期刊
NEPHROLOGY DIALYSIS TRANSPLANTATION
卷 29, 期 2, 页码 406-413出版社
OXFORD UNIV PRESS
DOI: 10.1093/ndt/gft378
关键词
chronic kidney disease; clinical trial; kidney function test; renal dialysis; uric acid
资金
- National Health and Medical Research 400 Council Project Grant [1043203]
- Queensland Government Health Research Fellowship
- Novartis
- Aspen
- Consorzio Mario Negri Sud
- Amgen Dompe
- L'Oreal For Women in Science Fellowship (Australia)
- L'Oreal For Women in Science Fellowship (New Zealand)
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 chi(2) = 1.9, I-2 = 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 chi(2) = 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.
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