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논문분류	춘계학술대회 초록집
제목	Hyperuricemia Treatment Reduces ESKD Risk and Mortality in CKD Patients: A Causal Inference Analysis Using the G-Formula Approach
저자	Ara Ko
출판정보	2024; 2024(1):
키워드
초록	Objectives: Hyperuricemia is recognized as an independent predictor of chronic kidney disease (CKD), but the role of treating it in CKD, especially when asymptomatic, remains under debate. The g-formula, valuable for epidemiological causal inference, allows estimation of effects in complex scenarios with time-varying factors and feedback loops among covariates. We used the g-formula to assess the impact of treating hyperuricemia in CKD patients using urate-lowering agents (ULAs). Methods: Employing the g-formula, we analyzed data from 28,660 CKD patients to build regression models, evaluating relationships among time-varying covariates: serum urate (UA), creatinine, and ULA prescription status, measured every 6 months. We also adjusted for time-invariant factors like diabetes and hypertension. Our focus was the impact of various strategies for managing hyperuricemia (always treating, treating if UA ≥ 7mg/dL, 9mg/dL, or 10mg/dL, or never treating) on end-stage kidney disease (ESKD) and all-cause mortality, supported by 1,000 bootstrap replicates for 95% confidence intervals (CIs). Results: Of the cohort, 6,571 patients had been prescribed allopurinol, febuxostat, or benzbromarone. Our findings reveal that any level of hyperuricemia treatment decreased ESKD and all-cause mortality risks compared to no treatment. Lower ULA thresholds were linked to dose-responsive relative risk (RR) reductions, particularly at 7mg/dL [RR reductions of -3.8% for ESKD (95% CI: -4.7% to -3.0%), and -2.8% for mortality (95% CI: -3.2% to -2.4%)]. Compared to the natural course, initiating treatment ≥9mg/dL or 10mg/dL, or not treating at all, significantly increased ESKD (RR of 1.006, 1.013, and 1.022 respectively) and mortality (RR of 1.003, 1.008, and 1.014 respectively), with a protective effect observed only at the 7mg/dL threshold (RR 0.983). Conclusions: Our study demonstrates that treating hyperuricemia in CKD patients significantly reduces the risk of ESKD and mortality. This suggests potential harm in not treating hyperuricemia at urate levels of 9mg/dL or higher.
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