Hyperuricemia during anti-tuberculosis therapy: clinical significance, risk factors and monitoring strategies
Abstract
During intensive phase of anti-tuberculosis chemotherapy, hyperuricemia was observed in 268 of 435 new pulmonary TB patients (60.6%, 95% CI 57.0–66.1%), complicated by arthralgia in 21.6% and signs of nephropathy in 1.5%. Pyrazinamide was associated with hyperuricemia in 262 of 268 cases. Independent risk factors of hyperuricemia by using logistic regression method were pre-treatment serum creatinine level > 80 mkmol/l (OR 1.99, 95%CI 1.11–3.57) and concomitant fluoroquinolone use (OR 1.97, 95%CI 1.12–3.49). Risk factors of arthralgia were female sex, body mass index > 22 kg/m2 and fluoroquinolone use. Median time for developing hyperuricemia was 36.5 days (IQR 21–72 days); earlier elevation of serum uric acid was reported in patients with pre-treatment serum creatinine level > 80 mkmol/l (p = 0,003 by log-rank test). In the absence of intervention, progressive course of hyperuricemia was more frequently observed in patients with early high elevation of serum uric acid level (> 600 mkmol/l before 6 wееks, OR 6.11, 95%CI 1.66–22.53, р = 0,005).
About the Authors
D. A. Ivanova
ГБУЗ города Москвы «Московский городской научно-практический центр борьбы с туберкулезом Департамента здравоохранения города Москвы»
Russian Federation
Russian Federation
S. E. Borisov
ГБУЗ города Москвы «Московский городской научно-практический центр борьбы с туберкулезом Департамента здравоохранения города Москвы»
Russian Federation
Russian Federation
A. M. Ryzhov
ГБУЗ города Москвы «Московский городской научно-практический центр борьбы с туберкулезом Департамента здравоохранения города Москвы»
Russian Federation
Russian Federation
References
1. Абдуллаев Р.Ю., Комиссарова О.Г., Чумакова Е.С., Одинец В.С. Уровень мочевой кислоты в сыворотке крови у больных впервые выявленным туберкулезом легких с множественной лекарственной устойчивостью возбудителя // Туберкулез и болезни легких. – 2017. – Т. 95. – № 4. – C. 31-36.
2. Гельберг И.С., Вольф С.Б., Врублевская Н.И. и др. Негативные воздействия полихимиотерапии у больных туберкулезом и пути их коррекции // Проблемы туберкулеза и болезней легких. – 2003. – № 4. – С. 12-15.
3. Об утверждении методических рекомендаций по совершенствованию диагностики и лечения туберкулеза органов дыхания / приказ Минздрава России № 951 от 29 декабря 2014 г. [Электронный ресурс ГАРАНТ.РУ] URL: http://www.garant.ru/products/ipo/prime/doc/70749840/ (Дата обращения 07.05.2017).
4. Федеральные клинические рекомендации по диагностике и лечению туберкулеза органов дыхания с множественной и широкой лекарственной устойчивостью / РОФ. Изд. 3-е. – М., 2015. [Электронный ресурс] URL: http://roftb.ru. (Дата обращения 07.05.2017).
5. Adebisi S.A., Oluboyo P.O., Okesina A.B. Effect of drug-induced hyperuricaemia on renal function in Nigerians with pulmonary tuberculosis // Afr. J. Med. Sci. – 2000. – Vol. 29. – N. 3-4. – P. 297-300.
6. Becker M.A. Asymptomatic hyperuricemia // UpToDate, 2013. [Электронный ресурс] URL: http://www.uptodate.com/contents/asymptomatic-hyperuricemia (Дата обращения 10.05.2017.)
7. Centers for Disease Control and Prevention. American Thoracic Society, CDC, and Infectious Diseases Society of America. Treatment of tuberculosis // Morbidity Mortality Weekly Rep (MMWR). – 2003. – Vol. 52 (RR-11). – P. 1-77.
8. Cheong E., Ryu S., Lee J.Y. et al. Association between serum uric acid and cardiovascular mortality and all-cause mortality: a cohort study // J. Hypertens. – 2017. – Vol. 35. – Suppl 1. –S. 3-9.
9. Companion Handbook to the WHO guidelines for the programmatic management of drug-resistant tuberculosis. – Geneva: WHO, 2014. [Электронный ресурс] URL: http://apps.who.int/iris/bitstream/10665/130918/1/9789241548809_eng.pdf. (Дата обращения 07.05.2017).
10. Division of Microbiology and Infection Diseases (DMID) adult toxicity table – DRAFT// Microbiology and Infectious Diseases Clinical Research Policies, Guidance, and Tools / National Institute of Allergy and Infectious Diseases, Bethesda, 2007. [Электронный ресурс] URL: http://www.niaid.nih.gov/LabsAndResources/resources/DMIDClinRsrch/Documents/dmidadulttox.pdf. (Дата обращения: 09.07.2013).
11. Ford E.S., Choi H.K. Associations between concentrations of uric acid with concentrations of vitamin A and beta-carotene among adults in the United States // Nutr. Res. – 2013. – Vol. 33. – N. 12. – P. 995-1002.
12. Gerdan V., Akkoc N., Ucan E.S. et al. Paradoxical increase in uric acid level with allopurinol use in pyrazinamide-induced hyperuricaemia // Singapore Med. J. – 2013. – Vol. 54. – P. 125–126.
13. Gulbay B.E., Gurkan O.U., Yildize O.A. et al. Side effects due to primary antituberculosis drugs during the initial phase of therapy in 1149 hospitalized patients for tuberculosis // Respir. Med. – 2006. – Vol. 100. – P. 1834-1842.
14. Gutman A.B., Yu T.F., Berger L. Renal function in gout. III. Estimation of tubular secretion and reabsorption of uric acid by use of pyrazinamide (pyrazinoic acid) // Am. J. Med. – 1969. – Vol. 47. – N. 4. – P. 575–592.
15. Harris A., Siegel L., Alloway J. Gout and hyperuricemia // Am. Fam. Phys. – 1999. – Vol. 59. – N. 4. – P. 925–934.
16. Inayat N., Shah R.H., Lakhair M.A., Sahito R. Hyperuricemia and arthralgia during pyrazinamide therapy in patients with pulmonary tuberculosis // Pak. J. Chest Med. – 2016. – Vol. 22. – N. 4. – P. 154-158.
17. Inoue T., Ikeda N., Kurasawa T. et al. Hyperuricemia and arthralgia during pyrazinamide treatment // Nihon Kokyuki Gakkai Zasshi. – 1999. – Vol. 37. – P. 115-118.
18. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease // Kidney Int. – 2013. – Vol. 3. – P. 1-150.
19. Kumar A.K., Gurumurthy P. Disposition of uric acid upon administration of ofloxacin alone and in combination with other anti-tuberculosis drugs // Indian J. Exp. Biol. – 2004. – Vol. 42. – N. 3. – P. 323-325.
20. Lacroix C., Guyonnaud M., Chaou С. et al. Interaction between allopurinol and pyrazinamide // Eur. Respir. J. – 1988. – N. 1. – P. 807-811.
21. Louthrenoo W., Hongsongkiat S., Kasitanon N. et al. Effect of antituberculous drugs on serum uric acid and urine uric acid excretion // J. Clin. Rheumatol. – 2015. – Vol. 21. – N. 7. – P. 346-348.
22. Mahantesh A, Hanumantharayappa B., Madhava R.P., Archana S.P. Effect of pyrazinamide induced hyperuricemia on patient compliance undergoing DOTS therapy for tuberculosis // RRJPTS. – 2014. – Vol. 2. – N. 2. – P. 12-18.
23. Pham A. Q., Doan A., Andersen M. Pyrazinamide-induced hyperuricemia // P T. – 2014. – Vol. 39. – N. 10. – P. 695-715.
24. Pichholiya M., Yadav A.K., Kothari N. et al. Effect of diet, body mass index, and proton pump inhibitors on antitubercular therapy–induced hyperuricemia in patients of tuberculosis // Natl. J. Physiol. Pharm. Pharmacol. – 2016. – Vol. 6. – N. 2. – P. 158–161.
25. Pichholiya M., Yadav A.K., Luhadia S.K. et al. A comparative study of efficacy and safety of febuxostat and allopurinol in pyrazinamide-induced hyperuricemic tubercular patients // Indian J. Pharmacol. – 2016. – Vol. 48. – N. 5. – P. 522–525.
26. Pillai A.P., Maldhure B.R., Zodpey S.P. Hyperuricemia during anti-tuberculous treatment // Lung India. – 1998. – N. 17. – P. 19-22.
27. Qureshi W., Hassan G., Kadri S.M. et al. Hyperuricemia and arthralgias during pyrazinamide therapy in patients with pulmonary tuberculosis // Lab. Med. – 2007. – Vol. 38. – N. 8. – P. 495–497.
28. Sismanlar T., Aslan A.T., Budakoglu I. Is hyperuricemia overlooked when treating pediatric tuberculosis patients with pyrazinamide? // J. Tropical Pediatrics. – 2015. – Vol. 61. – P. 351–356.
29. Solangi G.A., Zuberi B.F., Shaikh S., Shaikh W.M. Pyrazinamide induced hyperuricemia in patients taking anti-tuberculous therapy // J. Coll. Physicians Surg. Pak. – 2004. – Vol. 14. – N. 3. – Р. 136-138.
30. Taki H., Ogawa K., Murakami T., Nikai T. Epidemiological survey of hyperuricemia as an adverse reaction to antituberculous therapy with pyrazinamide // Kekkaku. – 2008. – Vol. 83. – N. 7. – P. 497-501.
31. Tosun A.K., Koca N.T., Karataş G.K. Acute gouty arthritis during pyrazinamide treatment: a case report //Mod. Rheumatol. – 2004. – Vol. 14. – N. 4. – P. 306-308.
Review
For citations:
Ivanova D.A., Borisov S.E., Ryzhov A.M. Hyperuricemia during anti-tuberculosis therapy: clinical significance, risk factors and monitoring strategies. Tuberculosis and socially significant diseases. 2017;(3):24-31. (In Russ.)
Views:
16
Email this article 