| Objective: To retrospectively analyze the clinical data of patients with chronic kidney disease(CKD)combined with gout,to understand the use and therapeutic effects of uric acid-lowering drugs in patients with CKD combined with gout,and to analyze whether CKD patients with gout are treated with uric acid-lowering drugs.Uric acid level,renal function and the impact on patients’ hospitalization costs,explore the differences in the effects of different uric acid-lowering drug treatments on uric acid levels and renal function levels,in order to provide data support for clinical drug use.Methods: Screened patients with chronic kidney disease and gout in the HIS system of a comprehensive tertiary hospital between July 2012 and March 2020,and divided them into the uric acid-lowering treatment group(UALT)according to whether they received uric acid-lowering drug treatment.Group)and the undecreased uric acid treatment group(non-UALT group).The clinical data of the study subjects were collected,and the age,gender,source of the department,underlying diseases,use of renal protective drugs and uric acid lowering drugs of the two groups of patients were statistically analyzed,as well as changes in the renal function indicators of the patients before and after treatment.Results:1.A total of 843 hospitalized patients with CKD and gout who met the research criteria were included in this study.Among them,there were 384 cases in the UALT group(348 males,36 females,male: female = 9.7:1),with an average age of 60 years,the youngest age was 16 years old,and the oldest age was 88 years old.There were 459 cases in the non-UALT group(424 males,35 females,male:female=12.1:1),with an average age of 60 years,the youngest age was 19 years old,and the oldest age was 90 years old.2.The patients included in this study are widely distributed.Patients in the UALT group come from 27 departments in the hospital,and patients in the non-UALT group come from 34 departments in the hospital,mainly in the Department of Nephrology,Endocrinology,and Rheumatology.3.More than 70% of patients in this study have more than 5 basic diseases,among which the most common basic diseases are hypertension and cardiac insufficiency.4.In this study,the frequency of use of renal protective drugs from high to low is Chinese patent medicines,glucocorticoids,renin-angiotensin system inhibitors,and immunosuppressive drugs.Commonly used Chinese patent medicines include Niaoduqing granules,Bailing capsules,and Shenfukang capsules.Among the renal protective drug treatment regimens used by patients,the regimen of using Chinese patent medicine alone or combining Chinese patent medicine with western medicine is the most common.5.In this study,the anti-gout drugs used by the patients were mainly allopurinol,febuxostat,and benzbromarone to lower blood uric acid,and colchicine,glucocorticoids,and non-steroidal anti-inflammatory drugs to control and prevent acute Onset,adjuvant treatment with sodium bicarbonate to alkalize urine.Allopurinol alone,febuxostat alone,benzbromarone alone and allopurinol combined with benzbromarone are used most frequently in the treatment regimens for lowering uric acid.6.At admission,the median blood uric acid values of male and female patients in the UALT group were 600 μmol/L and 605 μmol/L,respectively,the median blood uric acid values of male and female patients in the non-UALT group were529 μmol/L and 492 μmol/L,respectively.At discharge,the median blood uric acid values of male and female patients in the UALT group were 482 μmol/L and 443 μmol/L,respectively,the median blood uric acid values of male and female patients in the non-UALT group were 448 μmol/L and 466 μmol/L,respectively.Before hospitalization,the blood uric acid level in the UALT group was significantly higher than that in the non-UALT group(p<0.05),after treatment,there was no difference in the blood uric acid level between the two groups.Compared with before treatment,after uric acid-lowering treatment in UALT group,uric acid was significantly reduced(p<0.05),after hospitalization in non-UALT group,blood uric acid level was also significantly reduced(p<0.05).7.After hospitalization,the levels of urea nitrogen and creatinine in the UALT group were significantly reduced(p<0.05),the clearance of endogenous creatinine and bicarbonate levels were significantly increased(p<0.05),and the levels of cystatin C were significantly different Not statistically significant(p>0.05),urea nitrogen and creatinine levels in the non-UALT group were significantly reduced(p<0.05),bicarbonate levels were significantly increased(p<0.05),endogenous creatinine clearance,cystatin There was no statistically significant difference in C level(p>0.05).8.After hospitalization,patients who were treated with allopurinol regimen to lower uric acid,the endogenous creatinine clearance rate and bicarbonate level were significantly higher than before treatment(p<0.05),and the blood uric acid,urea nitrogen,and creatinine levels were higher than before treatment.Significantly decreased before treatment(p<0.05),and the level of cystatin C did not change significantly,patients who used febuxostat to lower uric acid had a significantly higher bicarbonate than before treatment(p<0.05),blood uric acid and urea nitrogen The level was significantly lower than before treatment(p<0.05),and the levels of endogenous creatinine clearance,creatinine,and cystatin C were not statistically significant,patients who used benzbromarone to lower uric acid had a higher level of endogenous creatinine clearance than Significantly decreased before treatment(p<0.05),cystatin C level was significantly higher than before treatment(p<0.05),there was no significant difference in blood uric acid,urea nitrogen,creatinine,and bicarbonate levels before and after treatment,allopurine was used In patients with alcohol combined with benzbromarone for lowering uric acid,blood uric acid and urea nitrogen levels were significantly lower than before treatment(p<0.05).There was no statistical difference in the treatment levels of bicarbonate,endogenous creatinine clearance,creatinine,and cystatin C Learn meaning.9.The total hospitalization expenses and western medicine expenses incurred by patients in the UALT group were significantly lower than those in the non-UALT group(p<0.05),and the costs of Chinese patent medicines in the UALT group were significantly higher than those in the non-UALT group(p>0.05).Conclusions:1.The CKD patients with gout in this study are concentrated in middle-aged and elderly men,with an average age of 60 years.There are many underlying diseases,the most common of which is cardiovascular disease.2.In this study,patients with CKD combined with gout who received uric acid-lowering drugs were often treated with allopurinol alone,febuxostat alone,benzbromarone alone or allopurinol combined with benzbromarone treatment regimens.The treatment with allopurinol alone is the most common and the effect of reducing uric acid is obvious.3.This study found that allopurinol can improve the renal function of patients with chronic kidney disease complicated by gout,thereby delaying the progression of CKD,benzbromarone can cause the patient’s endogenous creatinine clearance rate to decrease,and reduce the patient’s glomerular filtration rate,suggesting Clinically,attention should be paid to the use of benzbromarone to avoid possible acute kidney injury in patients. |
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