Effects of uric acid-lowering therapy in patients with chronic kidney disease: A meta-analysis

Abstract

Background and objectivesThe effects of uric acid-lowering therapy in patients with chronic kidney disease (CKD) remain uncertain. Therefore, we undertook a systematic review and meta-analysis to investigate the effects of uric acid-lowering agents on major clinical outcomes of CKD.Design, setting, participants, and measurementsAccording to the pre-specified protocol that was registered with PROSPERO (No. CRD42016038030), we searched systematically in MEDLINE, EMBASE, and the Cochrane Library for trials up to February 2016. Prospective, randomized, controlled trials assessing the effects of uric acid-lowering agents on cardiovascular and kidney outcomes in patients with CKD were included. Random-effects analytical methods were used.ResultsSixteen eligible trials were identified, providing data for 1,211 patients with CKD, including 146 kidney failure events and 69 cardiovascular events. Uric acid-lowering therapy produced a 55% relative risk (RR) reduction (95% confidence interval [95% CI], 31–64) for kidney failure events (P < 0.001), and a 60% RR reduction (95% CI, 17–62) for cardiovascular events (P < 0.001), but had no significant effect on the risk of all-cause death (RR, 0.86; 95% CI, 0.50–1.46). The mean differences in rate of decline in the estimated glomerular filtration rate (4.10 mL/min/1.73 m2 per year slower in uric acid-lowering therapy recipients, 95% CI, 1.86–6.35) and the standardized mean differences in the change in proteinuria or albuminuria (−0.23 units of standard deviation greater in uric acid-lowering therapy recipients; 95% CI, −0.43 to −0.04) were also statistically significant.ConclusionsUric acid-lowering therapy seemed to improve kidney outcomes and reduce the risk of cardiovascular events in adults with CKD.

Effect of immediate and prolonged GLP‐1 receptor agonist administration on uric acid and kidney clearance: Post‐hoc analyses of four clinical trials

“…Accordingly, the indication for plasma UA‐lowering therapy, with either xanthine‐oxidase inhibitors or uricosuric agents, may be broader than that for gout or UA nephrolithiasis. Interestingly, in studies in diverse populations including type 2 diabetes mellitus (T2DM) patients, plasma UA‐lowering therapy improved surrogate cardio‐renal end points, although dedicated large‐sized trials, such as the ongoing ALL‐HEART study (ISRCTN32017426), are needed to firmly establish causation between UA lowering and long‐term clinical outcomes …”

“…Interestingly, in studies in diverse populations including type 2 diabetes mellitus (T2DM) patients, 4,[9][10][11] plasma UA-lowering therapy improved surrogate cardio-renal end points, although dedicated large-sized trials, such as the ongoing ALL-HEART study (ISRCTN32017426), are needed to firmly establish causation between UA lowering and long-term clinical outcomes. 4 Over the last 3 decades, multiple antihyperglycaemic drug classes, with different modes of action, have been successfully licensed for the treatment of hyperglycaemia in T2DM.…”

Dotinurad: a novel selective urate reabsorption inhibitor as a future therapeutic option for hyperuricemia

“…Studies that investigate whether UAlowering therapy is effective for cardiorenal protection partly answers the question because they provides an insight about the causal relationship between increased UA levels and CV diseases. Indeed, a substantial number of reviews and 1 3 meta-analysis that were recently conducted has shown that UA-lowering therapies retard the progression of cardiorenal disease, thereby leading to a better prognosis [9][10][11][12][13][14].…”

Comparative Efficacy of the Course Injection Therapy with Iniectran or in Combination with Fermathron in Patients with Osteoarthritis of the Ankle Joints on the Background of Genytron Basic Application

“…включили в метаанализ наиболее значимые на тот момент времени работы, вы-Обзор полненные с целью оценки эффекта разных уратснижающих терапий (в 15 исследованиях назначали ингибиторы ксантиноксидазы аллопуринол или фебуксостат, в одном -препарат пегуриказы пеглотиказа) при ХБП. Полученные результаты позволили констатировать снижение ОР развития почечной недостаточности более чем в 1,5 раза, сердечно-сосудистых катастроф на 60% и расчетной СКФ на 4,10 мл/ мин/1,73 м 2 в год [23]. Наиболее показательными были результаты исследования, проведенного M. Goicoechea и соавт.…”