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BMC Nephrology
Published in: BMC Nephrology 1/2015

Open Access 01-12-2015 | Research article

Urate lowering therapy to improve renal outcomes in patients with chronic kidney disease: systematic review and meta-analysis

Authors: Tahir Kanji, Mandark Gandhi, Catherine M Clase, Robert Yang

Published in: BMC Nephrology | Issue 1/2015

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Abstract

Background

Hyperuricemia may contribute to renal injury. We do not know whether use of treatments that lower urate reduce the progression of chronic kidney disease (CKD) and cardiovascular disease. We performed a systematic review and meta-analysis of randomized controlled trials to assess the benefits and risks of treatments that lower urate in patients with stages 3-5 CKD.

Methods

We searched MEDLINE, EMBASE, CENTRAL, Web of Science and trial registers for randomized controlled trials (RCTs) without language restriction. Two authors independently screened articles, assessed risk of bias and extracted data. Data obtained included serum uric acid, serum creatinine or other estimates of glomerular filtration rate, incidence of end-stage renal disease (ESRD), systolic and diastolic blood pressure, proteinuria, cardiovascular disease and adverse events.

Results

From the 5497 citations screened, 19 RCTs enrolling 992 participants met our inclusion criteria. Given significant heterogeneity in duration of follow-up and study comparators, only trials greater than 3 months comparing allopurinol and inactive control were meta-analyzed using random effects models. Pooled estimate for eGFR was in favour of allopurinol with a mean difference (MD) of 3.2 ml/min/1.73 m2, 95% CI 0.16-6.2 ml/min/1.73 m2, p = 0.039 and this was consistent with results for serum creatinine. Statistically significant reductions in serum uric acid, systolic and diastolic blood pressure were found, favouring allopurinol. There were insufficient data on adverse events, incidence of ESRD and cardiovascular disease for analysis.

Conclusions

Adequately powered RCTs are needed to establish whether treatments that lower urate have beneficial renal and cardiovascular effects.
Appendix
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Metadata
Title
Urate lowering therapy to improve renal outcomes in patients with chronic kidney disease: systematic review and meta-analysis
Authors
Tahir Kanji
Mandark Gandhi
Catherine M Clase
Robert Yang
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Nephrology / Issue 1/2015
Electronic ISSN: 1471-2369
DOI
https://doi.org/10.1186/s12882-015-0047-z

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WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

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