Effects of uric acid-lowering therapy on the progression of chronic kidney disease: a systematic review and meta-analysis

• Published in: Renal failure Vol. 40; no. 1; pp. 289 - 297
• Main Authors: Liu, Xuemei, Zhai, Tingting, Ma, Ruixia, Luo, Congjuan, Wang, Huifang, Liu, Liqiu
• Format: Journal Article
• Language: English
• Published: England Taylor & Francis 01.11.2018; Taylor & Francis Ltd; Taylor & Francis Group
• Subjects: chronic kidney disease; Clinical Study; Clinical trials; Creatinine; Creatinine - blood; Disease Progression; Glomerular Filtration Rate; Humans; Hyperuricemia - blood; Hyperuricemia - drug therapy; Hyperuricemia - mortality; Hyperuricemia - physiopathology; Kidney - physiopathology; Kidney diseases; Meta-analysis; randomized controlled trials; Randomized Controlled Trials as Topic; Renal Insufficiency, Chronic - blood; Renal Insufficiency, Chronic - drug therapy; Renal Insufficiency, Chronic - mortality; Renal Insufficiency, Chronic - physiopathology; Sensitivity analysis; Treatment Outcome; Uric acid; Uric Acid - blood; uric acid-lowering therapy; Uricosuric Agents - therapeutic use; uric acid-lowering therapy; chronic kidney disease; Uric acid; randomized controlled trials
• ISSN: 0886-022X; 1525-6049
• DOI: 10.1080/0886022X.2018.1456463

Objectives: Whether uric acid levels were associated with the progression of chronic kidney disease (CKD) remained controversial. This meta-analysis was aimed to assess the effect of lowering serum uric acid therapy on the progression of CKD to clarify the role of uric acid in the progression of CKD indirectly. Methods: Pubmed, Embase, the Cochrane library, CBM were searched for randomized controlled trials (RCTs) that assessed the efficiency of lowering serum uric acid therapy on the progression of CKD without language restriction. Summary estimates of weighted mean differences (WMDs) and relative risk (RR) were obtained by using random-effect or fixed-effect models. Sensitivity analyses were performed to identify the source of heterogeneity. Results: A total of 12 randomized controlled trials with 832 CKD participants were included in the analysis. Pooled estimate for eGFR was in favor of lowering serum uric acid therapy with a mean difference (MD) of 3.88 ml/min/1.73 m 2 , 95% CI 1.26-6.49 ml/min/1.73 m 2 , p = .004 and this was consistent with results for serum creatinine. The risk of worsening of kidney function or ESRD or death was significantly decreased in the treatment group compared to the control group (RR 0.39, 95% CI 0.28-0.52, p< .01). Conclusions: Uric acid-lowering therapy may be effective in retarding the progression of CKD. Further randomized controlled trials should be performed to confirm the effect of lowering serum uric acid therapy on the progression of CKD.