Perubahan Kadar Asam Urat dan Estimasi Laju Filtrasi Glomerulus pada Pasien Penyakit Ginjal Kronis yang Menggunakan Terapi Alopurinol
DOI:
https://doi.org/10.35790/ecl.v14i1.65797Keywords:
penyakit ginjal kronis; hiperurisemia; alopurinolAbstract
Abstract: Chronic kidney disease (CKD) is closely associated with hyperuricemia. Allopurinol is recommended for patients with CKD stages 2–5 to reduce serum uric acid levels, although its renoprotective effects may vary depending on patient characteristics. This study aimed to obtain changes in serum uric acid and estimated glomerular filtration rate (eGFR) in CKD patients receiving allopurinol therapy at Prof. Dr. R. D. Kandou Hospital Manado during 2021–2024. A retrospective longitudinal descriptive design was employed. As an exploratory purpose, pre–post therapeutic analyses and subgroup comparisons were conducted. The results showed that the greatest reduction in serum uric acid was observed among patients aged 30–65 years, males, those with type 1 diabetes mellitus, and individuals with stage G5 CKD. Increases in eGFR were noted in patients aged <30 years, females, and those with rheumatic heart disease as a comorbidity. Conversely, decreases in eGFR were found in patients aged ≥30 years, males, those with liver cirrhosis, and individuals in CKD stages G2–G3. In conclusion, changes in serum uric acid and eGFR among CKD patients receiving allopurinol vary according to age, sex, comorbidities, and stage of CKD.
Keywords: chronic kidney disease; hyperuricemia; allopurinol
Abstrak: Penyakit ginjal kronis (PGK) berhubungan erat dengan hiperurisemia. Alopurinol direkomendasikan pada pasien PGK stadium 2-5 untuk menurunkan kadar asam urat, meskipun efek renoprotektifnya dapat bervariasi menurut karakteristik pasien. Penelitian ini bertujuan mendeskripsikan perubahan kadar asam urat dan estimasi laju filtrasi glomerulus (eLFG) pada pasien PGK pengguna alopurinol di RSUP Prof. Dr. R. D. Kandou Manado periode 2021–2024. Jenis penelitian ialah deskriptif longitudinal retrospektif. Sebagai tujuan eksploratif, dilakukan analisis pre–post terapi serta komparatif antar-subkelompok. Hasil penelitian mendapatkan penurunan kadar asam urat terbesar pada kelompok usia 30–65 tahun, laki-laki, komorbid diabetes melitus tipe 1, dan stadium G5. Peningkatan eLFG terjadi pada kelompok usia <30 tahun, perempuan, dan komorbid penyakit jantung rematik. Sebaliknya, penurunan eLFG terlihat pada kelompok usia ≥30 tahun, laki-laki, kelompok komorbid sirosis, serta stadium G2–G3. Simpulan penelitian ini ialah perubahan kadar asam urat dan eLFG pada pasien PGK yang menggunakan alopurinol bervariasi menurut usia, jenis kelamin, komorbid, dan stadium PGK.
Kata kunci: penyakit ginjal kronis; hiperurisemia; alopurinol
References
1. National Kidney Foundation-Kidney Disease Outcomes Quality Initiative. Clinical practice guidelines: for chronic kidney disease: evaluation, classification and stratification. New York: NKF-K/DOQI; 2024.
2. Hartanto H, Susi N, Wulansari P, Mahanani DA, editors. Patofisiologi: Konsep Klinis Proses-Proses Penyakit (6th ed). Jakarta: EGC; 2012.
3. Alkilany R, Einstadter D, Antonelli M. Urate-lowering therapy for patients with gout on hemodialysis. Int J Rheum Dis. 2022;25(7):769-74. Doi: https://doi.org/10.1111/1756-185X.14334
4. Foresto-Neto O, Ávila VF, Arias SCA, Zambom FFF, Rempel LCT, Faustino VD, et al. NLRP3 inflammasome inhibition ameliorates tubulointerstitial injury in the remnant kidney model. Laboratory Investigation. 2018; 98(6):773-82. Doi: https://doi.org/10.1038/s41374-018-0029-4
5. Noronha IL, Santa-Catharina GP, Andrade L, Coelho VA, Jacob-Filho W, Elias RM. Glomerular filtration in the aging population. Front Med (Lausanne). 2022;15(9):769329. Doi: https://doi.org/10.3389/fmed.2022.769329
6. Zhang C, Qian H, Cui Y, Li X, Cheng Y, Gao L. Associations between estradiol and hyperuricemia and the mediating effects of TC, TG, and TyG: NHANES 2013-2016. Front. Endocrinol. 2024;15:1422470. Doi: https://doi.org/10.3389/fendo.2024.1422470
7. Farahmand M, Tehrani FR, Khalili D, Cheraghi L, Azizi F. Endogenous estrogen exposure and chronic kidney disease; a15-year prospective cohort study. BMC Endocr Disord. 2021;21(1):155. Doi: https://doi.org/10.1186/s12902-021-00817-3
8. Qaseem A, Harris R, Forciea MA. Management of acute and recurrent gout: a clinical practice guideline from the american college of physician. Ann Intern Med. 2017;166(1):58-68. Doi: https://doi.org/10.7326/m16-0570
9. Sharbaf FG, Assadi F. Effect of allopurinol on the glomerular filtration rate of children with chronic kidney disease. Pediatric Nephrol. 2018;33(8):1405–9. Doi: https://doi.org/10.1007/s00467-018-3943-1
10. Bayram D, Tuğrul Sezer M, İnal S, Altuntaş A, Kıdır V, Orhan H. The effects of allopurinol on metabolic acidosis and endothelial functions in chronic kidney disease patients. Clin Exp Nephrol. 2015;19(3):443–9. Doi: https://doi.org/10.1007/s10157-014-1012-z
11. Doria A, Galecki AT, Spino C, Pop-Busui R, Cherney DZ, Lingvay I, et al. Serum urate lowering with allopurinol and kidney function in type 1 diabetes. NEJM. 2020;382(26):2493–503. Doi: https://doi.org/10.1056/nejmoa1916624
12. Goicoechea M, de Vinuesa SG, Verdalles U. Effect of allopurinol in chronic kidney disease progression and cardiovascular risk. Clin J Am Soc Nephrol. 2010;5(8):1388–93. Doi: https://doi.org/10.2215/cjn.01580210
13. Badve SV, Pascoe EM, Tiku A, Boudville N, Brown FG, Cass A, et al. Effects of allopurinol on the progression of chronic kidney disease. NEJM. 2020;382(26):2504–13. Doi: https://doi.org/10.1056/nejmoa1915833
14. Pilemann-Lyberg S, Persson F, Frystyk J, Rossing P. The effect of uric acid lowering treatment on albuminuria and renal function in Type 1 diabetes: a randomized clinical trial. Diabet Med. 2018;35(3):392-3. Doi: https://doi.org/10.1111/dme.13577
15. Mandal AK, Leask MP, Estiverne C, Choi HK, Merriman TR, Mount DB. Genetic and physiological effects of insulin on human urate homeostasis. Front Physiol. 2021;12:713710. Doi: https://doi.org/10.3389/fphys.2021.713710
16. Geetha S, Sivakumar DK, Priya MR, Malathi S. Study of serum uric acid level in liver cirrhosis and its correlation with child turcotte pugh score. Int J Curr Pharm Rev Res. 2023;15(12):212-8. Doi: https://dx.doi.org/10.18203/2349-3933.ijam20243816
17. Pratama H. Sindrom hepatorenal. CDK-224. 2015;42(1):30–4. Doi: https://doi.org/10.55175/cdk.v42i1.1050
18. Khadka M, Pantha B, Karki L. Correlation of uric acid with glomerular filtration rate in chronic kidney disease. JNMA J Nepal Med Assoc. 2018;56(212):724-7. Doi: https://doi.org/10.31729/jnma.3700
19. Sayekti S, Meinawati L, Sari K. Gambaran kadar asam urat pada pasien gagal ginjal kronis setelah hemodialisa di RSUD Kabupaten Kediri J. Sintesis. 2024;5(2):110–23.Doi: https://doi.org/10.56399/jst.v5i2.192
20. Shi Y, Chen W, Jalal D, Li Z, Chen W, Mao H, et al. Clinical outcome of hyperuricemia in IgA nephropathy: a retrospective cohort study and randomized controlled trial. Kidney Blood Press Res. 2012;35(3):153–60. Doi: https://doi.org/10.1159/000331453
21. Krishnamurthy A, Lazaro D, Stefanov DG, Blumenthal D, Gerber D, Patel S. The effect of allopurinol on renal function. Clin Rheumatol. 2017;23(1):1–5. Doi: https://doi.org/10.1097/rhu.00000000000004
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Christina Angelica, Octavianus R. H. Umboh, Frans E. N. Wantania
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
COPYRIGHT
Authors who publish with this journal agree to the following terms:
Authors hold their copyright and grant this journal the privilege of first publication, with the work simultaneously licensed under a Creative Commons Attribution License that permits others to impart the work with an acknowledgment of the work's origin and initial publication by this journal.
Authors can enter into separate or additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (for example, post it to an institutional repository or publish it in a book), with an acknowledgment of its underlying publication in this journal.
Authors are permitted and encouraged to post their work online (for example, in institutional repositories or on their website) as it can lead to productive exchanges, as well as earlier and greater citation of the published work (See The Effect of Open Access).
