Kataoka H et al.Sci Rep. 2022 Mar 8;12(1):3784.

慢性肾脏疾病(CKD)的定义已经广泛传播并被普遍接受。然而，CKD5的研究仍存在一些争议，包括肾硬化和降尿酸治疗影响。肾硬化症的特点是无蛋白尿或蛋白尿极少，CKD患者中的高尿酸血症已引起广泛关注，并与肾小动脉病相关。

一项随机、双盲、多中心研究纳入395例3期CKD和无症状高尿酸血症患者。分为非布索坦组（n=203）与安慰剂组（n=192），根据蛋白尿和血清肌酐浓度分类，在无蛋白尿的亚队列中，非布索坦组的eGFR平均值显著高于安慰剂组(P= 0.007)

研究结果提示，无蛋白尿者易出现临床肾硬化症，与安慰剂相比，非布索坦对无蛋白尿的3期CKD无症状高尿酸血症患者肾功能的下降有所缓解。

Abstract

Attribute-based medicine is essential for patient-centered medicine. To date, the groups of patients with chronic kidney disease (CKD) requiring urate-lowering therapy are clinically unknown. Herein, we evaluated the efficacy of febuxostat using a cross-classification, attribute-based research approach. We performed post hoc analysis of multicenter, randomized, double-blind, placebo-controlled trial data for 395 patients with stage 3 CKD and asymptomatic hyperuricemia. Participants were divided into febuxostat or placebo groups and subcohorts stratified and cross-classified by proteinuria and serum creatinine concentrations. In patients stratified based on proteinuria, the mean eGFR slopes were significantly higher in the febuxostat group than in the placebo group (P = 0.007) in the subcohort without proteinuria. The interaction between febuxostat treatment and presence of proteinuria in terms of eGFR slope was significant (P for interaction = 0.019). When cross-classified by the presence of proteinuria and serum creatinine level, the mean eGFR slopes significantly differed between the febuxostat and placebo groups (P = 0.040) in cross-classified subcohorts without proteinuria and with serum creatinine level ≥ median, but not in the cross-classified subcohorts with proteinuria and serum creatinine level < median. Febuxostat mitigated the decline in kidney function among stage 3 CKD patients with asymptomatic hyperuricemia without proteinuria.

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