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Rasburicase versus intravenous allopurinol for non-malignancy-associated acute hyperuricemia in paediatric cardiology patients

Published online by Cambridge University Press:  27 August 2019

Jeffrey D. Moss ,
May Wu ,
David M. Axelrod  and
David M. Kwiatkowski Open the ORCID record for David M. Kwiatkowski [Opens in a new window]
Jeffrey D. Moss
Affiliation:
Department of Pharmacy, Lucile Packard Children’s Hospital Stanford, Palo Alto, USA
May Wu
Affiliation:
Department of Pharmacy, Lucile Packard Children’s Hospital Stanford, Palo Alto, USA
David M. Axelrod
Affiliation:
Division of Cardiology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, USA
David M. Kwiatkowski*
Affiliation:
Division of Cardiology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, USA
*
Author for correspondence: D. M. Kwiatkowski, MD, 750 Welch Road, Suite 321, Palo Alto, CA 94304, USA. Tel: 650-721-2121; Fax: 650-724-5650; E-mail: dkwiat@stanford.edu
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Abstract

Objectives:

Limited data exist for management of hyperuricemia in non-oncologic patients, particularly in paediatric cardiac patients. Hyperuricemia is a risk factor for acute kidney injury and may prompt treatment in critically ill patients. The primary objective was to determine if rasburicase use was associated with greater probability normalisation of serum uric acid compared to allopurinol. Secondary outcomes included percent reduction in uric acid, changes in serum creatinine, and cost of therapy.

Design:

A single-centre retrospective chart review.

Setting:

A 20-bed quaternary cardiovascular ICU in a university-based paediatric hospital in California.

Patients:

Patients admitted to cardiovascular ICU who received rasburicase or intravenous allopurinol between 2015 and 2016.

Interventions:

None.

Measurements and main results:

Data from a cohort of 14 patients receiving rasburicase were compared to 7 patients receiving IV allopurinol. Patients who were administered rasburicase for hyperuricemia were more likely to have a post-treatment uric acid level less than 8 mg/dl as compared to IV allopurinol (100 versus 43%; p = 0.0058). Patients who received rasburicase had a greater absolute reduction in post-treatment day 1 uric acid (−9 mg/dl versus −1.9 mg/dl; p = 0.002). There were no differences in post-treatment day 3 or day 7 serum creatinine or time to normalisation of serum creatinine. The cost of therapy normalised to a 20 kg patient was greater in the allopurinol group ($18,720 versus $1928; p = 0.001).

Conclusion:

In a limited paediatric cardiac cohort, the use of rasburicase was associated with a greater reduction in uric acid levels and associated with a lower cost compared to IV allopurinol.

Keywords

Rasburicaseallopurinoluric acidpaediatricscardiologyhyperuricemia
Type
Original Article
Information
Cardiology in the Young , Volume 29 , Issue 9 , September 2019 , pp. 1160 - 1164
Copyright
© Cambridge University Press 2019 

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References

Anker, SD, Doehner, W, Rauchhaus, M et al. Uric acid and survival in chronic heart failure: validation and application in metabolic, functional, and hemodynamic staging. Circulation 2003; 107: 1991–1997.CrossRefGoogle ScholarPubMed
Strasak, AM, Kelleher, CC, Brant, LJ et al. Serum uric acid is an independent predictor for all major forms of cardiovascular death in 28, 613 elderly women: a prospective 21-year follow-up study. Int J Cardiol 2008; 125: 232–239.CrossRefGoogle ScholarPubMed
Gotsman, I, Keren, A, Lotan, C, Zwas, DR. Changes in uric acid levels and allopurinol use in chronic heart failure: association with improved survival. J Card Fail 2012; 18: 694–701.CrossRefGoogle ScholarPubMed
Culleton, BF, Larson, MG, Kannel, WB, Levy, D. Serum uric acid and risk for cardiovascular disease and death: the Framingham Heart Study. Ann Intern Med 1999; 131: 7–13.CrossRefGoogle ScholarPubMed
Zhang, J, Dierckx, R, Mohee, K, Clark, AL, Cleland, JG. Xanthine oxidase inhibition for the treatment of cardiovascular disease: an updated systematic review and meta-analysis. ESC Heart Fail 2017; 4: 40–45.CrossRefGoogle ScholarPubMed
Baldree, LA, Stapleton, FB. Uric acid metabolism in children. Pediatr Clin North Am. 1990; 37: 391–418.CrossRefGoogle ScholarPubMed
Cooper, DS, Kwiatkowki, DM, Goldstein, SL, Krawczeski, CD. Acute kidney injury and cardiorenal syndromes in pediatric cardiac intensive care. Pediatr Crit Care Med 2016; 17: S250–256.CrossRefGoogle ScholarPubMed
Fathallah-Shaykh, SA, Cramer, MT. Uric acid and the kidney. Pediatr Nephrol 2014; 29: 999–1008.CrossRefGoogle ScholarPubMed
ELITEK (rasburicase) [package insert]. New York, New York: Sanofi-Synthelabo; 2002.Google Scholar
Boutin, A, Blackman, A, O’sullivan, DM, Forcello, N. The value of fixed rasburicase dosing versus weight-based dosing in the treatment and prevention of tumor lysis syndrome. J Oncol Pharm Pract. 2019; 25: 577–583.CrossRefGoogle ScholarPubMed
Vadhan-Raj, S, Fayad, LE, Fanale, MA, et al. A randomized trial of a single-dose rasburicase versus five-daily doses in patients at risk for tumor lysis syndrome. Ann Oncol. 2011; 23: 1640–1645.CrossRefGoogle ScholarPubMed
ALOPRIM (allopurinol) [package insert]. Rockford, IL: Mylan Institutional; 2017.Google Scholar
Hobbs, DJ, Steinke, JM, Chung, JY, Barletta, GM, Bunchman, TE. Rasburicase improves hyperuricemia in infants with acute kidney injury. Pediatr Nephrol 2010; 25: 305–9.CrossRefGoogle ScholarPubMed
Goldman, SC, Holcenberg, JS, Finklestein, JZ et al. A randomized comparison between rasburicase and allopurinol in children with lymphoma or leukemia at high risk for tumor lysis. Blood 2001; 97: 2998–3003.CrossRefGoogle ScholarPubMed
De Angelis, S, Noce, A, Di Renzo, L et al. Is rasburicase an effective alternative to allopurinol for management of hyperuricemia in renal failure patients? A double blind-randomized study. Eur Rev Med Pharmacol Sci 2007; 11: 179–84.Google ScholarPubMed
Kellum, JA, Lameire, N, KDIGO AKI guideline working group. Diagnosis, evaluation and management of acute kidney injury: a KDIGO summary (part 1). Crit Care 2013; 17: 204.CrossRefGoogle Scholar
Lexi-Comp, Inc. (Lexi-Drugs®). Lexi-Comp, Inc.; January 29, 2015. Accessed 3/18/2018.Google Scholar
Xu, X, Hu, J, Song, N, Chen, R, Zhang, T, Ding, X. Hyperuricemia increases the risk of acute kidney injury: a systematic review and meta-analysis. BMC Nephrol 2017; 18: 27.CrossRefGoogle ScholarPubMed
Ejaz, AA, Kambhampati, G, Ejaz, NI et al. Post-operative serum uric acid and acute kidney injury. J Nephrol 2012; 25: 497–505.CrossRefGoogle ScholarPubMed
Ejaz, AA, Dass, B, Lingegowda, V et al. Effect of uric acid lowering therapy on the prevention of acute kidney injury in cardiovascular surgery. Int Urol Nephrol 2013; 45: 449–58.CrossRefGoogle ScholarPubMed
Rodríguez-Hernández, JL, Rodríguez-González, F, Riaño-Ruiz, M, Martínez-Quintana, E. Risk factors for hyperuricemia in congenital heart disease patients and its relation to cardiovascular death. Congenit Heart Dis 2018; 13: 655–662.CrossRefGoogle ScholarPubMed
Conger, JD. Acute uric acid nephropathy. Med Clin North Am 1990; 74: 859–871.CrossRefGoogle ScholarPubMed
Nakagawa, T, Mazzali, M, Kang, DH et al. Hyperuricemia causes glomerular hypertrophy in the rat. Am J Nephrol 2003; 23: 2–7.CrossRefGoogle ScholarPubMed
Mazzali, M, Hughes, J, Kim, YG. Elevated uric acid increases blood pressure in the rat by a novel crystal-independent mechanism. Hypertension 2001; 38: 1101–1106.CrossRefGoogle ScholarPubMed
Corry, DB, Eslami, P, Yamamoto, K, Nyby, MD, Makino, H, Tuck, ML. Uric acid simulated vascular smooth muscle cell proliferation and oxidative stress via the renin-angiotensin system. J Hypertens 2008; 26:269–275.CrossRefGoogle Scholar
Kang, DH, Nakagawa, T, Feng, L. A role for uric acid in the progression of renal disease. J Am Soc Nephrol 2002; 13: 2888–2897.CrossRefGoogle ScholarPubMed
Nakagawa, T, Mazzali, M, Kang, DH, Sanchez-Lozada, LG, Herrera-Acosta, J, Johnson, RJ. Uric acid—a uremic toxin? Blood Purif 2006; 24: 67–70.CrossRefGoogle ScholarPubMed
Christen, S, Finckh, B, Lykkesfeldt, J et al. Oxidative stress precedes peak systemic inflammatory response in pediatric cardiopulmonary bypass operation. Free Radic Biol Med 2005; 38: 1323–32.CrossRefGoogle ScholarPubMed
Cortes, J, Moore, JO, Maziarz, RT et al. Control of plasma uric acid in adults at risk for tumor Lysis syndrome: efficacy and safety of rasburicase alone and rasburicase followed by allopurinol compared with allopurinol alone--results of a multicenter phase III study. J Clin Oncol 2010; 28: 4207–13.CrossRefGoogle ScholarPubMed