Kidney Res Clin Pract.  2019 Sep;38(3):373-381. 10.23876/j.krcp.19.007.

Physicians' perceptions of asymptomatic hyperuricemia in patients with chronic kidney disease: A questionnaire survey

Affiliations
  • 1Department of Internal Medicine, National Medical Center, Seoul, Korea. reginaprayer@gmail.com
  • 2Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea.
  • 3Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
  • 4Department of Internal Medicine, Seonam Hospital, Seoul, Korea.
  • 5Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
  • 6Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
  • 7Department of Nephrology, Inje University Busan Paik Hospital, Busan, Korea.
  • 8Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea.
  • 9Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Korea. dhkang@ewha.ac.kr

Abstract

BACKGROUND
Hyperuricemia is associated with the development and progression of chronic kidney disease (CKD) as well as cardiovascular diseases. However, there is no consistent recommendation regarding the treatment of asymptomatic hyperuricemia (AHU) in CKD patients. Here, we surveyed Korean physicians' perceptions regarding the diagnosis and management of AHU in CKD patients.
METHODS
Questionnaires on the management of AHU in CKD patients were emailed to regular members registered with the Korean Society of Nephrology.
RESULTS
A total of 158 members answered the questionnaire. Among the respondents, 49.4%/41.1% were considered hyperuricemic in male CKD patients whereas 36.7%/20.9% were considered hyperuricemic in female CKD patients when defined by serum uric acid level over 7.0/8.0 mg/dL, respectively. A total of 80.4% reported treating AHU in CKD patients. The most important reasons to treat AHU in CKD patients were renal function preservation followed by cerebro-cardiac protection. Majority of respondents (59.5%) thought that uric acid-lowering agents (ULAs) were the most effective method for controlling serum uric acid levels. Approximately 80% chose febuxostat as the preferred medication. A total of 32.3% and 31.0%, respectively, initiated ULA treatment if the serum uric acid level was more than 8.0 or 9.0 mg/dL, respectively. In addition, 39.2% and 30.4% answered that target serum uric acid levels of less than 6.0 or 7.0 mg/dL, respectively, were appropriate. The two major hurdles to prescribing ULAs were concerns of adverse reactions and the existing lack of evidence (i.e., the absence of Korean guidelines).
CONCLUSION
Most Korean physicians treat AHU in CKD patients to prevent CKD progression and cerebro-cardiovascular complications.

Keyword

Asymptomatic hyperuricemia; Chronic kidney disease; Survey; Treatment
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