Effect Of Uric Acid-lowering Therapy In Patients With CKD:A Meta-analysis

Objective:Chronic kidney disease(CKD)is a severe public health challenge.Published data have implicated that elevated serum uric acid concentration is associated with the progression of CKD.The effects of uric acid-lowering therapy in patients with CKD remain uncertain.We undertook a systematic review and meta-analysis to investigate the effects of uric acid-lowering agents on major clinical outcomes.Methods:We systematically searched MEDLINE,Embase,and the Cochrane Library for trials until February 2016.Prospective,randomized,controlled trials assessing the effects of uric acid-lowering agents on cardiovascular and kidney outcomes in people with CKD were included.Random-effects analytical methods were used.Study selection,data extraction,and quality assessment were performed independently by 2 investigators.Results:Sixteen eligible trials were identified,providing data for 1 211 patients with CKD,including 146 kidney failure events and 69 cardiovascular events.Uric acid-lowering therapy produced a 55% RR reduction(95% CI,31 to 64)for kidney failure events(P < 0.001),an 60% RR reduction(95% CI,17 to 62)for cardiovascular events(P < 0.001),but had no significantly effect on the risk of all-cause death(RR,0.86;95% CI,0.50 to 1.46).The mean differences for rate of decline in eGFR(4.10ml/min/1.73m2 per year slower in uric acid-lowering therapy recipients,95% CI,1.86 to 6.35)and the standardized mean differences for the change in proteinuria or albuminuria(-0.23 units of standard deviation greater in uric acid-lowering therapy recipients;95% CI,-0.43 to-0.04)were also statistically significant.Conclusions:The uric acid-lowering therapy seemed to improve the kidney outcomes and reduce the risk of cardiovascular events in adults with CKD.