Urate-lowering therapy for gout and asymptomatic hyperuricemia in the pediatric population: a cross-sectional study of a Japanese health insurance database

Abstract Background Our previous research showed that uric acid lowering therapy (ULT) for gout and hyperuricemia is being prescribed for pediatric patients even though these drugs have not been approved for use in children. However, the actual clinical situation has not been clearly elucidated. In this paper, we provide an in-depth look at the details of actual clinical practice. Methods This retrospective cross-sectional study accessed health insurance data for 696,277 children from April 2016 through March 2017 to identify pediatric patients with gout or asymptomatic hyperuricemia, calculate the proportion of patients prescribed ULTs, and analyze population characteristics. Adherence and mean dose for febuxostat and allopurinol, the most commonly prescribed drugs, were also analyzed. Results Among children with gout or asymptomatic hyperuricemia, we found that 35.1% (97/276) were prescribed ULT. This proportion increased with age, especially among males. By comorbidity, ULT was prescribed to 47.9% (46/96) of patients with kidney disease, 41.3% (26/63) for cardiovascular disease, 40.0% (6/15) for Down syndrome, and 27.1% (32/118) for metabolic syndrome. In patients with kidney disease, febuxostat was prescribed more than twice as frequently as allopurinol (28 vs. 12). Median values for the medication possession ratio (MPR) of febuxostat and allopurinol were 70.1 and 76.7%, respectively, and prescriptions were continued for a relatively long period for both drugs. Both drugs were prescribed at about half the adult dose for patients 6–11 years old and about the same as the adult dose for patients 12–18 years old. Conclusions This study showed that the continuous management of serum uric acid is being explored using off-label use of ULT in pediatric patients with gout or asymptomatic hyperuricemia in Japan. Drug selection is based on patient characteristics such as sex, age, and comorbidities, and pediatric dosage is based on usage experience in adults. To develop appropriate pediatric ULT, clinical trials are needed on the efficacy and safety of ULT in the pediatric population. Trial registration UMIN000036029.

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Prevalence of gout and asymptomatic hyperuricemia in the pediatric population: a cross-sectional study of a Japanese health insurance database

BMC Pediatrics ◽

10.1186/s12887-020-02379-0 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Shuichi Ito ◽

Tomoko Torii ◽

Akihiro Nakajima ◽

Takeshi Iijima ◽

Hiroshi Murano ◽

...

Keyword(s):

Uric Acid ◽

Health Insurance ◽

Pediatric Population ◽

Gouty Arthritis ◽

Cross Sectional Study ◽

Sectional Study ◽

Insurance Claims ◽

Cross Sectional ◽

Total Prevalence ◽

Health Insurance Claims

Abstract Background Although gout is rare in children, chronic sustained hyperuricemia can lead to monosodium urate deposits progressing to gout, just as in adults. This study assessed prevalence and characteristics of gout and asymptomatic hyperuricemia, and incidence of gouty arthritis in the pediatric population, using data from Japanese health insurance claims. The diagnosis and treatment of pediatric gout and hyperuricemia were analyzed, and specific characteristics of those patients were assessed. Since Japanese guidelines recommend treatment with uric acid lowering drugs for asymptomatic hyperuricemia as well as for gout, these data were also used to investigate the real-world use of uric acid lowering drugs in a pediatric population. Methods This cross-sectional study was based on a 2016–2017 Japanese health insurance claims database, one of the largest epidemiology claims databases available in Japan, which included 356,790 males and 339,487 females 0–18 years of age. Outcomes were measured for prevalence, patient characteristics, treatment with uric acid lowering drugs for gout and asymptomatic hyperuricemia, and prevalence and incidence of gouty arthritis. Because uric acid can be elevated by some forms of chemotherapy, data from patients under treatment for malignancies were excluded from consideration. Results Total prevalence of gout and asymptomatic hyperuricemia in 0–18 year-olds was 0.040% (276/696,277 patients), with gout prevalence at 0.007% (48/696,277) and asymptomatic hyperuricemia at 0.033% (228/696,277). Prevalence of gout and asymptomatic hyperuricemia was highest in adolescent males, at 0.135% (176/130,823). The most common comorbidities for gout and asymptomatic hyperuricemia were metabolic syndrome at 42.8% (118/276) and kidney disease at 34.8% (96/276). Of the patients diagnosed with gout or asymptomatic hyperuricemia, 35.1% (97/276) were treated with uric acid lowering drugs. Gouty arthritis developed in 43.8% (21/48) of gout patients during the study, at an incidence of 0.65 flares/person-year. Conclusions Even the pediatric population could be affected by asymptomatic hyperuricemia, gout, and gouty arthritis, and uric acid lowering drugs are being used in this population even though those drugs have not been approved for pediatric indications. Such off-label use may indicate a potential need for therapeutic agents in this population. Trial registration UMIN000036029.

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Association between serum uric acid and chronic kidney disease in patients with hypertension: A multicenter nationwide cross‐sectional study

Journal of Evidence-Based Medicine ◽

10.1111/jebm.12364 ◽

2019 ◽

Vol 12 (4) ◽

pp. 235-242 ◽

Cited By ~ 6

Author(s):

Wisit Kaewput ◽

Charat Thongprayoon ◽

Ram Rangsin ◽

Prajej Ruangkanchanasetr ◽

Tarun Bathini ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Uric Acid ◽

Kidney Disease ◽

Serum Uric Acid ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional

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The effect of hepcidin on components of metabolic syndrome in chronic kidney disease: a cross-sectional study

Revista da Associação Médica Brasileira ◽

10.1590/1806-9282.66.8.1100 ◽

2020 ◽

Vol 66 (8) ◽

pp. 1100-1107

Author(s):

Sibel Gökçay Bek ◽

Berna Üstüner ◽

Necmi Eren ◽

Zeynep Sentürk ◽

Betül Kalender Gönüllü

Keyword(s):

Metabolic Syndrome ◽

Chronic Kidney Disease ◽

Uric Acid ◽

Kidney Disease ◽

Cross Sectional Study ◽

Renal Diseases ◽

Sectional Study ◽

C Reactive Protein ◽

Cross Sectional ◽

Reactive Protein

SUMMARY BACKGROUND Hepcidin is an important regulator of iron homeostasis. OBJECTIVES This cross-sectional study was conducted to evaluate the association between hepcidin and components of metabolic syndrome in patients with chronic kidney disease (CKD). DESIGN AND SETTING 103 CKD patients and 59 healthy volunteers were included in the study from the University Hospital. METHODS Serum hepcidin levels were measured by enyzme-linked immunosorbent assay (ELISA) test. As for the study parameters, age, sex, body mass index, renal diseases, serum biochemistry, complete blood count, iron and total iron-binding capacity, ferritin, high-sensitive C-reactive protein (hsCRP), C- reactive protein (CRP), and erythrocyte sedimentation rate (ESR) were evaluated. RESULTS The mean age of the patients was 58.63 ± 11.8 years. Hepcidin level was significantly associated with hypertension and higher uric acid levels (P < 0.05). There was a positive correlation between hepcidin and urea, uric acid, creatinine, ferritin, CRP, ESR, phosphorus, triglyceride, low-density lipoprotein (LDL), proteinuria and albuminuria in 24-hour urine collection. A negative correlation was found between hepcidin and estimated glomerular filtration rate (eGFR), hemoglobin, hematocrit, calcium, 25 OH vitamin D, pH, and bicarbonate levels. CONCLUSION Hepcidin, a well-known hormone regulator of iron metabolism, may play an important role in the pathogenesis of metabolic syndrome in patients with CKD, and further studies might delineate in-depth its potential as a promising early marker in these patients.

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A retrospective cross-sectional study of the associated factors of hyperuricemia in patients with chronic kidney disease

Journal of International Medical Research ◽

10.1177/0300060520919224 ◽

2020 ◽

Vol 48 (6) ◽

pp. 030006052091922

Author(s):

Li-Ping Guo ◽

Qin Wang ◽

Yu Pan ◽

Yan-Lin Wang ◽

Ze-Jin Zhang ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Uric Acid ◽

Kidney Disease ◽

Serum Creatinine ◽

Serum Uric Acid ◽

Cross Sectional Study ◽

Serum Phosphate ◽

Sectional Study ◽

Clinical Factors ◽

Cross Sectional

Objective To investigate the prevalence of hyperuricemia in patients at different stages of chronic kidney disease (CKD) and the association of serum uric acid (SUA) with several clinical factors in a retrospective cross-sectional study of non-dialysis CKD patients at two hospitals in Shanghai, China. Methods The prevalence of hyperuricemia in CKD patients and the association of SUA with other clinical factors were examined using analysis of variance, chi-squared test, multivariate analysis, and other statistical methods. Results A total of 663 CKD patients were enrolled, of which approximately 52% had hyperuricemia. CKD patients with hyperuricemia had lower hemoglobin and estimated glomerular filtration rate (eGFR) levels but higher blood urea nitrogen, serum creatinine, and serum phosphate levels than those without hyperuricemia. Serum uric acid level was positively associated with age, blood urea nitrogen , serum creatinine, cystatin C, and serum phosphate and negatively associated with hemoglobin and eGFR. In addition, CKD patients with anemia and hyperphosphatemia had a higher prevalence of hyperuricemia than those without anemia or hyperphosphatemia. Conclusions The prevalence of hyperuricemia increased with CKD progression supporting the use of urate-lowering treatment for patients with CKD stage 1 to 4.

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TREATMENT OF UNSTABLE THORACOLUMBAR FRACTURES IN PEDIATRIC PATIENTS

Coluna/Columna ◽

10.1590/s1808-185120151403152473 ◽

2015 ◽

Vol 14 (3) ◽

pp. 227-229 ◽

Cited By ~ 1

Author(s):

Roberto Chapa Sosa ◽

Edgar Rubén Urrutia Vega

Keyword(s):

Pediatric Patients ◽

Pediatric Population ◽

Cross Sectional Study ◽

Thoracolumbar Fracture ◽

Anatomical Site ◽

Thoracolumbar Fractures ◽

Sectional Study ◽

Neurological Damage ◽

Cross Sectional ◽

Common Cause

Objective:To analyze the characteristics of unstable thoracolumbar fractures in the pediatric population.Methods:A retrospective cross-sectional study was conducted with pediatric patients (0 to 15 years) who presented with unstable thoracolumbar fracture with or without neurological damage. Twenty-four operated patients were analyzed: 13 male and 11 female.Results:Falls from height are the most common cause, being the thoracolumbar junction the anatomical site most frequently injured.Conclusion:The thoracolumbar fractures are rare in the pediatric population, as well as post-surgical instrumentation structural deformities.

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Urinary excretion of uric acid is negatively associated with albuminuria in patients with chronic kidney disease: a cross-sectional study

BMC Nephrology ◽

10.1186/s12882-018-0892-7 ◽

2018 ◽

Vol 19 (1) ◽

Cited By ~ 5

Author(s):

Fengqin Li ◽

Hui Guo ◽

Jianan Zou ◽

Weijun Chen ◽

Yijun Lu ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Uric Acid ◽

Kidney Disease ◽

Urinary Excretion ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Negatively Associated

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Uric Acid Is Independently Associated with Diabetic Kidney Disease: A Cross-Sectional Study in a Chinese Population

PLoS ONE ◽

10.1371/journal.pone.0129797 ◽

2015 ◽

Vol 10 (6) ◽

pp. e0129797 ◽

Cited By ~ 23

Author(s):

Dandan Yan ◽

Yinfang Tu ◽

Feng Jiang ◽

Jie Wang ◽

Rong Zhang ◽

...

Keyword(s):

Uric Acid ◽

Kidney Disease ◽

Chinese Population ◽

Diabetic Kidney Disease ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Diabetic Kidney

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Cross-sectional study of the clinical characteristics and outcomes of children hospitalized with COVID-19 in Lima, Peru

Medwave ◽

10.5867/medwave.2021.01.8107 ◽

2021 ◽

Vol 21 (01) ◽

pp. e8107-e8107

Author(s):

Jesús Domínguez Rojas ◽

Matilde Estupiñan Vigil ◽

Raquel Garcés-Ghilardi ◽

Giancarlo Alvarado-Gamarra ◽

Olguita del Águila ◽

...

Keyword(s):

Respiratory Failure ◽

Acute Abdomen ◽

Pediatric Patients ◽

Pediatric Population ◽

Cross Sectional Study ◽

Hospitalized Patients ◽

Sectional Study ◽

Cross Sectional ◽

Presenting Symptoms ◽

Inflammatory Syndrome

Introduction Coronavirus 2019 (SARS-CoV-2) infection in children occurred in Peru as of March 2020, leading to pediatric patients' hospitalization in areas adapted for this purpose at the Edgardo Rebagliati Martins National Hospital. In the beginning, the demand for hospitalization was low, but it increased gradually. Consistent with international reports, the majority of patients presented mild or moderate symptoms. Nonetheless, there were also severe cases, even fatal ones. Objectives To describe the characteristics and clinical outcome of pediatric patients with COVID-19 hospitalized in a referral hospital in Lima, Peru, between March and August 2020. Methods A descriptive and inferential cross-sectional study was carried out. The population includes all hospitalized patients in the Department of Pediatrics, with clinical and surgical diagnoses associated with COVID-19. Results We included 100 patients, with an average age of 83.4 ± 54 months, with a predominance of male patients (55%). Hospitalized patients were grouped into five categories: respiratory failure (17%), multisystemic inflammatory syndrome (MIS-C) (31%), neurological presentation (19%), acute abdomen (20%), and patients with oncological problems (13%). Most of the patients (74%) had comorbidities. Regarding the presenting symptoms, intestinal pain predominated in the appendicitis group (90%, p < 0.001), fever was present in most patients with respiratory failure (64.7%); multisystemic inflammatory syndrome (90.3%), neurological manifestations (15.8%), acute abdomen (50%) and oncological conditions (61.5%) were also present in these patients. Kawasaki symptoms were found in 38.7% of the patients with multisystemic inflammatory syndrome. Mortality was 4%. Respiratory problems (29.4%) and multisystemic inflammatory syndrome (22.6%) required admission to intensive care, more frequently than the other presentations (p = 0.008). Conclusions We conclude that the vulnerability in the pediatric population is the one that has preexisting conditions. We divided our patients according to presentation, diagnosis, and complications, which were predominantly respiratory. We also had oncological patients with COVID-19.

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