Prevention of kidney function decline using uric acid-lowering therapy in chronic kidney disease patients: a systematic review and network meta-analysis

Tsukamoto, Shunichiro; Okami, Naohito; Yamada, Takayuki; Azushima, Kengo; Yamaji, Takahiro; Kinguchi, Sho; Uneda, Kazushi; Kanaoka, Tomohiko; Wakui, Hiromichi; Tamura, Kouichi

doi:10.1007/s10067-021-05956-5

Cited by 26 publications

(19 citation statements)

References 40 publications

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“…One might hope that meta-analyses might help resolve the issues, but even here there remains confusion, because some recent studies suggest that treatment of asymptomatic hyperuricemia in CKD does slow progression, 52 , 53 whereas others are mixed or indeterminant, 50 , 54 , 55 and some are negative. 56 Some meta-analyses show benefit with only specific urate-lowering drugs, such as febuxostat.…”

Section: Gout and Ckdmentioning

confidence: 99%

Uric Acid and Chronic Kidney Disease: Still More to Do

Johnson¹,

Sánchez-Lozada²,

Lanaspa³

et al. 2023

Kidney International Reports

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Section: Gout and Ckdmentioning

confidence: 99%

Uric Acid and Chronic Kidney Disease: Still More to Do

Johnson¹,

Sánchez-Lozada²,

Lanaspa³

et al. 2023

Kidney International Reports

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“…acid-lowering therapy would prevent kidney function decline in patients with CKD (28). In addition, our findings put insights into whether maintaining uric acid lower than the therapeutic standard would delay CKD progression.…”

Section: Discussionmentioning

confidence: 76%

“…High uric acid may result in arteriolosclerosis, glomerular injury, and tubulointerstitial fibrosis, either directly triggering urate crystals or indirectly causing vascular injuries ( 27 ). One systemic review study supported that improving uric acid abnormality by uric acid-lowering therapy would prevent kidney function decline in patients with CKD ( 28 ). In addition, our findings put insights into whether maintaining uric acid lower than the therapeutic standard would delay CKD progression.…”

Section: Discussionmentioning

confidence: 99%

Factors associated with renal function state transitions: A population-based community survey in Taiwan

Tsai

Lin

Hsu

et al. 2022

Front. Public Health

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BackgroundUnderstanding renal function state transition risk and associated factors in community residences is vital for appropriate preventive and care actions. We aim to investigate factors affecting renal function state transitions through 10-year longitudinal community screening surveys.MethodsThe prospective cohort study included participants who attended the screening program ≥2 times from 2001 to 2009 and were divided into two cohorts: those with baseline estimated glomerular filtration rate (eGFR) ≥60 (n = 46,278) and those with eGFR 59–30 mL/min/1.73 m2 (n = 4,656). We applied the illness-death model to identify associated factors with eGFR <60 and death for the cohort with baseline eGFR ≥60 and eGFR <30 and death for that with baseline eGFR ≥59–30.ResultsAmong the followed-up participants, 3,018 (6.5%) in the cohort of baseline eGFR ≥60 mL/min/1.73 m2 and 322 (6.9%) in the cohort of eGFR 59–30 mL/min/1.73 m2 experienced renal function state transition during a median over 7-year follow-up. Besides eGFR and grade of proteinuria, diabetes mellitus (adding nearly 50% hazard rate) is the main factor associated with both state transitions. Other early-phase eGFR state transition risk factors were metabolic syndrome score, triglyceride, uric acid, fasting blood sugar, and high-density lipoprotein cholesterol. Males, poor hemoglobin, high triglyceride, and high low-density lipoprotein cholesterol were all linked with the late-phase eGFR state transition hazard rate.ConclusionThe study developed the state transition functions for community participants with varying renal function levels. Further actions to develop precision screening plans and services that incorporate personal risk factors and state transition risks are necessary.

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“…The previous study showed that eGFR levels were significantly higher after ULT, and the change of eGFR was negatively correlated with the change in UA levels [ 17 ]. A recent meta-analysis found that ULT might be useful for improvement of eGFR and reduction of urinary albumin/creatinine ratio in CKD patients [ 18 ]. The result was similar to many other meta-analysis [ 19 – 21 ].…”

Section: Discussionmentioning

confidence: 99%

The association among uric acid, microalbumin and estimated glomerular filtration rate in hypertensive patients: a case control study

Chou

Wei²,

Chen³

et al. 2023

BMC Cardiovasc Disord

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Objective To estimate the relationship among uric acid (UA), 24-h microalbumin (24 h-MAU) and estimated glomerular filtration rate (eGFR) in hypertensive patients. Method The study enrolled adult patients hospitalized in TEDA International Cardiovascular Hospital. The study was used to explore the correlation among UA, 24 h-MAU and eGFR. Univariate analysis was used to compare continuous or categorical data groups according to data type. Multivariate analysis was used to explore the correlation among UA, Log 24 h-MAU and eGFR by linear regression, and the relationship among UA, 24 h-MAU ≥ 30 mg/24 h (increased 24 h-MAU) and eGFR < 90 ml·min−1·1.73 m−2 (mildly decreased eGFR) by logistic regression. Mediation effect analysis was used to explore the mediating effect of increased 24 h-MAU between UA and mildly decreased eGFR. Subgroup analysis was used to investigate the correlation among UA, 24 h-MAU and eGFR in different gender. Result Seven hundred and thirty-three inpatients were enrolled in the study, including 257 patients with hyperuricemia. The level of UA was 377.8 ± 99.9 μmol/L in all patients enrolled, and it was about 50.1% higher in hyperuricemia group (482.3 ± 58.8 μmol/L vs. 321.4 ± 63.5 μmol/L, P < 0.001). The prevalence of hyperuricemia was 35.1% (95%CI 31.6–38.5%). The univariate regression analysis showed that UA was significant related to Log 24 h-MAU, increased 24 h-MAU, eGFR and mildly decreased eGFR. After adjusted confounding factors, UA was significant related to Log 24 h-MAU (β = 0.163, P < 0.001), eGFR (β = − 0.196, P < 0.001), increased 24 h-MAU (quantitative analysis: OR = 1.045, 95%CI 1.020–1.071, P < 0.001; qualitative analysis: OR = 2.245, 95%CI 1.410–3.572, P = 0.001), but had no significant relationship with mildly decreased eGFR. Mediating effect analysis showed that increased 24 h-MAU partially mediated the relationship between UA and mildly decreased eGFR (relative indirect effect: 25.0% and 20.3% in quantitative analysis and qualitative analysis respectively). In the subgroup analysis, the results were stable and similar to the analysis for entry patients. Conclusion The prevalence of hyperuricemia was higher in hypertensive inpatients. UA was strongly associated with Log 24 h-MAU, eGFR and increased 24 h-MAU, while the correlation with mildly decreased eGFR was affected by multiple factors. And increased 24 h-MAU might be the intermediate factor between UA and mildly decreased eGFR.

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Prevention of kidney function decline using uric acid-lowering therapy in chronic kidney disease patients: a systematic review and network meta-analysis

Cited by 26 publications

References 40 publications

Uric Acid and Chronic Kidney Disease: Still More to Do

Uric Acid and Chronic Kidney Disease: Still More to Do

Factors associated with renal function state transitions: A population-based community survey in Taiwan

The association among uric acid, microalbumin and estimated glomerular filtration rate in hypertensive patients: a case control study

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