Effects of uric acid-lowering therapy (ULT) on renal and cardiovascular outcomes in CKD patients with asymptomatic hyperuricemia： A systematic review and meta-analysis

Abstract

Abstract Background It is well known that hyperuricemia and gout play an important role in patients with chronic kidney disease (CKD). However, the effect of uric acid-lowering therapy (ULT) on prognosis of CKD patients with asymptomatic hyperuricemia remains controversial. Methods Pubmed, EMBASE, China National Knowledge Internet (CNKI) and the Cochrane Library were searched systematically up to October 2021. RCTs assessing the effects of ULT on renal and/or cardiovascular outcomes in CKD patients with asymptomatic hyperuricemia were included. Results A total of 17 studies were included in the meta-analysis. Overall, compared with placebo or no treatment group, ULT group preserved the loss of estimated glomerular filtrating rate (eGFR) with a weighted mean difference (WMD) of 2.55 mL/min/1.73m2, 95%CI [1.31,3.79], p < 0.001 and lowered the increment of serum creatinine (Scr) with a WMD of -24.47µmol/L, 95% CI [-30.71,-18.23], (p < 0.001). ULT was associated with lower incidence of the events of doubling of Scr without dialysis (relative risk (RR) 0.32 [0.21, 0.49], p < 0.001). However, no difference was found for lower incidence of cardiovascular events (p = 0.052), all-cause mortality (p = 0.370), acute kidney injury (AKI) (p = 0.943) or progression to end-stage kidney disease (ESKD)(p = 0.572). Conclusions ULT delay the progression of renal impairment but did not significantly reduce the incidence of cardiovascular events in CKD patients with asymptomatic hyperuricemia.