PHYSICIAN PRACTICES IN THE MANAGEMENT OF ASYMPTOMATIC HYPERURICEMIA

Purpose: Conflicting practices exist among physicians of different specialties regarding asymptomatic hyperuricemia (AHU) management. Potential toxicities of urate-lowering therapy (ULT) highlight importance of its proper initiation. We aim to determine current practices on AHU management and factors considered in treatment decisions among physicians of different specialties in the Philippine General Hospital.

Method: This is a descriptive cross-sectional study. Patient charts at the Family Medicine, General Internal Medicine (IM), and IM Subspecialty Clinics (Cardiology, Endocrinology, Hematology, Nephrology, and Rheumatology), were screened, including those with elevated serum uric acid levels, and excluding those with gout or gouty nephropathy. Data regarding age, sex, initiation/continuation of ULTs, lifestyle modification advice, and co-morbidities were recorded. Physicians were then surveyed regarding practices in managing AHU. A sample size of 118 was computed based on the inappropriately treated AHU prevalence (22.5%). Pearson’s chi-squared test and paired t-tests difference of means determined associations between different factors and the decision to treat.

Results: One hundred thirty-six charts with AHU were included. Majority were male (52.21%) over age 40 (87.5%).  At least two co-morbidities were seen in 75.74%. More than one-third of physicians prescribed ULT for AHU, most frequently from Nephrology (51.47%), followed by Cardiology (37.5%), and General IM (27.59%). None of the rheumatologists did. Allopurinol was the most prescribed ULT (82.7%). Only 33% of patients were advised lifestyle modifications. Forty-one physicians (43.90% from General IM and the rest divided among the specialties) completed the study questionnaire. Serum uric acid level of >13 mg/dL had a statistically significant association with doctors’ tendency to treat with ULT (p = <0.001). Among the comorbidities, CKD was the most common reason for starting ULT at 95%. This is also the only comorbid, with or without hypertension, that had a significant association with physician’s decision to initiate ULT (p = 0.003).

Conclusion: More than one-third of physicians prescribed ULT for AHU, mostly from Nephrology. Only 33% of patients were advised lifestyle modifications. Serum uric acid level and presence of CKD is a primary consideration for initiating ULT for AHU.  With heavy AHU burden and potential for serious ULT side effects, proper management is warranted. We recommend further studies with results that can be used by a group of involved subspecialties to produce guidelines that specifically target AHU.