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Urate-lowering therapy and kidney outcomes in patients with chronic kidney disease and hyperuricemia

Sheng Nie1, Shiyu Zhou1, Ruixuan Chen1

  • 1State Key Laboratory of Multiorgan Injury Prevention and Treatment, Guangdong Provincial Key Laboratory of Renal Failure Research, Division of Nephrology, National Clinical Research Center for Kidney Disease, Guangdong Provincial Institute of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China.

Signal Transduction and Targeted Therapy
|December 8, 2025
PubMed

Insights

Urate-lowering therapy (ULT) significantly reduces kidney disease progression and mortality in patients with chronic kidney disease (CKD) and hyperuricemia. Further research is needed to confirm these findings in large clinical trials.

Area of Science:

  • Nephrology
  • Pharmacology
  • Epidemiology

Background:

  • Hyperuricemia is a modifiable risk factor for chronic kidney disease (CKD) progression.
  • The impact of urate-lowering therapy (ULT) on kidney outcomes in CKD patients remains controversial.
  • Evidence is needed to guide ULT use in managing CKD with hyperuricemia.

Purpose of the Study:

  • To evaluate the effectiveness of ULT compared to supportive care alone for kidney outcomes in patients with CKD and hyperuricemia.
  • To assess the impact of ULT on composite kidney outcomes, end-stage kidney disease (ESKD), and mortality.
  • To provide evidence for clinical decision-making regarding ULT in CKD management.

Main Methods:

  • A cohort study using a sequential target trial emulation framework.
  • Included 269,831 person-trials (56,936 unique persons) with CKD and hyperuricemia from the China Renal Data System.
  • Primary outcome: composite kidney outcome (≥40% eGFR decline or ESKD).

Main Results:

  • The 3-year cumulative incidence of composite kidney outcomes was lower in the ULT group (19.69%) versus the control group (23.22%).
  • ULT was associated with significantly reduced risk for ESKD, all-cause mortality, and cardiovascular mortality.
  • Subgroup and sensitivity analyses confirmed these beneficial effects of ULT.

Conclusions:

  • ULT is associated with a significantly lower risk of kidney disease progression and mortality in patients with stage 3 or higher CKD and hyperuricemia.
  • These findings suggest ULT is beneficial for managing CKD patients with elevated uric acid levels.
  • Further large randomized clinical trials are warranted to definitively establish the role of ULT in this population.

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