Urate-lowering agents for asymptomatic hyperuricemia in stage 3 – 4 chronic kidney disease: Controversial role of kidney function

Abstract

Because the serum uric acid level increases as the glomerular filtration rate (GFR) decreases, hyperuricemia is associated with chronic kidney disease (CKD). Although hyperuricemia is a risk factor for CKD progression, the causal role of uric acid remains controversial in patients with CKD and asymptomatic hyperuricemia. This study included 588 patients with stage 3-4 CKD and asymptomatic hyperuricemia. Using propensity score matching, 165 pairs treated and untreated with pharmacologic urate-lowering therapy were matched. Kaplan-Meier curves were constructed to determine the effect of urate-lowering agents on kidney survival. The prognostic value for kidney survival was ascertained using Cox regression analysis. The GFR changes over time between the patients treated and untreated with urate-lowering agents were assessed using a linear mixed model analysis. The mean age of the matched patients was 63.2 ± 12.7 years, and 52 (15.8%) patients had diabetic nephropathy. The mean estimated GFR (eGFR) and serum uric acid level were 36.7 mL/min/1.73 m 2 and 7.8 mg/dL, respectively. During a mean follow-up period of 41.9 months, 87 developed end-stage kidney disease (ESKD). The incidence rates of ESKD were comparable between the patients treated and untreated with urate-lowering agents. The Kaplan-Meier analysis indicated that kidney survival was also comparable between them. In the multivariate analysis, heart failure and low eGFR were the significant prognostic factors for kidney survival. However, pharmacologic urate-lowering therapy was not predictive of kidney survival. The overall GFR decline rate was also comparable between the groups (P = 0.13). The efficacy of pharmacologic urate-lowering therapy in delaying CKD progression remains controversial. Therefore, further randomized controlled trials are needed to confirm its efficacy in attenuating kidney function deterioration in patients with stage 3-4 CKD.

Bioactive Compounds from Plant-Based Functional Foods: A Promising Choice for the Prevention and Management of Hyperuricemia

“…HUA is considered to be a major risk factor of metabolic disorders after hypertension, hyperlipidemia, and hyperglycemia [ 8 ], and is considered to be the major pathological basis of gout, whereby approximately 5–12% of HUA patients have the possibility of developing gout [ 9 ]. Moreover, a large number of epidemiological studies have reported that HUA is closely related to diabetes, hypertension, obesity, cardiovascular disease, and kidney disease [ 10 , 11 , 12 , 13 ], which suggests that complications associated with HUA may increase in the coming years.…”

The Association Between Uric Acid and Symmetric Dimethylarginine Levels in the Patients Undergoing Twice-weekly Hemodialysis

“…Uric acid is a product of purine metabolism and is mainly excreted by kidneys (19). Consequently, hyperuricemia is highly prevalent in CKD patients (20). So, UA serum concentration depends on the rate of purine metabolism and the efficiency of its renal clearance, which is easily affected by dialysis (21).…”

Hyperuricemia, a Non-Independent Component of Metabolic Syndrome, Only Predicts Renal Outcome in Chronic Kidney Disease Patients without Metabolic Syndrome or Diabetes

“…UA increases renal inflammation and fibrosis [ 14 ], and UA crystals cause gouty nephropathy in basic studies [ 15 , 16 ]. Some observational studies have demonstrated the detrimental effect of hyperuricemia in CKD patients [ 17 ], but some studies disagree [ 18 ]. One explanation is that the progression of CKD elevates UA via reduced renal excretion [ 19 ].…”