14 Renal & Urology News
SUMMER 2022
www.renalandurologynews.com
Uric Acid-Lowering May Raise CKD Risk Findings do not support initiating this therapy to prevent development of chronic kidney disease URIC ACID-LOWERING therapy is associated with a higher risk for newonset chronic kidney disease (CKD) among patients with baseline serum uric acid levels of 8 mg/d or less, a new study finds. The therapy did not change the risk for individuals with higher baseline serum uric acid levels. “These findings do not support the initiation of uric acid-lowering therapy as a means to prevent the development of CKD,” investigators concluded. Among 269,651 patients (94% male) with a baseline estimated glomerular filtration rate (eGFR) of at least 60 mL/ min/1.73 m2 and no albuminuria treated at US Veterans Affairs health care facilities from 2004 to 2019, a total of 29,501 patients (10.9%) started uric acid-lowering therapy. The vast majority (99.7%) received allopurinol. Of the full cohort, 21.7% eventually experienced an eGFR
decline to less than 60 mL/min/1.73 m2, 25.5% new-onset albuminuria, and 0.2% end-stage kidney disease (ESKD). After propensity-score matching, use vs nonuse of uric acid-lowering therapy was associated with a significant 15% higher risk of eGFR decline to less
Higher risk observed in patients with uric acid levels of 8 mg/dL or less at baseline. than 60 mL/min/1.73 m2 and a significant 5% higher risk of albuminuria in the overall cohort, Csaba P. Kovesdy, MD, of Memphis VA Medical Center in Tennessee, and colleagues reported in JAMA Network Open. Allopurinol
Dysnatremias in ESKD Linked to Higher In-Hospital Mortality HYPERNATREMIA AND hyponatremia in
Sample. The racial composition was
hospitalized patients with end-stage kid-
39.2% White and 34.9% Black. The
ney disease (ESKD) are associated with
study population was 54.72% male and
higher in-hospital mortality and longer
45.28% female.
hospital length of stay (LOS), investiga-
Compared with patients who did not
tors concluded in a poster presented at
have hypernatremia, those with the
the National Kidney Foundation’s 2022
condition were significantly older (66.5
Spring Clinical Meeting in Boston.
vs 61.5 years) and significantly more
After adjusting for age, sex, race,
likely to be Black (38.1% vs 34.8%).
and comorbidities, hypernatremia and
Compared with patients who did
hyponatremia were significantly associ-
not have hyponatremia, patients with
ated with a 2.0- and 1.8-fold increased
hyponatremia were significantly older
risk for in-hospital death compared with
(63 vs 61 years), significantly more
patients without these conditions, Calvin
likely to be female (49.1% vs. 44.8%),
Ghimire, MD, of McLarin Flint Hospital in
and significantly less likely to be Black
Flint, Michigan, and colleagues reported.
(27.2% vs 35.9%).
Female patients had significantly lower
“Prevention of dysnatremia remains
in-hospital mortality and shorter LOS
vital and patient education remains a
compared with male patients.
cornerstone to achieve it,” Dr Ghimire’s
Patients with hypernatremia and
team wrote.
hyponatremia had a significantly longer
They also observed, “Effectiveness of
LOS than patients without these condi-
managing underlying comorbidities and
tions (11.6 vs 5.7 days and 8.9 vs 5.4
renal replacement methods to maintain
days, respectively).
normal sodium level as per the require-
The findings are from a study of
ment remains an unsolved mystery to
643,555 index hospitalizations for
prevent worse clinical outcomes and
ESKD identified in the National Inpatient
mortality.” ■
use did not decrease the risk for ESKD. Among individuals with baseline serum uric acid levels of 8 mg/dL or less, uric acid-lowering therapy was significantly associated with 24% and 7% increased risks for an eGFR less than 60 mL/min/1.73 m2 and albuminuria, respectively. The investigators did not find these associations among those with higher baseline serum uric acid levels. “Our findings of higher risk of incident CKD and albuminuria in patients with less severe elevations of serum uric concentration treated with urate lowering therapy may appear surprising, as we hypothesized that the lowering of uric acid levels would be beneficial owing to the detrimental effects of uric acid on various metabolic and cardiovascular processes,” the authors wrote. They also noted that the findings “support results of recent large
randomized clinical trials that found no benefit of allopurinol in delaying progression of established CKD.” Dr Kovesdy’s team said their study “is notable for its large size, national representativeness, and availability of comprehensive information on a broad array of clinical data.” They also acknowledged that their study was observational and retrospective, and thus open to confounding. “While we accounted for major known confounders of the development of kidney disease, residual confounding remains possible, such as the doses of various potentially nephrotoxic medications or the severity of cardiovascular disease or other comorbidities.” In addition, their analysis included mostly male US veterans, so it is unclear whether their results apply to women or nonveterans, they noted. ■
Endometrial CA Ups Risk for UTI, CKD
factors and those treated with chemotherapy and/or radiation, may be an important part of ongoing survivorship care after endometrial cancer.” The study population, which investigators identified using the Surveillance, Epidemiology, and End ResultsMedicare linked database (2004-2017), compared 44,386 women diagnosed with endometrial cancer with a control group of 221,219 women without a cancer history matched by age, race or ethnicity, and state of residence. In the endometrial cancer cohort, 65% of women had localized disease. Among women with endometrial cancer, the risk of most urinary outcomes tended to be higher among women who were older at cancer diagnosis, according to the investigators. For example, compared with women aged 66-69 years, those aged 70-74, 75-79, 80-84, and 85 years or older had a significant 1.06-, 1.25-, 1.42-, and 1.51-fold increased risk for lower UTI, respectively, and 1.22-, 1.47-, 1.82-, and 2.10fold increased risk for CKD, respectively, Dr Anderson’s team reported. The study identified racial and ethnic differences among women with endometrial cancer. For example, compared with White women, Black women had a 1.58- and 1.72-fold higher risk for CKD and renal failure, respectively, and Hispanic women had a 1.17-fold higher risk for lower UTIs. ■
WOMEN WITH endometrial cancer are at increased risk for urinary problems, including lower urinary tract infection (UTI) and chronic kidney disease (CKD), according to a recent study. An analysis of 265,605 women aged 66 years or older showed that women diagnosed with endometrial cancer had a 2.36-fold increased risk for lower UTI compared with women who did not have a history of cancer, Chelsea Anderson, PhD, MPH, of the Gillings School of Global Public Health at the University of North Carolina in Chapel Hill, and colleagues reported in Cancer Epidemiology, Biomarkers, & Prevention. They also had a 1.85- and 2.28-fold increased risk for CKD and kidney failure, respectively, and a 2.22fold increased risk for urinary stones. “Results of the current study suggest that older women with endometrial cancer have a higher risk of several urinary outcomes than similarly aged women without a cancer history,” the authors wrote. “Timely identification and treatment of these conditions, especially among those with preexisting risk
