Гиперурикемия как фактор риска контраст-индуцированного острого повреждения почек

Миронова О.Ю., Лакотка П.Г., Фомин В.В. Гиперурикемия как фактор риска контраст-индуцированного острого повреждения почек. Consilium Medicum. 2021; 23 (1): 25–27. DOI: 10.26442/20751753.2021.1.200572

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Mironova OIu, Lakotka PG, Fomin VV. Hyperuricemia as a risk factor of contrast-induced acute kidney injury. Consilium Medicum. 2021; 23 (1): 25–27. DOI: 10.26442/20751753.2021.1.200572

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Аннотация

Цель. Оценить частоту контраст-индуцированного острого повреждения почек (КИ-ОПП) у пациентов со стабильной ишемической болезнью сердца (ИБС) и гиперурикемией.
Материалы и методы. В наблюдательное открытое проспективное когортное исследование включены пациенты со стабильной ИБС, получающие оптимальную медикаментозную терапию и имеющие показания к проведению исследований с внутриартериальным введением контрастных веществ. Протокол зарегистрирован в системе clinicaltrials.gov под номером NCT04014153. Нами проведен субанализ группы пациентов с гиперурикемией (уровнем мочевой кислоты выше 7 мг/дл).
Результаты. Мы включили 1023 пациентов со стабильной ИБС. Страдали гиперурикемией 32 пациента. Частота КИ-ОПП в этой группе составила 6,25% (2 пациента), что оказалось в 2 раза ниже, чем у пациентов с нормальным уровнем мочевой кислоты (13,1%). Различия статистически незначимы. У пациентов с гиперурикемией в 3 раза чаще отмечались протеинурия, на 7% чаще – сахарный диабет и на 4,5% – анемия, однако полученные данные также статистически незначимы, по-видимому, с учетом малого размера выборки.
Заключение. Частота КИ-ОПП у пациентов с гиперурикемией в 2 раза ниже, чем у пациентов с нормальным уровнем мочевой кислоты. Необходимо проведение большего количества исследований у пациентов с метаболическим синдромом с большими выборками.

Ключевые слова: контраст-индуцированное острое повреждение почек, контраст-ассоциированное острое повреждение почек, контраст-индуцированная нефропатия, ишемическая болезнь сердца, чрескожное коронарное вмешательство, контрастное вещество, гиперурикемия

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Aim. To assess the prevalence of contrast-induced acute kidney injury (CI-AKI) in patients with stable coronary artery disease (CAD) and hyperuricemia.
Materials and methods. Patients with stable CAD receiving optimal medical therapy and with indications to coronary angiography and possible coronary angioplasty were included in an observational open prospective cohort study. The protocol of the study was registered in clinicaltrials.gov with ID NCT04014153. We conducted a sub-analysis of the group of patients with hyperuricemia (uric acid level >7 mg/dl).
Results. We included 1023 patients with stable CAD. 32 patients suffered from hyperuricemia. The rate of CI-AKI in this group was 6.25% (2 patients), that was lower than in patients with normal levels of uric acid (13.1%). The difference was not statistically significant probably due to the small number of patients with hyperuricemia. The patients with hyperuricemia had proteinuria 3 times more frequently, than patients without, the rate of diabetes mellitus was 7% higher as well as anemia by 4.5% but didn’t reach statistical significance.
Conclusion. The rate of CI-AKI in patients with hyperuricemia was twice lower than in patients with normal levels of uric acid. More research needs to be conducted in patients with metabolic syndrome in larger groups.

Keywords: contrast-induced acute kidney injury, contrast-associated acute kidney injury, contrast-induced nephropathy, coronary artery disease, percutaneous coronary intervention, contrast, hyperuricemia

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Список литературы

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1. Cheungpasitporn W, Thongprayoon C, Harrison AM, Erickson SB. Admission hyperuricemia increases the risk of acute kidney injury in hospitalized patients. Clin Kidney J 2016; 9 (1): 51–6.
2. Kang MW, Chin HJ, Joo KW, et al. Hyperuricemia is associated with acute kidney injury and all-cause mortality in hospitalized patients. Nephrology 2019; 24 (7): 718–24.
3. Xu X, Hu J, Song N, et al. Hyperuricemia increases the risk of acute kidney injury: A systematic review and meta-analysis. BMC Nephrol 2017; 18 (1): 1–14. DOI: 10.1186/s12882-016-0433-1
4. Richette P, Doherty M, Pascual E, et al. 2016 updated EULAR evidence-based recommendations for the management of gout. Ann Rheum Dis 2017; 76 (1): 29–42.
5. Keeley EC, Boura JA, Grines CL. Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: A quantitative review of 23 randomised trials. Lancet 2003; 361 (9351): 13–20.
6. Guo W, Song F, Chen S, et al. The relationship between hyperuricemia and contrast-induced acute kidney injury undergoing primary percutaneous coronary intervention: Secondary analysis protocol for the ATTEMPT RESCIND-1 study. Trials 2020; 21 (1): 1–5.
7. KDIGO Working Group. Clinical Practice Guideline for Acute Kidney Injury. Kidney Int Suppl 2012; 2 (1): 124–38. Available at: http://www.kdigo.org/clinical_practice_guidelines/pdf/KDIGO AKI Guideline.pdf
8. Williams B, Mancia G, De Backer G, et al. 2018 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2018; 25 (6): 1105–87.
9. Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2016; 37 (27): 2129–200m.
10. Dedov II, Shestakova MV, Mayorov AY, et al. Standards of specialized diabetes care. Diabetes Mellit 2017; 20 (1S): 1–112.
11. Khanna D, Fitzegarld J, Khanna P, et al. 2012 American College of Rheumatology Guidelines for Management of Gout Part I: Systematic Non-pharmacologic and Pharmacologic Therapeutic Approaches to Hyperuricemia. Arthritis Care Res 2012; 64 (10): 1431–46. Available at: http://www.ncbi.nlm.nih.gov/pubmed/3683400%5Cnhttp://www.pubmedcentral.nih.gov/articlerender.fcgi?ar...
12. Alimentary anemias. Report of the WHO scientific group. Geneva, 1970 (in Russian)
13. Mehran R, Aymong ED, Nikolsky E, et al. A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention: Development and initial validation. J Am Coll Cardiol 2004; 44 (7): 1393–9. DOI: 10.1016/j.jacc.2004.06.068

Авторы

О.Ю. Миронова*, П.Г. Лакотка, В.В. Фомин

ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия
*mironova_o_yu@staff.sechenov.ru

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Olga Iu. Mironova*, Polina G. Lakotka, Viktor V. Fomin

Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
*mironova_o_yu@staff.sechenov.ru

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