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Effect of uric-acid-lowering therapy on progression of chronic kidney disease: a meta-analysis
Ye-Fang Zhang1,2, Fan He1, Hong-Hui Ding3
1Department of Nephrology, Huazhong University of Science and Technology, Wuhan, 430030, China.
Insights
Uric-acid-lowering therapy (UALT) effectively slows chronic kidney disease (CKD) progression in patients with hyperuricemia. This treatment also reduces serum creatinine, blood urea nitrogen, and systolic blood pressure, indicating improved kidney function.
Area of Science:
- Nephrology
- Pharmacology
Background:
- Hyperuricemia is a common complication in chronic kidney disease (CKD) patients.
- Elevated uric acid levels are increasingly recognized as a risk factor for CKD progression.
Purpose of the Study:
- To assess the efficacy and safety of uric-acid-lowering therapy (UALT) in slowing CKD progression in patients with hyperuricemia.
- To evaluate the impact of UALT on key markers of kidney function and disease progression.
Main Methods:
- A systematic review and meta-analysis of randomized controlled trials (RCTs) were conducted.
- Searched major databases (Cochrane Library, PubMed, EMbase, CNKI, Wanfang, Vip) up to November 15, 2012.
- Included seven RCTs with 451 participants comparing UALT to control therapy.
Main Results:
- UALT significantly delayed the increase in serum creatinine and blood urea nitrogen.
- UALT improved the glomerular filtration rate and reduced systolic blood pressure.
- UALT lowered the risk of renal disease progression (RR=0.30, 95% CI: 0.19 to 0.46).
- No significant differences were observed in 24-h urinary protein or diastolic blood pressure.
Conclusions:
- UALT is effective in delaying the progression of CKD in patients with secondary hyperuricemia.
- The findings indirectly support hyperuricemia as a risk factor for CKD progression.
- UALT demonstrates a favorable safety profile regarding renal function markers.
Abstract:
The efficacy and safety of uric-acid-lowering therapy (UALT) on slowing the progression of chronic kidney disease (CKD) accompanied by hyperuricemia were assessed. We searched Cochrane Library, PubMed, EMbase, CNKI, Wanfang and Vip databases up to November 15, 2012 for randomized controlled trials (RCTs) which compared the effect of UALT to control therapy in hyperuricemic patients secondary to CKD, and then performed quality evaluation and meta-analysis on the included studies. Seven RCTs involving 451 cases were included. UALT delayed the increase of serum creatinine (MD=-62.55 μmol/L, 95% CI: -98.10 to -26.99) and blood urea nitrogen (MD= -6.15 mmol/L, 95% CI: -8.17 to -4.13) as well as the decrease of glomerular filtration rate [MD=5.65 mL/(min·1.73 m2), 95% CI: 1.88 to 9.41], decreased systolic blood pressure (SBP) (MD= -6.08 mmHg, 95% CI: -11.67 to -0.49), and reduced the risk of the renal disease progression (RR=0.30, 95% CI: 0.19 to 0.46). However, there was no statistically significant difference in 24-h urinary protein quantity and diastolic blood pressure (P>0.05). We identified that UALT could delay the progression of CKD with secondary hyperuricemia. And this also indirectly proved that hyperuricemia was a risk factor for the CKD progression.
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