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Who let the Gout Out? Targeting UricAcid Levels in Treating Gout Tools for Practice is proudly sponsored by the Alberta College of Family Physicians (ACFP). ACFP is a provincial, professional voluntary organization, representing more than 4,800 family physicians, family medicine residents, and medical students in Alberta. Established over sixty years ago, the ACFP strives for excellence in family practice through advocacy, continuing medical education and primary care research. www.acfp.ca May (...) 19, 2020 Who let the Gout Out? Targeting UricAcid Levels in Treating Gout Clinical Question: To prevent gout recurrence, should we dose urate lowering therapies (like allopurinol) to target uricacid levels? Bottom Line: Best evidence finds that increasing doses of allopurinol to achieve a specific serum urate target (example <360 µmol/L) does not reduce gout flares, pain, or function, compared to standard allopurinol dosing. Febuxostat increases cardiovascular and overall mortality and should
Relationship of Interleukin-1β Blockade With Incident Gout and Serum UricAcid Levels: Exploratory Analysis of a Randomized Controlled Trial. Although studies have shown that interleukin-1β (IL-1β) inhibitors can shorten gout attacks, whether they can prevent gout attacks is unclear.To examine the relationship among canakinumab, a monoclonal antibody targeting IL-1β; serum uricacid levels; and the incidence of gout attacks.Secondary exploratory analysis of a randomized controlled trial (...) . (ClinicalTrials.gov: NCT01327846).Many clinical sites in 39 countries.10 059 patients with a prior myocardial infarction and a high-sensitivity C-reactive protein (hsCRP) level of at least 19.1 nmol/L.Random allocation to canakinumab (50 mg, 150 mg, or 300 mg) versus placebo, administered subcutaneously every 3 months.Rates of gout attacks were compared across patients with different baseline concentrations of serum uricacid (≤404.5 µmol/L, 404.6 to 535.3 µmol/L, and ≥535.4 µmol/L) and in different intervention
Serum uricacid levels and multiple health outcomes: umbrella review of evidence from observational studies, randomised controlled trials, and Mendelian randomisation studies. Objective To map the diverse health outcomes associated with serum uricacid (SUA) levels.Design Umbrella review.Data sources Medline, Embase, Cochrane Database of Systematic Reviews, and screening of citations and references.Eligibility criteria Systematic reviews and meta-analyses of observational studies that examined
On admission serum sodium and uricacid levels predict 30Â day rehospitalization or death in patients with acute decompensated heart failure A considerable proportion of hospitalized patients for acute decompensated heart failure will be readmitted or die in short-term follow-up. In the present study, we aimed to assess the role of admission sodium (Na) and uricacid (UA) levels in the prediction of 30 day post-discharge heart failure readmission or all-cause mortality in advanced heart failure
Multiple UricAcid Bladder Stones: Clinical Presentation and Endoscopic Management Background: Bladder urinary calculi occur in 3%-8% of men with bladder outlet obstruction, and although most of them are composed of calcium, in a few cases uricacid bladder stones are diagnosed. Case Presentation: We present clinical images and therapeutic management of a 65-year-old diabetic man with significant prostate enlargement and >30 bladder stones, the largest being 17 mm. Despite the large stone (...) burden, the patient was managed by cystolithotripsy. Remarkably, stone composition analysis revealed 100% uricacid stone. Intraoperative and postoperative course were uneventfully. Conclusion: Uricacid bladder stone pathogenesis seems to be multifactorial with local and systemic factors contributing in different manners and even large stone burdens may be cystoscopically managed.
Uricacid predicts mortality and ischaemic stroke in subjects with diastolic dysfunction: the TromsÃ¸ Study 1994â€“2013 To investigate whether serum uricacid predicts adverse outcomes in persons with indices of diastolic dysfunction in a general population.We performed a prospective cohort study among 1460 women and 1480 men from 1994 to 2013. Endpoints were all-cause mortality, incident myocardial infarction, and incident ischaemic stroke. We stratified the analyses by echocardiographic (...) markers of diastolic dysfunction, and uricacid was the independent variable of interest. Hazard ratios (HR) were estimated per 59 μmol/L increase in baseline uricacid. Multivariable adjusted Cox proportional hazards models showed that uricacid predicted all-cause mortality in subjects with E/A ratio <0.75 (HR 1.12, 95% confidence interval [CI] 1.00-1.25) or E/A ratio >1.5 (HR 1.51, 95% CI 1.09-2.09, P for interaction between E/A ratio category and uricacid = 0.02). Elevated uricacid increased
Serum and Urinary Malondialdehyde (MDA), Uricacid, and Protein as markers of perinatal asphyxia Perinatal asphyxia (PA) is among the leading causes of neonatal morbidity and death in neonatal intensive care units (NICUs). The aims of this research were to determine the concentrations of malondialdehyde (MDA), urine MDA, uricacid, and protein in the cord blood of neonates with perinatal asphyxia and to determine their relationship with the severity of perinatal asphyxia.This matched case (...) -control study was conducted from October 2012 to March 2013. All of the cases and controls were selected from the Gynecology & Obstetrics Department and the NICUs, at Qous Central Hospital in Qena, Egypt. We allocated 20 full-term neonates who had perinatal asphyxia to the case group. Also, we selected 20 healthy neonates for the control group. The subjects were matched with respect to age and gender. At birth and 48 hours later, measurements were made of MDA in cord blood and urine, and uricacid
Zurampic (lesinurad) - To treat high blood uricacid levels associated with gout Zurampic Tablets U.S. Department of Health and Human Services Search FDA Submit search Zurampic Tablets Zurampic Tablets Company: Ardea Biosciences, Inc. Application No.: 207988 Approval Date: 12/22/2015 Persons with disabilities having problems accessing the PDF files below may call (301) 796-3634 for assistance. (PDF) (PDF) (PDF) (PDF) (PDF) (PDF) (PDF) (PDF) (PDF) (PDF) (PDF) (PDF) (PDF) (PDF) (PDF) Date created
Rilonacept for Gout Flare Prevention in Patients Receiving UricAcid-lowering Therapy: Results of RESURGE, a Phase III, International Safety Study To evaluate the safety and efficacy of once-weekly subcutaneous rilonacept 160 mg for prevention of gout flares in patients initiating or continuing urate-lowering therapy (ULT).This phase III study was conducted in the United States, South Africa, Europe, and Asia. Adults (n = 1315, 18-80 yrs) with gout, who were initiating or continuing ULT, were
Randomized Controlled Trial of Febuxostat Versus Allopurinol or Placebo in Individuals with Higher Urinary UricAcid Excretion and Calcium Stones Higher urinary uricacid excretion is a suspected risk factor for calcium oxalate stone formation. Febuxostat, a xanthine oxidoreductase inhibitor, is effective in lowering serum urate concentration and urinary uricacid excretion in healthy volunteers and people with gout. This work studied whether febuxostat, compared with allopurinol and placebo (...) , would reduce 24-hour urinary uricacid excretion and prevent stone growth or new stone formation.In this 6-month, double-blind, multicenter, randomized controlled trial, hyperuricosuric participants with a recent history of calcium stones and one or more radio-opaque calcium stone ≥ 3 mm (as seen by multidetector computed tomography) received daily febuxostat at 80 mg, allopurinol at 300 mg, or placebo. The primary end point was percent change from baseline to month 6 in 24-hour urinary uricacid
Association of plasma uricacid with ischaemic heart disease and blood pressure: mendelian randomisation analysis of two large cohorts. To assess the associations between both uricacid levels and hyperuricaemia, with ischaemic heart disease and blood pressure, and to explore the potentially confounding role of body mass index.Mendelian randomisation analysis, using variation at specific genes (SLC2A9 (rs7442295) as an instrument for uricacid; and FTO (rs9939609), MC4R (rs17782313), and TMEM18 (...) (rs6548238) for body mass index).Two large, prospective cohort studies in Denmark.We measured levels of uricacid and related covariables in 58,072 participants from the Copenhagen General Population Study and 10,602 from the Copenhagen City Heart Study, comprising 4890 and 2282 cases of ischaemic heart disease, respectively.Blood pressure and prospectively assessed ischaemic heart disease.Estimates confirmed known observational associations between plasma uricacid and hyperuricaemia with risk
UricAcid Measurement Improves Prediction of Cardiovascular Mortality in Later Life To estimate the association between uricacid and cardiovascular mortality in older adults, independent of traditional risk factors, and to estimate the risk prediction gain by adding uricacid measurements to the Framingham Cardiovascular Risk Score (FCRS).Longitudinal observational study of two population-based cohorts.The Established Populations for Epidemiologic Studies of the Elderly, Iowa (Iowa-EPESE (...) ) and the Third National Health and Nutritional Examination Survey (NHANES III).One thousand twenty-eight Iowa-EPESE participants and 1,316 NHANES III participants. Selected participants were aged 70 and older without overt cardiovascular disease, renal dysfunction, or diuretic use who lived for 3 years or longer after baseline.Outcome was age at cardiovascular death during follow-up (12–20 years). Uricacid and cardiovascular risk factors such as smoking, systolic blood pressure, diabetes mellitus, obesity
Medical therapies to reduce chronic kidney disease progression and cardiovascular risk: uricacid-lowering agents ____________________________________________________________________________________________________________ Early Chronic Kidney Disease December 2011 Page 1 of 9 Medical therapies to reduce chronic kidney disease progression and cardiovascular risk: uricacid-lowering agents Date written: July 2012 Author: Richard Phoon, David Johnson GUIDELINES a. We suggest that use of uricacid (...) be a consequence of reduced excretion, diuretic therapy, or oxidative stress. Although it is not clear whether urate plays a causative role or is an indirect marker of kidney function, uricacid lowering therapy has emerged as a potentially novel therapeutic treatment for slowing the progression of CKD SEARCH STRATEGY ____________________________________________________________________________________________________________ Early Chronic Kidney Disease July 2012 Page 2 of 9 Databases searched: Text words
Effect of a reduction in uricacid on renal outcomes during losartan treatment: a post hoc analysis of the reduction of end points in noninsulin-dependent diabetes mellitus with the Angiotensin II Antagonist Losartan Trial. 22124433 2012 02 07 2018 12 01 1524-4563 59 1 2012 Jan Hypertension (Dallas, Tex. : 1979) Hypertension Effect of a reduction in uricacid on renal outcomes during losartan treatment: a post hoc analysis of the reduction of end points in noninsulin-dependent diabetes mellitus (...) with the Angiotensin II Antagonist Losartan Trial. e1 10.1161/HYPERTENSIONAHA.111.186064 Dhaun Neeraj N Webb David J DJ eng Letter Comment 2011 11 28 United States Hypertension 7906255 0194-911X 0 Angiotensin II Type 1 Receptor Blockers 268B43MJ25 UricAcid JMS50MPO89 Losartan IM Hypertension. 2011 Jul;58(1):2-7 21632472 Angiotensin II Type 1 Receptor Blockers administration & dosage Diabetes Mellitus, Type 2 blood Diabetic Nephropathies prevention & control Female Glomerular Filtration Rate drug effects Humans
Serum uricacid levels improve prediction of incident type 2 diabetes in individuals with impaired fasting glucose: the Rancho Bernardo Study To determine whether serum uricacid predicts incident type 2 diabetes by glucose tolerance status in older community-dwelling adults.Participants without diabetes at baseline were evaluated for incident type 2 diabetes 13 years later. Baseline glucose tolerance status was defined as normoglycemia, impaired fasting glucose, and impaired postchallenge (...) glucose tolerance.A total of 566 participants were included (mean age 63.3 +/- 8.6 years; 41% men). Regression models adjusted for age, sex, BMI, diuretic use, and estimated glomerular filtration rate showed that for each 1 mg/dl increment in uricacid levels, incident type 2 diabetes risk increased by approximately 60%. When analyses were stratified by glucose status, uricacid levels independently predicted incident type 2 diabetes among participants who had impaired fasting glucose (odds ratio 1.75
Serum uricacid level as an independent risk factor for all-cause, cardiovascular, and ischemic stroke mortality: A chinese cohort study The association between hyperuricemia and cardiovascular events has been documented in high-risk groups, but is still undetermined in general populations, especially Chinese. This study assessed the temporal association between serum uricacid level, hyperuricemia, and cardiovascular mortality.A prospective cohort study of 41,879 men and 48,514 women ages (...) > or = 35 years was conducted using data from the MJ Health Screening Centers in Taiwan. Mortality from all causes, total cardiovascular disease (CVD), ischemic stroke, congestive heart failure, hypertensive disease, and coronary heart disease were compared according to increasing serum uricacid levels.A total of 1,151 (21.2%) events of 5,427 total deaths were ascribed to CVD (mean followup 8.2 years). Hazard ratios (HRs) for hyperuricemia (serum uricacid level >7 mg/dl) were estimated with Cox
Elevated uricacid increases the risk for kidney disease Recent epidemiologic studies suggest that uricacid predicts the development of new-onset kidney disease, but it is unclear whether uricacid is an independent risk factor. In this study, data from 21,475 healthy volunteers who were followed prospectively for a median of 7 yr were analyzed to examine the association between uricacid level and incident kidney disease (estimated GFR [eGFR] <60 ml/min per 1.73 m(2)). After adjustment (...) for baseline eGFR, a slightly elevated uricacid level (7.0 to 8.9 mg/dl) was associated with a nearly doubled risk for incident kidney disease (odds ratio 1.74; 95% confidence interval 1.45 to 2.09), and an elevated uricacid (> or =9.0 mg/dl) was associated with a tripled risk (odds ratio 3.12; 95% confidence interval 2.29 to 4.25). These increases in risk remained significant even after adjustment for baseline eGFR, gender, age, antihypertensive drugs, and components of the metabolic syndrome (waist
Association of three genetic loci with uricacid concentration and risk of gout: a genome-wide association study. Hyperuricaemia, a highly heritable trait, is a key risk factor for gout. We aimed to identify novel genes associated with serum uricacid concentration and gout.Genome-wide association studies were done for serum uricacid in 7699 participants in the Framingham cohort and in 4148 participants in the Rotterdam cohort. Genome-wide significant single nucleotide polymorphisms (SNPs (...) ) were replicated in white (n=11 024) and black (n=3843) individuals who took part in the study of Atherosclerosis Risk in Communities (ARIC). The SNPs that reached genome-wide significant association with uricacid in either the Framingham cohort (p<5.0 x 10(-8)) or the Rotterdam cohort (p<1.0 x 10(-7)) were evaluated with gout. The results obtained in white participants were combined using meta-analysis.Three loci in the Framingham cohort and two in the Rotterdam cohort showed genome-wide
Serum uricAcid and risk of cardiovascular mortality: a prospective long-term study of 83 683 austrian men The role of serum uricacid (SUA) as an independent risk factor for cardiovascular disease (CVD) remains controversial, and little is known about its prognostic importance for mortality from congestive heart failure (CHF) and stroke. Few large-scale epidemiologic studies with sufficient follow-up have addressed the association of SUA and CVD mortality in apparently healthy men across