LOWERING-HYPERURICEMIA TREATMENT ON CARDIOVASCULAR OUTCOMES IN PERITONEAL DIALYSIS PATIENTS: A PROSPECTIVE, MULTICENTER, DOUBLE BLIND RANDOMIZED CONTROLLED TRIAL

 

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LOWERING-HYPERURICEMIA TREATMENT ON CARDIOVASCULAR OUTCOMES IN PERITONEAL DIALYSIS PATIENTS: A PROSPECTIVE, MULTICENTER, DOUBLE BLIND RANDOMIZED CONTROLLED TRIAL

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Naya
Huang
Naya Huang huangnaya@163.com The First Affiliated Hospital, Sun Yat-sen University Department of Nephrology Guangzhou China *
Lanping Jiang jianglp@mail.sysu.edu.cn The First Affiliated Hospital, Sun Yat-sen University Department of Nephrology Guangzhou China -
Jinfeng Ye yejf7@mail2.sysu.edu.cn The First Affiliated Hospital, Sun Yat-sen University Department of Nephrology Guangzhou China -
Qian Zhou zhouq49@mail.sysu.edu.cn The First Affiliated Hospital, Sun Yat-sen University Department of Medical Statistics Guangzhou China -
Hao Zhang zhanghaoliaoqing@163.com The Third Xiangya Hospital, Central South University Department of Nephrology Changsha China -
Menghua Chen nxchenmh@163.com General Hospital of Ningxia Medical University Department of Nephrology Peritoneal Dialysis Center Yinchuan China -
Chen Yu yuchen@tongji.edu.cn Tongji Hospital, School of Medicine, Tongji University Department of Nephrology Shanghai China -
Huaying Shen shenhy513@sina.com Second Affiliated Hospital of Soochow University Department of Nephrology Suzhou China -
Yinghong Liu liuyh@csu.edu.cn The Second Xiangya Hospital, Central South University Department of Nephrology Changsha China -
Aiping Yin aipingyin112@163.com The First Affiliated Hospital of Medical College, Xi'an Jiaotong University Department of Nephrology Xi'an China -
Qinkai Chen timmyclz@163.com The First Affiliated Hospital of Nanchang University Department of Nephrology Nanchang China -
Zhanzheng Zhao zhanzhengzhao@zzu.edu.cn The First Affiliated Hospital of Zhengzhou University Department of Nephrology Zhengzhou China -
Qiang He strong_he@163.com Zhejiang Provincial People’s Hospital Department of Nephrology Hangzhou China -
Wei Chen chenwei99@mail.sysu.edu.cn The First Affiliated Hospital, Sun Yat-sen University Department of Nephrology Guangzhou China -
Xueqing Yu yuxueqing@gdph.org.cn Guangdong Provincial People’s Hospital and Guangdong Academy of Medical Sciences Department of Nephrology Guangzhou China -

Epidemiological and clinical studies have demonstrated a correlation between elevated serum hyperuricemia (SUA) and cardiovascular disease (CVD). Currently, there is limited and conflicting evidence regarding the association between SUA levels and cardiovascular events in the dialysis population. Whether urate-lowering therapy can improve cardiovascular outcomes in peritoneal dialysis (PD) patients remains an important and unanswered clinical question.

A multicenter, double-blind, randomized controlled trial involving maintenance PD patients with asymptomatic hyperuricemia was conducted. Patients were randomly assigned to receive febuxostat (40mg daily) or placebo. The primary outcome was cardiovascular events including cardiovascular mortality and non-fatal cardiovascular events. Secondary outcomes were all-cause mortality, cardiovascular mortality and non-fatal cardiovascular events, respectively. 

A total of 527 underwent randomization with 262 patients received febuxostat and 265 received placebo and were followed for a median of 24.05 (10.87~35.38) months. A primary outcome occurred in 21 patients (8.0%) in the febuxostat group and in 24 patients (9.0%) in the placebo group (hazard ratio, 0.82; 95% confidence interval [CI], 0.46-1.48; P=0.51). With regard to the all-cause mortality, and non-fatal cardiovascular events, there were no significant differences between febuxostat and placebo (hazard ratio for all-cause mortality, 0.67 [95% CI, 0.30 to 1.51], P=0.33; hazard ratio for non-fatal cardiovascular events, 0.65 [95% CI, 0.35 to 1.24], P=0.19;).  For cardiovascular mortality, there were only 5 events in febuxostat group and 1 event in placebo group, the events were not enough to perform comparable anFigure 2 Cumulative Kaplan–Meier Estimates of the Time to the First Occurrence of an End-Point Event.Risk Ratios for the All-cause Mortality According to Subgroupalysis between groups. In subgroup analysis, patients with age ≥50 years old had lower risks in febuxostat than placebo group for all-cause mortality and the composite outcomes of all-cause mortality and cardiovascular disease (hazard ratio for all-cause mortality in aged≥50 years old , 0.27 [95% CI, 0.07 to 1.00], P=0.036; hazard ratio for composite outcomes of all-cause mortality and cardiovascular disease in aged≥50 years old, 0.46 [95% CI, 0.23 to 0.94], P=0.029).  There was no significant difference between febuxostat and placebo groups in different gender and uric acid levels pertaining to primary or secondary outcomes. 


End point

Febuxostat

(n=262)

Placebo (n=265)

Hazard Ratio

(95%CI)

P value

 

no. of patients (%)

 

 

Primary endpoint: composite of cardiovascular mortality and non-fatal cardiovascular events

21 (8.0%)

24(9.0%)

0.82(0.46-1.48)

0.51

Secondary endpoints

 

 

 

 

     all-cause death

10 (3.8%)

14(5.3%)

0.67(0.30-1.51)

0.33

cardiovascular death

5 (1.9%)

1(0.4%)

4.69(0.55-40.17)

0.12

non-fatal cardiovascular events

16(6.1)

23(8.7%)

0.65(0.35-1.24)

0.19

 In PD patients with asymptomatic hyperuricemia, urate lowering treatment with febuxostat did not reduce the risk of cardiovascular event as compared with placebo. However, patients with age ≥50 years old had lower risks in febuxostat than placebo group for all-cause mortality and the composite outcomes of all-cause mortality and cardiovascular disease.

Kewords