Uric Acid-Lowering Therapy Helps Kidney, Heart
Hyperuricemia is common in patients with CKD
A study published in PLOS One found that uric acid-lowering therapy improved renal outcomes and lowered the risk of cardiovascular (CV) events in adult patients with chronic kidney disease (CKD).
To better understand the effects of uric acid-lowering therapy (e.g., allopurinol, febuxostat, pegloticase) in CKD patients, researchers performed a systematic review and meta-analysis to investigate its effects on clinical outcomes of CKD. They searched various databases for prospective, randomized, controlled clinical trials up to February 2016 that evaluated the effects of uric acid-lowering drugs on CV and kidney outcomes in patients with CKD.
A total of 16 trials were included (n=1211) for analysis, which include 146 cases of renal failure events and 69 reports of CV events. The primary outcomes were renal failure events (defined as >25% or 50% decrease in estimated glomerular filtration rate [eGFR] and doubling of serum creatinine and end stage renal disease [ESRD] during the follow-up period). Secondary outcomes included rate of change in eGFR per year and changes in proteinuria or albuminuria from baseline to end of follow-up, and CV events (eg, CV mortality, myocardial infarction, unstable angina, acute coronary syndromes, stroke, coronary revascularization procedures, peripheral revascularization procedures, heart failure requiring hospitalization, stent thrombosis), among others.
The authors found a 55% relative risk (RR) reduction (95% CI: 31–64) in renal failure events and a 41% RR (95% CI: 37–96) in ESRD risk with uric acid-lowering therapy compared with standard treatment or placebo. A 60% RR (95% CI: 17–62) was seen for CV events (P<0.001) with uric acid-lowering therapy compared with placebo or usual care control groups. However, there was no significant effect seen for risk of all-cause mortality (RR 0.86, 95% CI: 0.50–1.46).
There was a statistically significantly slower decline in the eGFR in patients who received uric acid-lowering therapy (4.10 mL/min/1.73m2 per year slower, 95% CI: 1.86–6.35). Also, the standardized mean differences in the change in proteinuria and albuminuria were –0.23 units of standard deviation greater in patients who received uric acid-lowering therapy (95% CI: –0.43 to –0.04).
"In conclusion, our meta-analysis indicated that uric acid-lowering therapy might improve kidney outcomes, including kidney failure events, proteinuria, and the rate of change in eGFR, and seems to reduce the risk of cardiovascular events in adults with CKD," the authors write.
Su X, Xu B, Yan B, Qiao X, Wang L. Effects of uric acid-lowering therapy in patients with chronic kidney disease: A meta-analysis. PLOS One. doi:10.1371/journal.pone.0187550