Гиперурикемия и поражение почек у пациентов с сердечно-сосудистыми заболеваниями

Миронова О.Ю. Гиперурикемия и поражение почек у пациентов с сердечно-сосудистыми заболеваниями. Терапевтический архив. 2022;94(12):1426–1430. DOI: 10.26442/00403660.2022.12.201999

© ООО «КОНСИЛИУМ МЕДИКУМ», 2022 г.

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Mironova OIu. Hyperuricemia and kidney damage in patients with cardiovascular disease: A review. Terapevticheskii Arkhiv (Ter. Arkh.). 2022;94(12):1426–1430. DOI: 10.26442/00403660.2022.12.201999

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Аннотация

Проведено множество исследований, подтверждающих влияние мочевой кислоты на функцию почек. Очевидно, что существует взаимосвязь между влиянием мочевой кислоты не только на функцию почек, но и на сердечно-сосудистую систему и повышение сердечно-сосудистого риска. В обзоре представлены основные сведения о патогенезе, принципах и особенностях назначения терапии пациентам с хронической болезнью почек (ХБП) и сердечно-сосудистой патологией. Много сведений в настоящее время указывают на то, что гиперурикемия, как с отложением кристаллов, так и без него, ассоциирована с высоким сердечно-сосудистым риском и снижением функции почек. Ряд исследований и метаанализов свидетельствует о том, что уратснижающая терапия предотвращает и замедляет снижение функции почек у пациентов с ХБП, многие из которых страдают сердечно-сосудистыми заболеваниями или как минимум имеют несколько факторов риска. Несмотря на то, что в настоящее время в рекомендации по лечению ХБП не включена рекомендация по назначению уратснижающей терапии, накоплено большое количество данных о потенциальной пользе такого лечения даже в отсутствие диагноза подагры. Предпочтительной группой препаратов для этой группы пациентов являются ингибиторы ксантиноксидазы, а для пациентов с расчетной скоростью клубочковой фильтрации ниже 30 мл/мин/1,73 м2, по-видимому, аллопуринол в настоящее время имеет большую доказательную базу по эффективности и безопасности назначения.

Ключевые слова: гиперурикемия, острое повреждение почек, хроническая болезнь почек, сердечно-сосудистые заболевания, артериальная гипертензия, ожирение, сахарный диабет, метаболический синдром, уратснижающая терапия, аллопуринол, фебуксостат

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Many studies have been conducted confirming the effect of uric acid (UA) on kidney function. It is obvious that there is a relationship between the effect of UA not only on kidney function, but also on the cardiovascular system, increasing cardiovascular risk. The review article provides basic information about the pathogenesis, principles and features of prescribing therapy to patients with chronic kidney disease (CKD) and cardiovascular disease. A lot of data currently indicates that hyperuricemia, both with and without crystal deposition, is associated with high cardiovascular risk and decreased kidney function. A number of studies and meta-analyses indicate that urate-reducing therapy prevents and slows down the decline in kidney function in patients with CKD, many of whom suffer from cardiovascular diseases or at least have several risk factors. Despite the fact that currently the guidelines for the treatment of CKD do not include a recommendation for the start of urate-lowering therapy, a large amount of data has been accumulated on the potential benefits of such treatment even in the absence of a diagnosis of gout. The preferred group of drugs for this group of patients are xanthine oxidase inhibitors, and for patients with eGFR below 30 ml/min/1.73 m2, it seems that allopurinol currently has larger evidence base for the efficacy and safety of prescribing.

Keywords: hyperuricemia, acute kidney injury, chronic kidney disease, cardiovascular disease, arterial hypertension, obesity, diabetes, metabolic syndrome, urate-lowering therapy, allopurinol, febuxostat

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Список литературы

1. Marangella M. Uric acid elimination in the urine. Pathophysiological implications. Contrib Nephrol. 2005;147:132-48. DOI:10.1159/000082551
2. Culleton BF, Larson MG, Kannel WB, et al. Serum uric acid and risk for cardiovascular disease and death: the Framingham Heart Study. Ann Intern Med. 1999;131:7-13. DOI:10.7326/0003-4819-131-1-199907060-00003
3. Richette P, Perez-Ruiz F, Doherty M, et al. Improving cardiovascular and renal outcomes in gout: what should we target? Nat Rev Rheumatol. 2014;10:654-61. DOI:10.1038/nrrheum.2014.124
4. Nashar K, Fried LF. Hyperuricemia and the progression of chronic kidney disease: is uric acid a marker or an independent risk factor? Adv Chronic Kidney Dis. 2012;19:386-91. DOI:10.1053/j.ackd.2012.05.004
5. Moe OW. Posing the question again: does chronic uric acid nephropathy exist? J Am Soc Nephrol. 2010;21:395-7. DOI:10.1681/ASN.2008101115
6. Johnson RJ, Kang D-H, Feig D, et al. Is there a pathogenetic role for uric acid in hypertension and cardiovascular and renal disease? Hypertens (Dallas, Tex 1979). 2003;41:1183-90. DOI:10.1161/01.HYP.0000069700.62727.C5
7. Berger L, Yü TF. Renal function in gout. IV. An analysis of 524 gouty subjects including long-term follow-up studies. Am J Med. 1975;59:605-13. DOI:10.1016/0002-9343(75)90222-3
8. Sato Y, Feig DI, Stack AG, et al. The case for uric acid-lowering treatment in patients with hyperuricaemia and CKD. Nat Rev Nephrol. 2019;15:767-75. DOI:10.1038/s41581-019-0174-z
9. Cheng D, Du R, Wu XY, et al. Serum Uric Acid is Associated with the Predicted Risk of Prevalent Cardiovascular Disease in a Community-dwelling Population without Diabetes. Biomed Environ Sci. 2018;31:106-14. DOI:10.3967/bes2018.013
10. Desideri G, Virdis A, Casiglia E, et al. Exploration into Uric and Cardiovascular Disease: Uric Acid Right for heArt Health (URRAH) Project, A Study Protocol for a Retrospective Observational Study. High Blood Press Cardiovasc Prev. 2018;25:197-202. DOI:10.1007/s40292-018-0250-7
11. Ndrepepa G. Uric acid and cardiovascular disease. Clin Chim Acta. 2018;484:150-63. DOI:10.1016/j.cca.2018.05.046
12. Zalawadiya SK, Veeranna V, Mallikethi-Reddy S, et al. Uric acid and cardiovascular disease risk reclassification: findings from NHANES III. Eur J Prev Cardiol. 2015;22:513-8. DOI:10.1177/2047487313519346
13. Borghi C, Cicero AFG. Serum Uric Acid and Cardiometabolic Disease: Another Brick in the Wall? Hypertension (Dallas, Tex. 1979). 2017;69:1011-3. DOI:10.1161/HYPERTENSIONAHA.117.09081
14. Borghi C, Rosei EA, Bardin T, et al. Serum uric acid and the risk of cardiovascular and renal disease. J Hypertens. 2015;33:1729-41. DOI:10.1097/HJH.0000000000000701
15. Gaita L, Timar R, Lupascu N, et al. The Impact Of Hyperuricemia On Cardiometabolic Risk Factors In Patients With Diabetes Mellitus: A Cross-Sectional Study. Diabetes Metab Syndr Obes. 2019;12:2003-10. DOI:10.2147/DMSO.S222570
16. De Cosmo S, Viazzi F, Pacilli A, et al. Serum Uric Acid and Risk of CKD in Type 2 Diabetes. Clin J Am Soc Nephrol. 2015;10:1921-9. DOI:10.2215/CJN.03140315
17. Feig DI, Madero M, Jalal DI, et al. Uric acid and the origins of hypertension. J Pediatr. 2013;162:896-902. DOI:10.1016/j.jpeds.2012.12.078
18. Grayson PC, Kim SY, LaValley M, et al. Hyperuricemia and incident hypertension: a systematic review and meta-analysis. Arthritis Care Res (Hoboken). 2011;63:102-10. DOI:10.1002/acr.20344
19. Zhang W, Sun K, Yang Y, et al. Plasma uric acid and hypertension in a Chinese community: prospective study and metaanalysis. Clin Chem. 2009;55:2026-34. DOI:10.1373/clinchem.2009.124891
20. Johnson RJ, Nakagawa T, Sanchez-Lozada LG, et al. Sugar, uric acid, and the etiology of diabetes and obesity. Diabetes. 2013;62:3307-15. DOI:10.2337/db12-1814
21. Kodama S, Saito K, Yachi Y, et al. Association between serum uric acid and development of type 2 diabetes. Diabetes Care. 2009;32:1737-42. DOI:10.2337/dc09-0288
22. Lv Q, Meng X-F, He F-F, et al. High serum uric acid and increased risk of type 2 diabetes: a systemic review and meta-analysis of prospective cohort studies. PLoS One. 2013;8:e56864. DOI:10.1371/journal.pone.0056864
23. Masuo K, Kawaguchi H, Mikami H, et al. Serum uric acid and plasma norepinephrine concentrations predict subsequent weight gain and blood pressure elevation. Hypertens (Dallas, Tex 1979). 2003;42:474-80. DOI:10.1161/01.HYP.0000091371.53502.D3
24. Johnson RJ, Nakagawa T, Jalal D, et al. Uric acid and chronic kidney disease: Which is chasing which? Nephrol Dial Transplant. 2013;28:2221-8. DOI:10.1093/ndt/gft029
25. Li L, Yang C, Zhao Y, et al. Is hyperuricemia an independent risk factor for new-onset chronic kidney disease?: A systematic review and meta-analysis based on observational cohort studies. BMC Nephrol. 2014;15:122. DOI:10.1186/1471-2369-15-122
26. Zhu P, Liu Y, Han L, et al. Serum uric acid is associated with incident chronic kidney disease in middle-aged populations: a meta-analysis of 15 cohort studies. PLoS One. 2014;9:e100801. DOI:10.1371/journal.pone.0100801
27. Jalal DI, Rivard CJ, Johnson RJ, et al. Serum uric acid levels predict the development of albuminuria over 6 years in patients with type 1 diabetes: findings from the Coronary Artery Calcification in Type 1 Diabetes study. Nephrol Dial Transplant. 2010;25:1865-9. DOI:10.1093/ndt/gfp740
28. Hovind P, Rossing P, Tarnow L, et al. Serum uric acid as a predictor for development of diabetic nephropathy in type 1 diabetes: an inception cohort study. Diabetes. 2009;58:1668-71. DOI:10.2337/db09-0014
29. Kanbay M, Solak Y, Afsar B, et al. Serum Uric Acid and Risk for Acute Kidney Injury Following Contrast. Angiology. 2017;68:132-44. DOI:10.1177/0003319716644395
30. Lapsia V, Johnson RJ, Dass B, et al. Elevated uric acid increases the risk for acute kidney injury. Am J Med. 2012;125:302.e9-17. DOI:10.1016/j.amjmed.2011.06.021
31. Миронова О.Ю., Фомин В.В. Гиперурикемия у пациентов со стабильной ишемической болезнью сердца и артериальной гипертензией и чрескожные коронарные вмешательства. Consilium Medicum. 2020;22(12):20-2 [Mironova OI, Fomin V V. Hyperuricemia in patients with stable coronary artery disease and arterial hypertension and percutaneous coronary interventions. Consilium Medicum. 2020;22(12):20-2 (in Russian)]. DOI:10.26442/20751753.2020.12.200555
32. Kim SY, Guevara JP, Kim KM, et al. Hyperuricemia and coronary heart disease: a systematic review and meta-analysis. Arthritis Care Res. 2010;62:170-80. DOI:10.1002/acr.20065
33. Wheeler JG, Juzwishin KDM, Eiriksdottir G, et al. Serum uric acid and coronary heart disease in 9,458 incident cases and 155,084 controls: prospective study and meta-analysis. PLoS Med. 2005;2:e76. DOI:10.1371/journal.pmed.0020076
34. Tangri N, Weiner DE. Uric acid, CKD, and cardiovascular disease: confounders, culprits, and circles. Am J Kidney Dis. 2010;56:247-50. DOI:10.1053/j.ajkd.2010.06.004
35. Kuwabara M, Niwa K, Hisatome I, et al. Asymptomatic Hyperuricemia Without Comorbidities Predicts Cardiometabolic Diseases: Five-Year Japanese Cohort Study. Hypertens (Dallas, Tex 1979). 2017;69:1036-44. DOI:10.1161/HYPERTENSIONAHA.116.08998
36. Odden MC, Amadu A-R, Smit E, et al. Uric acid levels, kidney function, and cardiovascular mortality in US adults: National Health and Nutrition Examination Survey (NHANES) 1988–1994 and 1999–2002. Am J Kidney Dis. 2014;64:550-7. DOI:10.1053/j.ajkd.2014.04.024
37. Garcia Puig J, Antón FM, Sanz AM, et al. Renal handling of uric acid in normal subjects by means of the pyrazinamide and probenecid tests. Nephron. 1983;35:183-6. DOI:10.1159/000183071
38. Wu AH, Gladden JD, Ahmed M, et al. Relation of serum uric acid to cardiovascular disease. Int J Cardiol. 2016;213:4-7. DOI:10.1016/j.ijcard.2015.08.110
39. Williams B, Mancia G, Spiering W, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018;39:3021-104. DOI:10.1093/eurheartj/ehy339
40. Чазова И.Е., Жернакова Ю.В., Кисляк О.А., и др. Консенсус по ведению пациентов с гиперурикемией и высоким сердечно-сосудистым риском: 2022. Системные гипертензии. 2022;19(1):5-22 [Chazova IE, Zhernakova YuV, Kislyak OA. Consensus on patients with hyperuricemia and high cardiovascular risk treatment: 2022. Systemic Hypertension. 2022;19(1):5-22 (in Russian)]. DOI:10.38109/2075-082X-2022-1-5-22
41. Xia X, Luo Q, Li B, et al. Serum uric acid and mortality in chronic kidney disease: A systematic review and meta-analysis. Metabolism. 2016;65:1326-41. DOI:10.1016/j.metabol.2016.05.009
42. Bonino B, Leoncini G, Russo E, et al. Uric acid in CKD: has the jury come to the verdict? J Nephrol. 2020;33:715-24. DOI:10.1007/s40620-020-00702-7
43. Li Q, Li X, Wang J, et al. Diagnosis and treatment for hyperuricemia and gout: a systematic review of clinical practice guidelines and consensus statements. BMJ Open. 2019;9:e026677. DOI:10.1136/bmjopen-2018-026677
44. Kielstein JT, Pontremoli R, Burnier M. Management of Hyperuricemia in Patients with Chronic Kidney Disease: a Focus on Renal Protection. Curr Hypertens Rep. 2020;22:102. DOI:10.1007/s11906-020-01116-3
45. Johnson RJ, Bakris GL, Borghi C, et al. Hyperuricemia, Acute and Chronic Kidney Disease, Hypertension, and Cardiovascular Disease: Report of a Scientific Workshop Organized by the National Kidney Foundation. Am J Kidney Dis. 2018;71:851-5. DOI:10.1053/j.ajkd.2017.12.009

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1. Marangella M. Uric acid elimination in the urine. Pathophysiological implications. Contrib Nephrol. 2005;147:132-48. DOI:10.1159/000082551
2. Culleton BF, Larson MG, Kannel WB, et al. Serum uric acid and risk for cardiovascular disease and death: the Framingham Heart Study. Ann Intern Med. 1999;131:7-13. DOI:10.7326/0003-4819-131-1-199907060-00003
3. Richette P, Perez-Ruiz F, Doherty M, et al. Improving cardiovascular and renal outcomes in gout: what should we target? Nat Rev Rheumatol. 2014;10:654-61. DOI:10.1038/nrrheum.2014.124
4. Nashar K, Fried LF. Hyperuricemia and the progression of chronic kidney disease: is uric acid a marker or an independent risk factor? Adv Chronic Kidney Dis. 2012;19:386-91. DOI:10.1053/j.ackd.2012.05.004
5. Moe OW. Posing the question again: does chronic uric acid nephropathy exist? J Am Soc Nephrol. 2010;21:395-7. DOI:10.1681/ASN.2008101115
6. Johnson RJ, Kang D-H, Feig D, et al. Is there a pathogenetic role for uric acid in hypertension and cardiovascular and renal disease? Hypertens (Dallas, Tex 1979). 2003;41:1183-90. DOI:10.1161/01.HYP.0000069700.62727.C5
7. Berger L, Yü TF. Renal function in gout. IV. An analysis of 524 gouty subjects including long-term follow-up studies. Am J Med. 1975;59:605-13. DOI:10.1016/0002-9343(75)90222-3
8. Sato Y, Feig DI, Stack AG, et al. The case for uric acid-lowering treatment in patients with hyperuricaemia and CKD. Nat Rev Nephrol. 2019;15:767-75. DOI:10.1038/s41581-019-0174-z
9. Cheng D, Du R, Wu XY, et al. Serum Uric Acid is Associated with the Predicted Risk of Prevalent Cardiovascular Disease in a Community-dwelling Population without Diabetes. Biomed Environ Sci. 2018;31:106-14. DOI:10.3967/bes2018.013
10. Desideri G, Virdis A, Casiglia E, et al. Exploration into Uric and Cardiovascular Disease: Uric Acid Right for heArt Health (URRAH) Project, A Study Protocol for a Retrospective Observational Study. High Blood Press Cardiovasc Prev. 2018;25:197-202. DOI:10.1007/s40292-018-0250-7
11. Ndrepepa G. Uric acid and cardiovascular disease. Clin Chim Acta. 2018;484:150-63. DOI:10.1016/j.cca.2018.05.046
12. Zalawadiya SK, Veeranna V, Mallikethi-Reddy S, et al. Uric acid and cardiovascular disease risk reclassification: findings from NHANES III. Eur J Prev Cardiol. 2015;22:513-8. DOI:10.1177/2047487313519346
13. Borghi C, Cicero AFG. Serum Uric Acid and Cardiometabolic Disease: Another Brick in the Wall? Hypertension (Dallas, Tex. 1979). 2017;69:1011-3. DOI:10.1161/HYPERTENSIONAHA.117.09081
14. Borghi C, Rosei EA, Bardin T, et al. Serum uric acid and the risk of cardiovascular and renal disease. J Hypertens. 2015;33:1729-41. DOI:10.1097/HJH.0000000000000701
15. Gaita L, Timar R, Lupascu N, et al. The Impact Of Hyperuricemia On Cardiometabolic Risk Factors In Patients With Diabetes Mellitus: A Cross-Sectional Study. Diabetes Metab Syndr Obes. 2019;12:2003-10. DOI:10.2147/DMSO.S222570
16. De Cosmo S, Viazzi F, Pacilli A, et al. Serum Uric Acid and Risk of CKD in Type 2 Diabetes. Clin J Am Soc Nephrol. 2015;10:1921-9. DOI:10.2215/CJN.03140315
17. Feig DI, Madero M, Jalal DI, et al. Uric acid and the origins of hypertension. J Pediatr. 2013;162:896-902. DOI:10.1016/j.jpeds.2012.12.078
18. Grayson PC, Kim SY, LaValley M, et al. Hyperuricemia and incident hypertension: a systematic review and meta-analysis. Arthritis Care Res (Hoboken). 2011;63:102-10. DOI:10.1002/acr.20344
19. Zhang W, Sun K, Yang Y, et al. Plasma uric acid and hypertension in a Chinese community: prospective study and metaanalysis. Clin Chem. 2009;55:2026-34. DOI:10.1373/clinchem.2009.124891
20. Johnson RJ, Nakagawa T, Sanchez-Lozada LG, et al. Sugar, uric acid, and the etiology of diabetes and obesity. Diabetes. 2013;62:3307-15. DOI:10.2337/db12-1814
21. Kodama S, Saito K, Yachi Y, et al. Association between serum uric acid and development of type 2 diabetes. Diabetes Care. 2009;32:1737-42. DOI:10.2337/dc09-0288
22. Lv Q, Meng X-F, He F-F, et al. High serum uric acid and increased risk of type 2 diabetes: a systemic review and meta-analysis of prospective cohort studies. PLoS One. 2013;8:e56864. DOI:10.1371/journal.pone.0056864
23. Masuo K, Kawaguchi H, Mikami H, et al. Serum uric acid and plasma norepinephrine concentrations predict subsequent weight gain and blood pressure elevation. Hypertens (Dallas, Tex 1979). 2003;42:474-80. DOI:10.1161/01.HYP.0000091371.53502.D3
24. Johnson RJ, Nakagawa T, Jalal D, et al. Uric acid and chronic kidney disease: Which is chasing which? Nephrol Dial Transplant. 2013;28:2221-8. DOI:10.1093/ndt/gft029
25. Li L, Yang C, Zhao Y, et al. Is hyperuricemia an independent risk factor for new-onset chronic kidney disease?: A systematic review and meta-analysis based on observational cohort studies. BMC Nephrol. 2014;15:122. DOI:10.1186/1471-2369-15-122
26. Zhu P, Liu Y, Han L, et al. Serum uric acid is associated with incident chronic kidney disease in middle-aged populations: a meta-analysis of 15 cohort studies. PLoS One. 2014;9:e100801. DOI:10.1371/journal.pone.0100801
27. Jalal DI, Rivard CJ, Johnson RJ, et al. Serum uric acid levels predict the development of albuminuria over 6 years in patients with type 1 diabetes: findings from the Coronary Artery Calcification in Type 1 Diabetes study. Nephrol Dial Transplant. 2010;25:1865-9. DOI:10.1093/ndt/gfp740
28. Hovind P, Rossing P, Tarnow L, et al. Serum uric acid as a predictor for development of diabetic nephropathy in type 1 diabetes: an inception cohort study. Diabetes. 2009;58:1668-71. DOI:10.2337/db09-0014
29. Kanbay M, Solak Y, Afsar B, et al. Serum Uric Acid and Risk for Acute Kidney Injury Following Contrast. Angiology. 2017;68:132-44. DOI:10.1177/0003319716644395
30. Lapsia V, Johnson RJ, Dass B, et al. Elevated uric acid increases the risk for acute kidney injury. Am J Med. 2012;125:302.e9-17. DOI:10.1016/j.amjmed.2011.06.021
31. Mironova OI, Fomin V V. Hyperuricemia in patients with stable coronary artery disease and arterial hypertension and percutaneous coronary interventions. Consilium Medicum. 2020;22(12):20-2 (in Russian). DOI:10.26442/20751753.2020.12.200555
32. Kim SY, Guevara JP, Kim KM, et al. Hyperuricemia and coronary heart disease: a systematic review and meta-analysis. Arthritis Care Res. 2010;62:170-80. DOI:10.1002/acr.20065
33. Wheeler JG, Juzwishin KDM, Eiriksdottir G, et al. Serum uric acid and coronary heart disease in 9,458 incident cases and 155,084 controls: prospective study and meta-analysis. PLoS Med. 2005;2:e76. DOI:10.1371/journal.pmed.0020076
34. Tangri N, Weiner DE. Uric acid, CKD, and cardiovascular disease: confounders, culprits, and circles. Am J Kidney Dis. 2010;56:247-50. DOI:10.1053/j.ajkd.2010.06.004
35. Kuwabara M, Niwa K, Hisatome I, et al. Asymptomatic Hyperuricemia Without Comorbidities Predicts Cardiometabolic Diseases: Five-Year Japanese Cohort Study. Hypertens (Dallas, Tex 1979). 2017;69:1036-44. DOI:10.1161/HYPERTENSIONAHA.116.08998
36. Odden MC, Amadu A-R, Smit E, et al. Uric acid levels, kidney function, and cardiovascular mortality in US adults: National Health and Nutrition Examination Survey (NHANES) 1988–1994 and 1999–2002. Am J Kidney Dis. 2014;64:550-7. DOI:10.1053/j.ajkd.2014.04.024
37. Garcia Puig J, Antón FM, Sanz AM, et al. Renal handling of uric acid in normal subjects by means of the pyrazinamide and probenecid tests. Nephron. 1983;35:183-6. DOI:10.1159/000183071
38. Wu AH, Gladden JD, Ahmed M, et al. Relation of serum uric acid to cardiovascular disease. Int J Cardiol. 2016;213:4-7. DOI:10.1016/j.ijcard.2015.08.110
39. Williams B, Mancia G, Spiering W, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018;39:3021-104. DOI:10.1093/eurheartj/ehy339
40. Chazova IE, Zhernakova YuV, Kislyak OA. Consensus on patients with hyperuricemia and high cardiovascular risk treatment: 2022. Systemic Hypertension. 2022;19(1):5-22 (in Russian). DOI:10.38109/2075-082X-2022-1-5-22
41. Xia X, Luo Q, Li B, et al. Serum uric acid and mortality in chronic kidney disease: A systematic review and meta-analysis. Metabolism. 2016;65:1326-41. DOI:10.1016/j.metabol.2016.05.009
42. Bonino B, Leoncini G, Russo E, et al. Uric acid in CKD: has the jury come to the verdict? J Nephrol. 2020;33:715-24. DOI:10.1007/s40620-020-00702-7
43. Li Q, Li X, Wang J, et al. Diagnosis and treatment for hyperuricemia and gout: a systematic review of clinical practice guidelines and consensus statements. BMJ Open. 2019;9:e026677. DOI:10.1136/bmjopen-2018-026677
44. Kielstein JT, Pontremoli R, Burnier M. Management of Hyperuricemia in Patients with Chronic Kidney Disease: a Focus on Renal Protection. Curr Hypertens Rep. 2020;22:102. DOI:10.1007/s11906-020-01116-3
45. Johnson RJ, Bakris GL, Borghi C, et al. Hyperuricemia, Acute and Chronic Kidney Disease, Hypertension, and Cardiovascular Disease: Report of a Scientific Workshop Organized by the National Kidney Foundation. Am J Kidney Dis. 2018;71:851-5. DOI:10.1053/j.ajkd.2017.12.009

Авторы

О.Ю. Миронова*

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

________________________________________________

Olga Iu. Mironova*

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

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