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Effects of uric acid-lowering therapy on renal outcomes: a systematic review and meta-analysis

Bose, Bhadran, Badve, Sunil V., Hiremath, Swapnil S., Boudville, Neil, Brown, Fiona G., Cass, Alan, de Zoysa, Janak R., Fassett, Robert C., Faull, Randall, Harris, David C., Hawley, Carmel M., Kanellis, John, Palmer, Suetonia C., Perkovic, Vlado, Pascoe, Elaine M., Rangan, Gopala K., Walker, Robert J., Walters, Giles and Johnson, David W. (2014). Effects of uric acid-lowering therapy on renal outcomes: a systematic review and meta-analysis. Nephrology Dialysis Transplantation,29(2):406-413.

Document type: Journal Article

IRMA ID 11035xPUB40
Title Effects of uric acid-lowering therapy on renal outcomes: a systematic review and meta-analysis
Author Bose, Bhadran
Badve, Sunil V.
Hiremath, Swapnil S.
Boudville, Neil
Brown, Fiona G.
Cass, Alan
de Zoysa, Janak R.
Fassett, Robert C.
Faull, Randall
Harris, David C.
Hawley, Carmel M.
Kanellis, John
Palmer, Suetonia C.
Perkovic, Vlado
Pascoe, Elaine M.
Rangan, Gopala K.
Walker, Robert J.
Walters, Giles
Johnson, David W.
Journal Name Nephrology Dialysis Transplantation
Publication Date 2014
Volume Number 29
Issue Number 2
ISSN 0931-0509   (check CDU catalogue open catalogue search in new window)
Scopus ID 2-s2.0-84893848420
Start Page 406
End Page 413
Total Pages 7
Place of Publication United Kingdom
Publisher Oxford University Press
HERDC Category C1 - Journal Article (DIISR)
Abstract Background
Non-randomized studies suggest an association between serum uric acid levels and progression of chronic kidney disease (CKD). The aim of this systematic review is to summarize evidence from randomized controlled trials (RCTs) concerning the benefits and risks of uric acid-lowering therapy on renal outcomes.

Methods
Medline, Excerpta Medical Database and Cochrane Central Register of Controlled Trials were searched with English language restriction for RCTs comparing the effect of uric acid-lowering therapy with placebo/no treatment on renal outcomes. Treatment effects were summarized using random-effects meta-analysis.

Results
Eight trials (476 participants) evaluating allopurinol treatment were eligible for inclusion. There was substantial heterogeneity in baseline kidney function, cause of CKD and duration of follow-up across these studies. In five trials, there was no significant difference in change in glomerular filtration rate from baseline between the allopurinol and control arms [mean difference (MD) 3.1 mL/min/1.73 m2, 95% confidence intervals (CI) −0.9, 7.1; heterogeneity χ2 = 1.9, I2 = 0%, P = 0.75]. In three trials, allopurinol treatment abrogated increases in serum creatinine from baseline (MD −0.4 mg/dL, 95% CI −0.8, −0.0 mg/dL; heterogeneity χ2 = 3, I2 = 34%, P = 0.22). Allopurinol had no effect on proteinuria and blood pressure. Data for effects of allopurinol therapy on progression to end-stage kidney disease and death were scant. Allopurinol had uncertain effects on the risks of adverse events.

Conclusions
Uric acid-lowering therapy with allopurinol may retard the progression of CKD. However, adequately powered randomized trials are required to evaluate the benefits and risks of uric acid-lowering therapy in CKD.
Keywords chronic kidney disease
clinical trial
kidney function test
renal dialysis
uric acid
DOI http://dx.doi.org/10.1093/ndt/gft378   (check subscription with CDU E-Gateway service for CDU Staff and Students  check subscription with CDU E-Gateway in new window)
 
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