Manejo de la hiperuricemia en pacientes en Argentina. Una encuesta mediante cuestionario

  • Guillermo A. De’Marziani Centro de Enfermedades Renales e Hipertensión Arterial (CEREHA), Buenos Aires
  • Teresa Bensusán Comité de Nefropatía Diabética, Sociedad Argentina de Diabetes (SAD), Buenos Aires
  • María Estela Canda Comité de Nefropatía Diabética, Sociedad Argentina de Diabetes (SAD), Buenos Aires
  • Yanina M. Castaño Comité de Nefropatía Diabética, Sociedad Argentina de Diabetes (SAD), Buenos Aires
  • Fabiana Davila Servicio de Diabetología, Hospital Universitario Austral, Buenos Aires
  • Guillermo Dieuzeide Centro de Atención Integral en Diabetes, Endocrinología y Metabolismo, Servicio de Endocrinología y Diabetes, Hospital Nuestra Señora del Carmen, Chacabuco, Buenos Aires
  • Claudio Daniel González Departamento de Farmacología, Escuela de Medicina, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno (CEMIC), Buenos Aires
  • Paula Iscoff Servicio de Nefrología, Hospital Interzonal General de Agudos Presidente Perón, Buenos Aires
  • Yanina V. Maccio Servicio de Nefrología y Diálisis, Centro Integral de Medicina de Alta Complejidad (CIMAC), San Juan
  • Estrella Menéndez Servicio Nutrición y Diabetes, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno (CEMIC), Buenos Aires
  • Elisa Morales Fresenius Medical Care, Neuquén
  • Liliana Obregon Servicio de Trasplante Renal. CRAI Sur-HIGA Gral. San Martín, La Plata, Buenos Aires
  • María J. Pomares Centro de Enfermedades Renales e Hipertensión Arterial (CEREHA), Buenos Aires
  • Jimena Soutelo Servicio de Endocrinología, Hospital Médico Policial Churruca-Visca, Buenos Aires
  • Fabiana P. Vázquez Servicio de Endocrinología, Metabolismo, Nutrición y Diabetes, Hospital Británico, Buenos Aires
  • Gloria Viñes Servicio de Nutrición y Diabetes, Hospital Privado de Comunidad (HPC), Buenos Aires
  • Alicia E. Elbert Centro de Enfermedades Renales e Hipertensión Arterial (CEREHA), Buenos Aires

Resumen

Introducción: Durante muchos años el ácido úrico se ha considerado como un producto metabólico inerte del metabolismo de las purinas, sin embargo, ha sido recientemente asociado a una serie de estados de enfermedad crónica. No hay hallazgos concluyentes disponibles en la actualidad para tomar una conducta activa clara respecto al tratamiento de ácido úrico sérico, y cuál sería su objetivo terapéutico. Material y métodos: Debido a esta controversia, se decidió llevar a cabo una encuesta para evaluar cuáles son las decisiones que se toman en este contexto, en el ámbito médico de la Argentina. Se consultó en qué pacientes se evaluaba en forma rutinaria el ácido úrico sérico, resultando en un 53.2% de todos los pacientes, sin diferenciar patologías, y un 11.5% refirió que no lo realiza rutinariamente. Con respecto al tratamiento sólo refirieron tratarlo con enfermedad renal un 62.5%; con diabetes 61.7%; con síndrome metabólico 60.4%; con enfermedad cardiovascular un 50.3%; con gota, cálculos renales o dolor articular, un 91.3%, 74% y 36.1% respectivamente. Resultados: Los datos de la encuesta confirman la falta de evidencia en el criterio para la selección de pacientes, a los fines de evaluar los niveles de ácido úrico sérico y su tratamiento. Conclusiones: De esta forma, se concluye que prima la necesidad de realizar estudios prospectivos y randomizados de las patologías con alta incidencia de uricemia elevada, para poder determinar normativas que orienten una conducta a los especialistas según los resultados obtenidos, y que dicha decisión no esté basada solo en la opinión de los expertos.

Citas

Oda M, Satta Y, Takenaka O, Takahata N. Loss of urate oxidase activity in hominoids and its evolutionary implications. Mol Biol Evol. 2002;19(5):640-53.

Adamopoulos D, Vlassopoulos C, Seitanides B, Contoyiannis P, Vassilopoulos P. The relationship of sex steroids to uric acid levels in plasma and urine. Acta Endocrinol (Copenh). 1977;85(1):198-208.

Keenan T, Zhao W, Rasheed A, Ho WK, Malik R, Felix JF, et al. Causal Assessment of Serum Urate Levels in Cardiometabolic Diseases Through a Mendelian Randomization Study. J Am Coll Cardiol. 2016;67(4):407-416.

Li X, Meng X, Timofeeva M, Tzoulaki I, Tsilidis KK, Ioannidis JP, et al. Serum uric acid levels and multiple health outcomes: umbrella review of evidence from observational studies, randomised controlled trials, and Mendelian randomisation studies. BMJ. 2017;357:j2376.

Feig DI, Kang D-H, Johnson RJ. Uric acid and cardiovascular risk. N Engl J Med. 2008;359(17):1811-21.

Rincon-Choles H, Jolly SE, Arrigain S, Konig V, Schold JD, Nakhoul G, et al. Impact of uric acid levels on kidney disease progression. Am J Nephrol. 2017;46(4):315-22.

Neogi T, George J, Rekhraj S, Struthers AD, Choi H, Terkeltaub RA. Are either or both hyperuricemia and xanthine oxidase directly toxic to the vasculature? A critical appraisal. Arthritis Rheum. 2012;64(2):327-38.

Gersch C, Palii SP, Kim KM, Angerhofer A, Johnson RJ, Henderson GN. Inactivation of nitric oxide by uric acid. Nucleosides Nucleotides Nucleic Acids. 2008;27(8):967-78.

Khosla UM, Zharikov S, Finch JL, Nakagawa T, Roncal C, Mu W, et al. Hyperuricemia induces endothelial dysfunction. Kidney Int. 2005;67(5):1739-42.

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(3-

:e71-8.

Yu MA, Sánchez-Lozada LG, Johnson RJ, Kang DH. Oxidative stress with an activation of the renin-angiotensin system in human vascular endothelial cells as a novel mechanism of uric acid-induced endothelial dysfunction. J Hypertens. 2010;28(6):1234-42.

Ames BN, Cathcart R, Schwiers E, Hochstein P. Uric acid provides an antioxidant defense in humans against oxidant- and radical-caused aging and cancer: a hypothesis. Proc Natl Acad Sci U S A. 1981;78(11):6858-62.

Wu J, Lei G, Wang X, Tang Y, Cheng H, Jian G, et al. Asymptomatic hyperuricemia and coronary artery disease in elderly patients without comorbidities. Oncotarget. 2017;8(46):80688-99.

Culleton BF, Larson MG, Kannel WB, Levy D. Serum uric acid and risk for cardiovascular disease and death: the Framingham Heart Study. Ann Intern Med. 1999;131(1):7-13.

Choi HK, Ford ES. Haemoglobin A1c, fasting glucose, serum C-peptide and insulin resistance in relation to serum uric acid levels, the Third National Health and Nutrition Examination Survey. Rheumatology (Oxford). 2008;47(5):713-7.

Dehghan A, van Hoek M, Sijbrands EJ, Hofman A, Witteman JC. High serum uric acid as a novel risk factor for type 2 diabetes. Diabetes Care. 2008;31(2):361-2.

Johnson RJ, Nakagawa T, Sanchez-Lozada LG, Shafiu M, Sundaram S, Le M, et al. Sugar, uric acid, and the etiology of diabetes and obesity. Diabetes. 2013;62(10):3307-15.

Johnson RJ, Segal MS, Srinivas T, Ejaz A, Mu W, Roncal C, et al. Essential hypertension, progressive renal disease, and uric acid: a pathogenetic link? J Am Soc Nephrol. 2005;16(7):1909-19.

Nagahama K, Inoue T, Kohagura K, Kinjo K, Ohya Y. Associations between serum uric acid levels and the incidence of hypertension and metabolic syndrome: a 4-year follow-up study of a large screened cohort in Okinawa, Japan. Hypertens Res. 2015;38(3):213-8.

Petta S, Cammà C, Cabibi D, Di Marco V, Craxì A. Hyperuricemia is associated with histological liver damage in patients with non-alcoholic fatty liver disease. Aliment Pharmacol Ther. 2011;34(7):757-66.

Zoppini G, Targher G, Negri C, Stoico V, Perrone F, Muggeo M, et al. Elevated serum uric acid concentrations independently predict cardiovascular mortality in type 2 diabetic patients. Diabetes Care. 2009;32(9):1716-20.

Zhao G, Huang L, Song M, Song Y. Baseline serum uric acid level as a predictor of cardiovascular disease related mortality and all-cause mortality: a meta-analysis of prospective studies. Atherosclerosis. 2013;231(1):61-8.

Johnson RJ, Kang DH, Feig D, Kivlighn S, Kanellis J, Watanabe S, et al. Is there a pathogenetic role for uric acid in hypertension and cardiovascular and renal disease? Hypertension. 2003;41(6):1183-90.

Weiner DE, Tighiouart H, Elsayed EF, Griffith JL, Salem DN, Levey AS. Uric acid and incident kidney disease in the community. J Am Soc Nephrol. 2008;19(6):1204-11.

Ficociello LH, Rosolowsky ET, Niewczas MA, Maselli NJ, Weinberg JM, Aschengrau A, et al. High-normal serum uric acid increases risk of early progressive renal function loss in type 1 diabetes: results of a 6-year follow-up. Diabetes Care. 2010;33(6):1337-43.

Jalal DI, Chonchol M, Chen W, Targher G. Uric acid as a target of therapy in CKD. Am J Kidney Dis. 2013;61(1):134-46.

Srivastava A, Kaze AD, McMullan CJ, Isakova T, Waikar SS. Uric acid and the risks of kidney failure and death in individuals With CKD. Am J Kidney Dis. 2018;71(3):362-370.

Ahola AJ, Sandholm N, Forsblom C, Harjutsalo V, Dahlström E, Groop PH. The serum uric acid concentration is not causally linked to diabetic nephropathy in type 1 diabetes. Kidney Int. 2017;91(5):1178-85.

Arévalo-Lorido JC, Carretero-Gómez J, Robles NR. Serum uric acid levels and outcome during admission in acute ischaemic stroke, depending on renal function. Int J Neurosci. 2018;128(10):906-912.

Justicia C, Salas-Perdomo A, Pérez-de-Puig I, Deddens LH, van Tilborg GAF, Castellví C, et al. Uric acid is protective after cerebral ischemia/reperfusion in hyperglycemic mice. Transl Stroke Res. 2017;8(3):294-305.

Hooper DC, Spitsin S, Kean RB, Champion JM, Dickson GM, Chaudhry I, et al. Uric acid, a natural scavenger of peroxynitrite, in experimental allergic encephalomyelitis and multiple sclerosis. Proc Natl Acad Sci U S A. 1998;95(2):675-80.

Parkinson Study Group SURE-PD Investigators, Schwarzschild MA, Ascherio A, Beal MF, Cudkowicz ME, Curhan GC, et al. Inosine to increase serum and cerebrospinal fluid urate in Parkinson disease: a randomized clinical trial. JAMA Neurol. 2014;71(2):141-50.

Soletsky B, Feig DI. Uric acid reduction rectifies prehypertension in obese adolescents. Hypertension. 2012;60(5):1148-56.

Feig DI, Soletsky B, Johnson RJ. Effect of allopurinol on blood pressure of adolescents with newly diagnosed essential hypertension: a randomized trial. JAMA. 2008;300(8):924-32.

Assadi F. Allopurinol enhances the blood pressure lowering effect of enalapril in children with hyperuricemic essential hypertension. J Nephrol. 2014;27(1):51-6.

Kanbay M, Huddam B, Azak A, Solak Y, Kadioglu GK, Kirbas I, et al. A randomized study of allopurinol on endothelial function and estimated glomular filtration rate in asymptomatic hyperuricemic subjects with normal renal function. Clin J Am Soc Nephrol. 2011;6(8):1887-94.

Beattie CJ, Fulton RL, Higgins P, Padmanabhan S, McCallum L, Walters MR, et al. Allopurinol initiation and change in blood pressure in older adults with hypertension. Hypertension. 2014;64(5):1102-7.

Madero M, Rodríguez Castellanos FE, Jalal D, Villalobos-Martín M, Salazar J, Vazquez-Rangel A, et al. A pilot study on the impact of a low fructose diet and allopurinol on clinic blood pressure among overweight and prehypertensive subjects: a randomized placebo controlled trial. J Am Soc Hypertens. 2015;9(11):837-44.

Goicoechea M, de Vinuesa SG, Verdalles U, Ruiz-Caro C, Ampuero J, Rincón A, et al. Effect of allopurinol in chronic kidney disease progression and cardiovascular risk. Clin J Am Soc Nephrol. 2010;5(8):1388-93.

Goicoechea M, Garcia de Vinuesa S, Verdalles U, Verde E, Macias N, Santos A, et al. Allopurinol and progression of CKD and cardiovascular events: long-term follow-up of a randomized clinical trial. Am J Kidney Dis. 2015;65(4):543-9.

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;29(2):406-13.

Pisano A, Cernaro V, Gembillo G, D'Arrigo G, Buemi M, Bolignano D. Xanthine oxidase inhibitors for improving renal function in chronic kidney disease patients: an updated systematic review and meta-analysis. Int J Mol Sci. 2017;18(11). pii: E2283.

Sampson AL, Singer RF, Walters GD. Uric acid lowering therapies for preventing or delaying the progression of chronic kidney disease. Cochrane Database Syst Rev. 2017;10:CD009460.

Nakaya I, Namikoshi T, Tsuruta Y, Nakata T, Shibagaki Y, Onishi Y, et al. Management of asymptomatic hyperuricaemia in patients with chronic kidney disease by Japanese nephrologists: a questionnaire survey. Nephrology (Carlton). 2011;16(5):518-21.

Yamanaka H, Japanese Society of Gout and Nucleic Acid Metabolism. Japanese guideline for the management of hyperuricemia and gout: second edition. Nucleosides Nucleotides Nucleic Acids. 2011;30(12):1018-29.

Kidney Disease. Improving Global Outcomes (KDIGO). KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Chapter 3: Management of progression and complications of CKD. Kidney Int Suppl. 2013;3:73-90.

Kuo CF, Grainge MJ, Zhang W, Doherty M. Global epidemiology of gout: prevalence, incidence and risk factors. Nat Rev Rheumatol. 2015;11(11):649-62.

Kuo CF, Luo SF. Gout: Risk of premature death in gout unchanged for years. Nat Rev Rheumatol. 2017;13(4):200-1.

Khanna D, Fitzgerald JD, Khanna PP, Bae S, Singh MK, Neogi T, et al. 2012 American College of Rheumatology guidelines for management of gout. Part 1: systematic nonpharmacologic and pharmacologic therapeutic approaches to hyperuricemia. Arthritis Care Res (Hoboken). 2012;64(10):1431-46.

Richette P, Doherty M, Pascual E, Barskova V, Becce F, Castañeda-Sanabria J, et al. 2016 updated EULAR evidence-based recommendations for the management of gout. Ann Rheum Dis. 2017;76(1):29-42.

Publicado
2019-09-19
Cómo citar
1.
De’Marziani GA, Bensusán T, Canda ME, Castaño YM, Davila F, Dieuzeide G, González CD, Iscoff P, Maccio YV, Menéndez E, Morales E, Obregon L, Pomares MJ, Soutelo J, Vázquez FP, Viñes G, Elbert AE. Manejo de la hiperuricemia en pacientes en Argentina. Una encuesta mediante cuestionario. Rev Nefrol Dial Traspl. [Internet]. 19 de septiembre de 2019 [citado 29 de marzo de 2024];39(3):175-83. Disponible en: http://vps-1689312-x.dattaweb.com/index.php/rndt/article/view/462
Sección
Artículo Original