The therapy of lowering uric acid in patients with chronic kidney disease (Part 2)
Allow me to continue the discussion we started last week.
Based on a study involving persons from the United States, uric acid–lowering therapy was not associated with improved kidney functions or end stage kidney disease (ESKD) or albuminuria.
This is contrary to the hypothesis, as it has been established that uric acid–lowering therapy, which is done using mainly allopurinol, is linked with new onset chronic kidney disease and showed no association with incident ESKD.
The link of uric acid–lowering therapy with unfavorable kidney results was limited to patients with baseline serum uric acid levels of 8 mg/dL or less, while the same links were not significant in patients with serum uric acid levels greater than 8 mg/dL.
As such, the results do not support a direct benefit of urate lowering on the development of new-onset CKD.
The study supports that allopurinol may help in delaying progression of established CKD.
Elevated serum uric acid can be lowered using readily available medicines.
Smaller trials suggested benefits from lowering serum uric acid levels in patients with pre-existing kidney disease.
However, in 2 large randomized clinical trials involving patients with type 1 diabetes and in patients without diabetes, it was found that treatment of hyperuricemia did not result in improved progression of pre-existing kidney disease.
The impact of uric acid lowering therapies on the incidence of new-onset CKD has been less well studied in clinical trials.
We will continue with this discussion in our column next week.