The prevalence of gout and hyperuricaemia increased in Italy from 2005 to 2009. A high recurrence rate for gout attack was observed during the first year following the first episode. Early management of hyperuricaemia in patients at higher risk of recurrent gout attack should be considered in primary care.

Background and objectives Rising prevalence of CKD requires active involvement of general practitioners to limit ESRD and mortality risk. However, the outcomes of patients with CKD exclusively managed by general practitioners are ill defined. Results Overall 64% of patients were in stage 3a, and 4.5% of patients were in stages 3b-5. Patients with stages 1 and 2 were younger, were predominantly men, more frequently had diabetes, and had lower prevalence of previous cardiovascular disease than patients with stages 3a-5. Hypertension was frequent in all CKD stages (80%-94%), whereas there was a lower prevalence of dyslipidemia, albuminuria, and obesity associated with more advanced CKD. During the follow-up (median=7.2 years; interquartile range=4.7-7.7), 6592 patients died and 295 started ESRD. Compared with stages 1 and 2 (reference), mortality risk (hazard ratio, 95% confidence interval) was higher in stages 3b-5 (1.66, 1.49-1.86, 2.75, 2.41-3.13 and 2.54, 2.01-3.22, respectively) but not stage 3a (1.11, 0.99-1.23). Similarly, ESRD risk (hazard ratio, 95% confidence interval) was not higher at stage 3a (1.44, 0.79-2.64) but was greater in stages 3b-5 (11.0, 6.3-19.5, 91.2, 53.2-156.2 and, 122.8, 67.9-222.0, respectively). Among modifiable risk factors, anemia and albuminuria significantly predicted either outcome, whereas hypertension only predicted mortality.Conclusions In patients with CKD not referred to nephrology, risks of ESRD and mortality were higher in those with CKD stages 3b-5.

A zithromycin is a widely prescribed broad-spectrum macrolide used mainly for the treatment of respiratory and urinary tract bacterial infections. Concerns have been raised recently regarding its arrhythmogenic potential, a risk already known to be associated with the first marketed macrolide, erythromycin.1-6 Several case reports have described QTinterval prolongation, 7-9 torsades de pointes 10-12 and polymorphic ventricular tachycardia 13 following use of azithromycin. Many observational studies have reported conflicting results about the association between azithromycin use and cardiovascular death.14-21 Because the known azithromycin-related cardiac events are related to QT-interval prolongation, torsades de pointes and ventricular arrhythmia, 18,19 these observational studies are limited by the broad category of cardiovascular death used as an outcome, which likely only partially captured cardiac risk associated with azithromycin use. To date, only 1 observational study has investigated the association between azithromycin use and ventricular arrhythmia specifically. 22Given the conflicting findings regarding this widely used antibiotic and the lack of data on ventricular arrhythmia specifically, we aimed to quantify the association between azithromycin use and the risk of ventricular arrhythmia using data from a network of 7 health care databases from 5 European countries. Methods Study design and settingWe conducted a nested case-control study within a cohort of new antibiotic users identified from a network of 7 populationbased health care databases in 5 European countries that partic- ABSTRACT BACKGROUND: There are conflicting findings from observational studies of the arrhythrogenic potential of azithromycin. Our aim was to quantify the association between azithromycin use and the risk of ventricular arrhythmia. RESEARCH Use of azithromycin and risk of ventricular arrhythmia