Subject : Assessment of Lifestyle and PHArmacological Approaches in HyperUricemiA with Chronic Kidney Disease (ALPHA-UA)
Hyperuricemia, characterized by elevated serum uric acid levels, is a common metabolic condition that often coexists with chronic kidney disease (CKD). The interplay between hyperuricemia and kidney disease is complex, with each condition potentially exacerbating the other. Effective management of hyperuricemia in patients with CKD requires a comprehensive approach that combines pharmacological interventions with lifestyle modifications. Understanding the attitudes and practices of healthcare providers regarding these strategies is essential for optimizing patient outcomes. This study aims to assess the leveraging of pharmacological and lifestyle-related attitudes towards managing hyperuricemia in patients with kidney disease through a questionnaire-based survey. Hyperuricemia affects a significant portion of the global population, with prevalence rates ranging from 5% to 20% depending on the region and population studied. It is closely associated with gout, cardiovascular diseases, and CKD.
Chronic kidney disease itself affects approximately 10% of the global population, posing substantial healthcare challenges and economic burdens due to the need for long-term treatment and management strategies. In India, the prevalence of hyperuricemia and CKD is on the rise, with an increasing number of individuals diagnosed with these conditions annually. Recent studies indicate that about 12% of the Indian population has hyperuricemia, while CKD affects around 17% of adults.
The rising prevalence is attributed to changes in lifestyle, diet, and increasing incidence of diabetes and hypertension, which are major risk factors for both conditions. Hyperuricemia results from an overproduction or underexcretion of uric acid. It can lead to the formation of urate crystals, causing gout and kidney stones. The pathophysiology of hyperuricemia in CKD involves a feedback loop where impaired kidney function reduces uric acid excretion, further increasing serum uric acid levels and exacerbating kidney damage through crystal deposition and inflammation.
The complications of hyperuricemia in CKD patients include increased risk of gout, accelerated progression of kidney disease, and heightened cardiovascular risk. Current pharmacotherapy for hyperuricemia includes xanthine oxidase inhibitors (such as allopurinol and febuxostat) which reduce uric acid production, and uricosuric agents (such as probenecid) which enhance uric acid excretion. Guidelines from national and international bodies, including the American College of Rheumatology (ACR) and the Kidney Disease: Improving Global Outcomes (KDIGO) organization, recommend these treatments based on individual patient profiles and disease severity. Landmark clinical trials, such as the CARES trial for febuxostat, have provided significant insights into the efficacy and safety of these medications in managing hyperuricemia and its complications.
Despite the availability of effective pharmacological treatments, there remains a critical need for strategies that combine drugs with complementary mechanisms of action to optimize outcomes. Additionally, integrating lifestyle modifications such as diet and exercise into treatment plans can enhance the effectiveness of pharmacological therapies. Investigating healthcare providers' perspectives on these combined approaches is crucial for developing comprehensive management strategies for hyperuricemia in CKD patients. This survey, ALPHA-UA, aims to gather insights from healthcare providers on the use of combined pharmacological and lifestyle strategies, addressing existing gaps in treatment and fostering the adoption of evidence-based practices.
Thus, this retrospective, cross-sectional multicenter survey study is aimed to understand Hyperuricemia with Chronic Kidney Disease management practices in India.
We invite you to participate in this survey. On acceptance, you will need to fill the survey questionnaire form provided.
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