Asymptomatic hyperuricemia and chronic kidney disease: Narrative review of a treatment controversial

Eleftheriadis, Theodoros; Golphinopoulos, Spyridon; Pissas, Georgios; Stefanidis, Ioannis

doi:10.1016/j.jare.2017.05.001

Cited by 67 publications

(60 citation statements)

References 78 publications

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“…Large randomized clinical trials on treatment of hyperuricemia for primary or secondary CKD prophylaxis are underway in populations with hypertension. 39 Our results also indicated that patients in the third tertile UA group were significantly more often treated with thiazide diuretics. It is well know that thiazide diuretics induce hyperuricemia.…”

Section: Discussionsupporting

confidence: 60%

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Serum uric acid is associated with incidence of heart failure with preserved ejection fraction and cardiovascular events in patients with arterial hypertension

Fan

Zhang

et al. 2018

J of Clinical Hypertension

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The objective of the present study was to evaluate clinical implications of serum uric acid (UA) on the progression of heart failure with preserved ejection fraction (HFpEF) in hypertensive patients. A total of 1009 adult patients with left ventricular hypertrophy and suspected left ventricular diastolic dysfunction were enrolled at our hospital from January 2008 to December 2011. With a median follow‐up of 7.2 years, 136 (13.2%) patients developed new‐onset HFpEF and 151 (15.0%) had major adverse cardiovascular events (MACEs). Compared with the lowest UA tertile of UA (<302 μmol L−1), subjects in the highest tertile (>367 μmol L−1) had a higher risk of developing new‐onset HFpEF (HR: 1.761, 95% CI: 1.119‐2.772, P = .015) as well as MACEs (HR: 1.664, 95% CI: 1.086‐2.547, P = .019). Our findings indicate that hyperuricemia is associated with detrimental effects in terms of the incidence of new‐onset HFpEF as well as MACEs in hypertensive patient.

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Section: Discussionsupporting

confidence: 60%

“…However, these trials were of limited duration and included only small number of patients. Large randomized clinical trials on treatment of hyperuricemia for primary or secondary CKD prophylaxis are underway in populations with hypertension …”

Section: Discussionmentioning

confidence: 99%

Serum uric acid is associated with incidence of heart failure with preserved ejection fraction and cardiovascular events in patients with arterial hypertension

Fan

Zhang

et al. 2018

J of Clinical Hypertension

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“…Hyperuricemia is a known risk factor for the development and progression of CKD [68]. However, according to the KDIGO guideline there is insufficient evidence to support or refute the use of agents to lower serum uric acid concentrations in people with CKD and either symptomatic or asymptomatic hyperuricemia in order to delay the progression of CKD.…”

Section: Hyperuricemiamentioning

confidence: 99%

Impact of Recent Clinical Trials on Nephrology Practice: Are We in a Stagnant Era?

et al. 2018

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Background: Although renal replacement therapy prevents death from uremia, survival among patients with acute and chronic kidney diseases (CKD) remains an imperative concern. The expected life span of US dialysis patients 60–64 years of age is approximately 4.5 years; this is similar to that of patients with lung cancer. Despite substantial progress in many medical specialties over the past decades (e.g., notable reductions in myocardial infarction, stroke, and mortality rates in the general population), survival among dialysis patients has not improved significantly over the same period. A few decades ago, HIV infection and AIDS were pretty much a death sentence. Because of progress in HIV treatment, now it can be controlled with a daily pill, and ongoing research is pushing treatment even further and controls the virus with longer-acting treatment. A cure is no longer impossible for HIV and other viral infections such as hepatitis B and C and many malignancies, but so far there is no cure for CKD. Summary: Billions of dollars have been spent on kidney disease research in the past decades, with no tangible progress in clinical practice. The challenges of improving the quantity and quality of trials in nephrology are enormous. The number of randomized controlled trials (RCTs) published in nephrology is lower than that in other medical subspecialties, and most of the big RCTs in nephrology yield negative results. Nephrology studies evaluating hard clinical endpoints or surrogate endpoints are scarce. Key Message: Herein we discuss the slow progress in nephrology research that has impacted clinical practice over the last couple of decades and highlight the major obstacles, challenges, and potential solutions.

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“…Hyperuricemia is defined as a serum UA level > 416 µmol/L in males and >357 µmol/L in females [1]. There are several ways to define UA: (i) a statistical definition that defines high uric acid (HUA) as serum (S)UA lying more than 2 standard deviations above the mean (>458 µmol/L in men or >393 µmol/L in women) [2]; (ii) a physicochemical definition of HUA, taking into account the saturation point for monosodium urate crystals (≥357 mcmol/l) [3]; (iii) a risk definition based UA values associated with an increased cardiovascular risk (476 or 535 mcmol/l as the limit to begin treatment) [4] or (iv) a risk for kidney function definition based on upper limited expected SUA values according to serum creatinine (SCr <0,132 µmol/L: SUA >535 µmol/L, SCr 0,132-0.176 µmol/L: SUA >595 µmol/L, and SCr >0.176 µmol/L: SUA >714 mg/dL [5]).…”

mentioning

confidence: 99%

“…Asian patients with end-stage renal disease (ESRD) present higher rates of HUA, and men have a higher risk of HUA and gout in the general population [7]. Data from several studies have associated HUA with increased incidence and/or progression of CKD [2,4,[7][8][9][10][11][12][13][14][15][16][17].…”

mentioning

confidence: 99%

The unanswered Questions in Hyperuricemia: is it a cause of chronic kidney disease, a compensation mechanism, a coincidence, a consequence of disease or concurrent phenomenon?

Kolesnyk

2018

Ukr. Journ. Nephrol. and Dial.

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Chronic kidney disease (CKD) has become a global public health problem because of its high prevalence and the accompanying increase in the risk of end-stage renal disease, cardiovascular disease, and premature death. The role of uric acid (UA) in the pathogenesis and progression of CKD remains controversial. Although many evidence-based studies have suggested that UA itself may harm patients with CKD by increasing inflammation and CKD progression, the issue is still a matter of discussions. In this review we try to clarify what is hyperuricemia – cause of CKD, compensation, coincidence, consequence of CKD or it is only an epiphenomenon, and to evaluate current evidence of different types of targeted hypouricemic therapy effectiveness. So, to treat or not to treat?

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Asymptomatic hyperuricemia and chronic kidney disease: Narrative review of a treatment controversial

Abstract: Graphical abstract

Cited by 67 publications

References 78 publications

Serum uric acid is associated with incidence of heart failure with preserved ejection fraction and cardiovascular events in patients with arterial hypertension

Serum uric acid is associated with incidence of heart failure with preserved ejection fraction and cardiovascular events in patients with arterial hypertension

Impact of Recent Clinical Trials on Nephrology Practice: Are We in a Stagnant Era?

The unanswered Questions in Hyperuricemia: is it a cause of chronic kidney disease, a compensation mechanism, a coincidence, a consequence of disease or concurrent phenomenon?

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