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Urate-lowering Therapy and Chronic Kidney Disease Development in Patients with Gout
Fu-Shun Yen1, James Cheng-Chung Wei2,3,4, Chia-Ling Chang5,6
1Dr. Yen's Clinic, Taoyuan City, Taiwan.
Insights
Urate-lowering therapy (ULT) did not significantly reduce the risk of developing chronic kidney disease (CKD). However, ULT showed a protective effect in patients with diabetes mellitus and without hypertension, suggesting a potential benefit in specific subgroups.
Area of Science:
- Nephrology
- Rheumatology
- Public Health
Background:
- Chronic kidney disease (CKD) is a growing global health issue.
- Hyperuricemia is linked to CKD, and urate-lowering therapy (ULT) may slow its progression.
- The role of ULT in preventing new-onset CKD requires further investigation.
Purpose of the Study:
- To compare the incidence of CKD in gout patients with and without ULT use.
- To evaluate the association between ULT and the risk of developing new-onset CKD.
Main Methods:
- A 13-year population-based retrospective cohort study.
- Compared 7126 ULT users with 7126 matched ULT nonusers.
- Adjusted for sex, age, region, comorbidities, and medications.
Main Results:
- Overall CKD incidence was 1.7 per 100 person-years for both groups.
- No significant difference in CKD risk between ULT users and nonusers (aHR: 0.97).
- ULT showed a trend towards lower CKD risk in patients with diabetes mellitus and without hypertension (aHR: 0.52).
- Uricosuric agents were associated with a lower risk of incident CKD compared to xanthine oxidase inhibitors (aHR: 0.81).
Conclusions:
- ULT is not generally associated with a reduced risk of developing CKD.
- ULT may offer a protective effect against incident CKD in patients with diabetes mellitus and without hypertension.
- Different ULT agents may have varying effects on CKD development.
Abstract:
Objectives: Chronic kidney disease (CKD) has emerged as a global health concern. Many studies have identified an association between hyperuricemia and CKD, and some studies have revealed that urate-lowering therapy (ULT) can attenuate CKD progression. However, only a few studies have explored the role of ULT in the prevention of new onset CKD. Methods: To compare the risk of incident CKD between users and nonusers of ULT in patients with gout, we conducted a 13-year population-based retrospective cohort study. Overall incidence of CKD was compared between 7126 ULT users and 7126 matched ULT nonusers. Results: The CKD incidence rate for both the users and nonusers of ULT was 1.7 per 100 person-years, after adjusting for sex, age, region of residence, comorbidities, and medications used. No significant difference in CKD risk (adjusted hazard ratio [aHR]: 0.97; 95% confidence interval [CI]: 0.88-1.07) was noted between the ULT users and nonusers. In the subgroup of patients with diabetes mellitus (DM) and without hypertension (HT), ULT tended to be associated with lower risk of incident CKD (aHR: 0.52; 0.95% CI: 0.28-0.97). Compared with the risk of new onset CKD in patients receiving xanthine oxidase inhibitors, those receiving uricosuric agents seemed to have a lower risk of developing CKD (aHR: 0.81, 95% CI: 0.67-0.99). Conclusion: This population-based cohort study indicated that ULT is not associated with lower risk of CKD development. However, in the subgroup of patients with DM and without HT, ULT is associated with significantly lower risk of incident CKD.
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