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Multicenter randomized controlled trial of intensive uric acid lowering therapy for CKD patients with hyperuricemia:
Tetsuya Yamamoto1, Masato Kasahara2, Kenji Ueshima3
1Gyoumeikan Hospital, Osaka, Japan.
Insights
Intensive uric acid-lowering therapy (ULT) did not significantly improve albuminuria in chronic kidney disease (CKD) patients. This study found no added renal protection from intensive ULT compared to standard therapy for CKD with hyperuricemia.
Area of Science:
- Nephrology
- Internal Medicine
- Pharmacology
Background:
- Chronic kidney disease (CKD) is a global health concern.
- Hyperuricemia is common in CKD patients and may contribute to disease progression.
- The potential renal benefits of intensive uric acid-lowering therapy (ULT) in CKD remain unclear.
Purpose of the Study:
- To compare the efficacy of intensive ULT versus standard ULT in reducing albuminuria in CKD patients with hyperuricemia.
- To assess the renal protective effects of intensive ULT.
Main Methods:
- A multicenter randomized controlled trial involving CKD patients with hyperuricemia.
- Participants were randomized to intensive ULT (serum UA 4.0–4.9 mg/dL) or standard ULT (serum UA 6.0–6.9 mg/dL) using topiroxostat.
- The primary endpoint was the change in the log-transformed urine albumin-to-creatinine ratio (ACR) from baseline to 52 weeks.
Main Results:
- 352 patients were analyzed. Both groups achieved target serum uric acid levels.
- Mean serum UA decreased from baseline in both standard and intensive therapy groups.
- No significant difference in the change of log ACR was observed between the intensive and standard ULT groups at 52 weeks.
Conclusions:
- Intensive ULT did not demonstrate a significant benefit in improving albuminuria levels in CKD patients with hyperuricemia.
- The study suggests that intensive ULT does not offer superior renal protection compared to standard ULT in this population.
- Further research may be needed to explore alternative strategies for renal protection in CKD.
Background:
We investigate whether Intensive uric acid (UA)-lowering therapy (ULT) provides increased renal protection compared with standard therapy in chronic kidney disease (CKD) patients.
Methods:
This was a multicenter randomized controlled trial. Only CKD patients with hyperuricemia were included in this study. The participants were randomly assigned to either the Intensive therapy group (target serum UA level ≥ 4.0 mg/dL and < 5.0 mg/dL) or the standard therapy group (serum UA level ≥ 6.0 mg/dL and < 7.0 mg/dL). ULT was performed using topiroxostat, a non-purine-type selective xanthine oxidase inhibitor. The primary endpoint was change in the logarithmic value of urine albumin to the creatinine ratio (ACR) between baseline and week 52 of the treatment.
Results:
Three hundred fifty-two patients were included in the full analysis set. In the Standard therapy group, mean serum UA was 8.23 mg/dL at baseline and 6.13 mg/dL at 52 weeks. In the Intensive therapy group, mean serum UA was 8.15 mg/dL at baseline and 5.25 mg/dL at 52 weeks. There was no significant difference in changes in log ACR at 52 weeks between the Intensive therapy and the Standard therapy groups.
Conclusion:
This study did not reveal the benefit of Intensive ULT to improve albuminuria levels. (UMIN000026741 and jRCTs051180146).
