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Time to target uric acid to retard CKD progression
Takanori Kumagai1,2, Tatsuru Ota1, Yoshifuru Tamura1
1Department of Internal Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan.
Clinical and Experimental Nephrology
|June 25, 2016
Summary
High uric acid (UA) may worsen chronic kidney disease (CKD). Lowering serum UA below 6.5 mg/dL might prevent end-stage renal disease (ESRD), but more research is needed.
Area of Science:
- Nephrology
- Metabolic Disorders
- Urology
Background:
- Serum uric acid (SUA) is a potential risk factor for chronic kidney disease (CKD).
- Observational studies link elevated SUA to CKD incidence and progression.
- Current evidence on SUA-lowering therapy for CKD is inconclusive due to small studies.
Purpose of the Study:
- To review the relationship between SUA and kidney disease.
- To determine optimal management strategies for asymptomatic hyperuricemia in CKD patients.
- To explore future research directions, including Mendelian randomization.
Main Methods:
- Review of existing observational studies and meta-analyses.
- Analysis of animal models demonstrating UA-induced kidney damage.
- Examination of urate transporter roles in UA metabolism.
Main Results:
- Elevated SUA independently predicts CKD development.
- A SUA threshold below 6.5 mg/dL may be crucial for preventing ESRD.
- Animal models show SUA increase causes glomerular hypertension and tubulointerstitial fibrosis.
Conclusions:
- Further large-scale, randomized trials are necessary to confirm the benefits of SUA-lowering therapy.
- Understanding UA metabolism, particularly intestinal roles, is key.
- Evidence suggests a potential threshold for SUA to prevent ESRD in CKD.
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