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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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