2020
DOI: 10.1093/ckj/sfaa236
|View full text |Cite
|
Sign up to set email alerts
|

The dirty little secret of urate-lowering therapy: useless to stop chronic kidney disease progression and may increase mortality

Abstract: Hyperuricaemia is frequent in chronic kidney disease (CKD). Observational studies have shown an association with adverse outcomes and acquired hyperuricaemia (meaning serum urate levels as low as 1.0 mg/dL) in animal models induces kidney injury. This evidence does not justify the widespread use of urate-lowering drugs for asymptomatic hyperuricaemia in CKD. However, promising results from small, open-label studies led some physicians to prescribe urate-lowering drugs to slow CKD progression. Two recent, large… Show more

Help me understand this report

Search citation statements

Order By: Relevance

Paper Sections

Select...
2
1
1

Citation Types

0
9
0

Year Published

2021
2021
2024
2024

Publication Types

Select...
8
1

Relationship

1
8

Authors

Journals

citations
Cited by 14 publications
(9 citation statements)
references
References 53 publications
0
9
0
Order By: Relevance
“…Several groups have suggested that asymptomatic hyperuricemia in CKD is benign and should not be treated, or may even be beneficial. 9 , 10 , 11 , 12 Here, we present our countering viewpoint with recommendations for how to move forward. For purposes of the discussion, our analysis will be separately about those who have gout and CKD, and those with asymptomatic hyperuricemia and CKD.…”
mentioning
confidence: 99%
“…Several groups have suggested that asymptomatic hyperuricemia in CKD is benign and should not be treated, or may even be beneficial. 9 , 10 , 11 , 12 Here, we present our countering viewpoint with recommendations for how to move forward. For purposes of the discussion, our analysis will be separately about those who have gout and CKD, and those with asymptomatic hyperuricemia and CKD.…”
mentioning
confidence: 99%
“…These two clinical trials not only showed negative findings on slowing the eGFR decline by allopurinol, but also revealed the possible concerns regarding the adverse effects of allopurinol treatment. Both of these studies revealed a trend of increasing mortality and serious adverse events in patients on allopurinol [ 88 , 89 , 90 , 91 ]. Although some investigators have argued that the study population should be optimized by enrolling younger, nonproteinuric CKD patients with a better preserved GFR, these low-risk patients might maintain a stable GFR even after the placebo treatment [ 90 ].…”
Section: Treatment and Evidence Of Clinical Trialsmentioning
confidence: 99%
“…Both of these studies revealed a trend of increasing mortality and serious adverse events in patients on allopurinol [ 88 , 89 , 90 , 91 ]. Although some investigators have argued that the study population should be optimized by enrolling younger, nonproteinuric CKD patients with a better preserved GFR, these low-risk patients might maintain a stable GFR even after the placebo treatment [ 90 ]. In addition, a recent large cohort study revealed that the lower the eGFR, the higher the prevalence of hyperuricemia and gout [ 92 ], and patients with a lower GFR had a higher risk of CKD progression, which might have led the group to consider treatment.…”
Section: Treatment and Evidence Of Clinical Trialsmentioning
confidence: 99%
“…4 10 17 In addition, results from two recent randomised clinical trials showed that, among those with asymptomatic hyperuricaemia and CKD, allopurinol provided no renoprotective benefits and potentially doubled the risk of death. [18][19][20] Clearly, the introduction of ULT for asymptomatic hyperuricaemia should be considered only after carefully assessing the clinical risks and benefits and the health economics of such treatment.…”
Section: Inflammatory Arthritismentioning
confidence: 99%