Authors: Yuka Sato, Daniel I. Feig, Austin G. Stack, Duk- Hee Kang, Miguel A. Lanaspa,A. Ahsan Ejaz, L. Gabriela Sánchez- Lozada, Masanari Kuwabara,Claudio Borghi and Richard J. Johnson
Hyperuricaemia is common among patients with chronic kidney disease (CKD), and increases in severity with the deterioration of kidney function. Although existing guidelines for CKD management do not recommend testing for or treatment of hyperuricaemia in the absence of a diagnosis of gout or urate nephrolithiasis, an emerging body of evidence supports a direct causal relationship between serum urate levels and the development of CKD. Here, we review randomized clinical trials that have evaluated the effect of urate-lowering therapy (ULT) on the rate of CKD progression. Among trials in which individuals in the control arm experienced progressive deterioration of kidney function (which we define as ≥4 ml/min/1.73 m² over the course of the study - typically 6 months to 2 years), treatment with ULT conferred consistent clinical benefits. In contrast, among trials where clinical progression was not observed in the control arm, treatment with ULT was ineffective, but this finding should not be used as an argument against the use of uric acid-lowering therapy. Although additional studies are needed to identify threshold values of serum urate for treatment initiation and to confirm optimal target levels, we believe that sufficient evidence exists to recommend routine measurement of serum urate levels in patients with CKD and consider initiation of ULT among those who are hyperuricaemic with evidence of deteriorating renal function, unless specific contraindications exist.
Sato Y, Feig DI, Stack AG, Kang DH, Lanaspa MA, Ejaz AA, Sánchez-Lozada LG,Kuwabara M, Borghi C, Johnson RJ. The case for uric acid-lowering treatment inpatients with hyperuricaemia and CKD. Nat Rev Nephrol. 2019 Jul 11. doi:10.1038/s41581-019-0174-z. [Epub ahead of print] Review. PubMed PMID: 31296965.