THU0687 The impact of urate-lowering therapy on kidney function (IMPULSKF): preliminary results

Abstract

Background: The extended 2016 EULAR updated report states that for patients on ULT, SUA level should be monitored and maintained to <6 mg/dL (360 mmol/ L). SUA level <3 mg/dL (180 mmol/L) is not recommended in the long term. And among EULAR proposals for future research is mentioned the optimal duration for prophylaxis of acute attacks when starting ULT, long‐term impact of very low urate levels on the central nervous system, impact of ULT on kidney function. Objectives: This project aims to investigate the impact of two target levels uratelowering therapy (ULT) caused by hyperuricemia (HU) on kidney function and CKD progression measured by eGFR and albuminuria (A). This trial had been formulated by 2016 updated EULAR evidence‐based recommendations for the management of gout as a perspective proposal task for future research. The key points are: 1) an unknown target HU level and 2) the time duration of ULT resulting in preserved kidney function in two subject groups a) with gout and b) without gout but highly elevated uricemia and CKD. Methods: The trial has POEM design with 36 months duration. IMPULsKF is a Clinical Randomised Prospective Controlled Open Multicenter trial that randomly (by chance) assigns 180 participants in parallel groups. These patients with high SUA level (>8 mg/dL; 480 mmol/L) were divided into 2 arms (90+90) 1) with gout (EULAR's criteria) and 2) without gout but with presence of CKD 1‐4) and 2 target SUA levels in each group as 5 mg/dL (300 mmol/L) and ultralow SUA <3 mg/dL (180 mmol/L) achieved either with allopurinol or febuxostat. The data obtained will be compared with control group (45 with gout without CKD and 45 with CKD). Results: Retrospective analysis and 6 mothes in trial results has been shown that treatment with febuxostat improves GFR and BP control in patients with asymptomatic HU in non‐diabetic CKD 2‐3.2 Febuxostat treatment led to the most beneficial decrease in the level of uric acid (‐223+/‐16 mmol/l, p