With Hypertension: A Multicenter Nationwide Cross-Sectional Study. J Evid Based Med [Internet]. [cited 2019 Sep 20];0(0). Available from: https://onlinelibrary.wiley.com/doi/abs/10.1111/jebm.12364

40. Herliana E. Penyakit Asam Urat Kandas Berkat Herbal [Internet]. Jakarta: FMedia; 2014 [cited 2019 Oct 30]. 122 p. Available from: https://agromedia.net/katalog/penyakit-asam-urat-kandas-berkat-herbal/

41. Malik UZ, Hundley NJ, Romero G, Radi R, Freeman BA, Tarpey MM, et al. Febuxostat Inhibition of Endothelial-Bound XO: Implications for Targeting Vascular ROS Production. Free Radic Biol Med. 2011 Jul 1;51(1):179–84.

42. Hosoya T, Kimura K, Itoh S, Inaba M, Uchida S, Tomino Y, et al. The effect of febuxostat to prevent a further reduction in renal function of patients with hyperuricemia who have never had gout and are complicated by chronic kidney disease stage 3: study protocol for a multicenter randomized controlled study. Trials. 2014 Jan 16;15:26.

43. Ye P, Yang S, Zhang W, Lv Q, Cheng Q, Mei M, et al. Efficacy and Tolerability of Febuxostat in Hyperuricemic Patients With or Without Gout: A Systematic Review and Meta-Analysis. Clin Ther. 2013 Feb 1;35(2):180–9.

44. Tani S, Nagao K, Hirayama A. Effect of Febuxostat, a Xanthine Oxidase Inhibitor, on Cardiovascular Risk in Hyperuricemic Patients with Hypertension: A Prospective, Open-label, Pilot Study. Clin Drug Investig. 2015;35(12):823–31.

45. Cha R, Kim SH, Bae EH, Yu M, Choi BS, Choi HY, et al. Physicians’ Perceptions of Asymptomatic Hyperuricemia in Patients With Chronic Kidney Disease: A Questionnaire Survey. Kidney Res Clin Pract. 2019 Sep;38(3):373–81.

46. Kakutani-Hatayama M, Kadoya M, Okazaki H, Kurajoh M, Shoji T, Koyama H, et al. Nonpharmacological Management of Gout and Hyperuricemia: Hints for Better Lifestyle. Am J Lifestyle Med. 2015 Sep 2;11(4):321–9.

47. Ewadh MJ, Smaism MF, Jawad AM, Mkhlof S, Aljubouri OM, Ewadh MM. Using Soursop Extracts for Natural Gout Treatment. J Biosci Bioeng. 2015;3(5):37.

48. Alatas H, Sja’bani M, Mustofa M, Mukti AG, Bawazier LA, Irijanto F, et al. The effects of soursop supplementation on blood pressure, serum uric acid, and kidney function in a prehypertensive population in accordance with the 2017 ACC/AHA guideline. J Hum Hypertens. 2019 Aug 28;1–10.

49. Alatas H. Pengaruh Pemberian Minuman Suplemen Buah Sirsak Pada Penderita Prehipertensi Dengan Asam Urat Normal Tinggi [Dissertation]. [Yogyakarta]: Universitas Gadjah Mada; 2018.

50. Sja’bani M, Irijanto F, Prasanto H, Bawazier LA, Zulaela Z, Harsoyo S, et al. Soursop Consumption Supplement In Pre And Stage 1 Hypertension Kidney Disease Patients With Hyperuricemia. Nephrology. 2014 Apr 24;19(S2):77-202 PS3-082.

51. Alatas H, Sja’bani M, Irijanto F, Mustofa, Mukti AG, Bawazier LA, et al. Soursop fruit (Annona muricata Linn.) consumption does not increase serum potassium levels and not significant in cardiovascular risk improvements of prehypertension subjects. J Med Sci [Internet]. 2018 [cited 2019 Sep 17];50(4). Available from: https://jurnal.ugm.ac.id/bik/article/view/35410

52. Sja’Bani M, Alatas H, Mustofa M, Mukti Ghufron A, Bawazier Aziza L, Irijanto F, et al. SUN-319 Soursop Supplementation Has Benefit Effects On Blood Pressure And Serum Uric Acid But Does Not Affect Kidney Functions And Serum Potassium Levels: An RCT Study. Kidney International Reports. 2019 Jul 1;4(7, Supplement):S292–3.

53. Liu X, Zhai T, Ma R, Luo C, Wang H, Liu L. Effects of Uric Acid-Lowering Therapy on The Progression of Chronic Kidney Disease: A Systematic Review and Meta-Analysis. Ren Fail. 2018 Apr 5;40(1):289–97.

54. Bose B, Badve SV, Hiremath SS, Boudville N, Brown FG, Cass A, et al. Effects of uric acid-lowering therapy on renal outcomes: a systematic review and meta-analysis. Nephrol Dial Transplant. 2014 Feb 1;29(2):406–13.

55. Kanji T, Gandhi M, Clase CM, Yang R. Urate lowering therapy to improve renal outcomes in patients with chronic kidney disease: systematic review and meta-analysis. BMC Nephrol [Internet]. 2015 Apr 19 [cited 2019 Oct 10];16. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4431373/

56. Chung T-T, Yu K-H, Kuo C-F, Luo S-F, Chiou M-J, Lan W-C, et al. Impact of Urate-Lowering Drugs on The Progression and Recovery From Chronic Kidney Disease Among Gout Patients. Arthritis Res Ther [Internet]. 2019 [cited 2019 Oct 10];21. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6751683/

57. Whelton A, MacDonald P, Zhao L, Hunt B, Gunawardhana L. Renal Function in Gout: Long-Term Treatment Effects of Febuxostat. J Clin Rheumatol. 2011 Jan;17(1):7–13.

58. Whelton A, MacDonald PA, Chefo S, Gunawardhana L. Preservation of Renal Function during Gout Treatment with Febuxostat: A Quantitative Study. Postgrad Med. 2013 Jan 1;125(1):106–14.

59. Sircar D, Chatterjee S, Waikhom R, Golay V, Raychaudhury A, Chatterjee S, et al. Efficacy of Febuxostat for Slowing the GFR Decline in Patients With CKD and Asymptomatic Hyperuricemia: A 6-Month, Double-Blind, Randomized, Placebo-Controlled Trial. Am J Kidney Dis. 2015 Dec;66(6):945–50.

60. Schumacher HR, Becker MA, Wortmann RL, MacDonald PA, Hunt B, Streit J, et al. Effects of febuxostat versus allopurinol and placebo in reducing serum urate in subjects with hyperuricemia and gout: A 28-week, phase III, randomized, double-blind, parallel-group trial. Arth Care Res. 2008;59(11):1540–8.

61. Becker MA, Schumacher HR, Espinoza LR, Wells AF, MacDonald P, Lloyd E, et al. The urate-lowering efficacy and safety of febuxostat in the treatment of the hyperuricemia of gout: the CONFIRMS trial. Arthritis Res Ther. 2010 Apr 6;12(2):R63.

62. Yamaguchi A, Harada M, Yamada Y, Hashimoto K, Kamijo Y. Identification of chronic kidney disease patient characteristics influencing the renoprotective effects of febuxostat therapy: a retrospective follow-up study. BMC Nephrol [Internet]. 2017 May 18 [cited 2019 Sep 12];18. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5437587/

63. Inoue M-K, Yamamotoya T, Nakatsu Y, Ueda K, Inoue Y, Matsunaga Y, et al. The Xanthine Oxidase Inhibitor Febuxostat Suppresses the Progression of IgA Nephropathy, Possibly via Its Anti-Inflammatory and Anti-Fibrotic Effects in the gddY Mouse Model. Int J Mol Sci [Internet]. 2018 Dec 10 [cited 2019 Sep 12];19(12). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6320819/

64. Lin T-C, Hung L, Chen Y-C, Lo W-C, Lin C, Tam K-W, et al. Effects Of Febuxostat On Renal Function In Patients With Chronic Kidney Disease: A Systematic Review And Meta-Analysis. Med. 2019 Jul;98(29):e16311.

65. Tsuji T, Ohishi K, Takeda A, Goto D, Sato T, Ohashi N, et al. The Impact of Serum Uric Acid Reduction on Renal Function And Blood Pressure in Chronic Kidney Disease Patients With Hyperuricemia. Clin Exp Nephrol. 2018 Dec 1;22(6):1300–8.

66. Jeon HJ, Oh J, Shin DH. Urate-Lowering Agents For Asymptomatic Hyperuricemia In Stage 3 – 4 Chronic Kidney Disease: Controversial Role Of Kidney Function. PLoS One. 2019 Jun 17;14(6):e0218510.

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Published

2021-03-27

How to Cite

Alatas, H. (2021). Penatalaksanaan Hiperurisemia Pada Penyakit Ginjal Kronik (CKD). Herb-Medicine Journal: Terbitan Berkala Ilmiah Herbal, Kedokteran Dan Kesehatan, 4(1), 1–19. https://doi.org/10.30595/hmj.v4i1.5805