Effects of uric acid-lowering therapy on renal outcomes: A systematic review and meta-analysis

Bose, Bhadran, Badve, Sunil V., Hiremath, Swapnil S., Boudville, Neil, Brown, Fiona G., Cass, Alan, De Zoysa, Janak R., Fassett, Robert G., Faull, Randall, Harris, David C., Hawley, Carmel M., Kanellis, John, Palmer, Suetonia C., Perkovic, Vlado, Pascoe, Elaine M., Rangan, Gopala K., Walker, Robert J., Walters, Giles and Johnson, David W. (2014) Effects of uric acid-lowering therapy on renal outcomes: A systematic review and meta-analysis. Nephrology Dialysis Transplantation, 29 2: 406-413. doi:10.1093/ndt/gft378


Author Bose, Bhadran
Badve, Sunil V.
Hiremath, Swapnil S.
Boudville, Neil
Brown, Fiona G.
Cass, Alan
De Zoysa, Janak R.
Fassett, Robert G.
Faull, Randall
Harris, David C.
Hawley, Carmel M.
Kanellis, John
Palmer, Suetonia C.
Perkovic, Vlado
Pascoe, Elaine M.
Rangan, Gopala K.
Walker, Robert J.
Walters, Giles
Johnson, David W.
Title Effects of uric acid-lowering therapy on renal outcomes: A systematic review and meta-analysis
Journal name Nephrology Dialysis Transplantation   Check publisher's open access policy
ISSN 0931-0509
1460-2385
Publication date 2014-02-01
Year available 2013
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1093/ndt/gft378
Open Access Status Not Open Access
Volume 29
Issue 2
Start page 406
End page 413
Total pages 8
Place of publication Oxford, United Kingdom
Publisher Oxford University Press
Language eng
Formatted abstract
Background.
Non-randomized studies suggest an association between serum uric acid levels and progression of chronic kidney disease (CKD). The aim of this systematic review is to summarize evidence from randomized controlled trials (RCTs) concerning the benefits and risks of uric acid-lowering therapy on renal outcomes.

Methods.
Medline, Excerpta Medical Database and Cochrane Central Register of Controlled Trials were searched with English language restriction for RCTs comparing the effect of uric acid-lowering therapy with placebo/no treatment on renal outcomes. Treatment effects were summarized using random-effects meta-analysis.

Results.
Eight trials (476 participants) evaluating allopurinol treatment were eligible for inclusion. There was substantial heterogeneity in baseline kidney function, cause of CKD and duration of follow-up across these studies. In five trials, there was no significant difference in change in glomerular filtration rate from baseline between the allopurinol and control arms [mean difference (MD) 3.1 mL/min/1.73 m 2, 95% confidence intervals (CI) -0.9, 7.1; heterogeneity χ2 = 1.9, I2 = 0%, P = 0.75]. In three trials, allopurinol treatment abrogated increases in serum creatinine from baseline (MD -0.4 mg/dL, 95% CI -0.8, -0.0 mg/dL; heterogeneity χ2 = 3, I 2 = 34%, P = 0.22). Allopurinol had no effect on proteinuria and blood pressure. Data for effects of allopurinol therapy on progression to end-stage kidney disease and death were scant. Allopurinol had uncertain effects on the risks of adverse events.

Conclusions.
Uric acid-lowering therapy with allopurinol may retard the progression of CKD. However, adequately powered randomized trials are required to evaluate the benefits and risks of uric acid-lowering therapy in CKD.
Keyword Chronic kidney disease
Clinical trial
Kidney function test
Renal dialysis
Uric acid
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes First published online: September 15, 2013

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: Official 2014 Collection
School of Human Movement and Nutrition Sciences Publications
School of Medicine Publications
 
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