Impact of urate-lowering therapy on the course of chronic kidney disease in patients with asymptomatic hyperuricemia: a meta-analysis of randomized controlled trials
- 作者: Mazurov V.I.1,2, Sayganov S.A.1, Martynov A.I.3, Bashkinov R.A.1,2, Gaydukova I.Z.1,2, Sapozhnikov K.V.4, Tolkacheva D.G.4, Sableva N.A.4, Tsinzerling A.Y.2
-
隶属关系:
- North-Western State Medical University named after I.I. Mechnikov
- Clinical Rheumatology Hospital No. 25
- A.I. Yevdokimov Moscow State University of Medicine and Dentistry
- Russian Presidential Academy of National Economy and Public Administration
- 期: 卷 15, 编号 4 (2023)
- 页面: 5-18
- 栏目: Reviews
- ##submission.dateSubmitted##: 20.10.2023
- ##submission.dateAccepted##: 12.11.2023
- ##submission.datePublished##: 13.01.2024
- URL: https://journals.eco-vector.com/vszgmu/article/view/604850
- DOI: https://doi.org/10.17816/mechnikov604850
- ID: 604850
如何引用文章
详细
The presented study has been carried out to identify the effect of urate-lowering therapy with xanthine oxidase inhibitors on glomerular filtration rate and serum uric acid in patients with asymptomatic hyperuricemia and chronic kidney disease. A systematic review of randomized controlled trials has been conducted; its results based on meta-analysis has been evaluated.
A systematic search and selection of publications in Embase, PubMed, Cochrane Library, and eLibrary databases has been performed. The studied drugs were xanthine oxidase inhibitors: allopurinol and febuxostat. The study considered the following parameters such as efficacy endpoints, namely, glomerular filtration rate and serum uric acid after 3–15 months of follow-up. Clinical and methodological heterogeneity of the included randomized controlled trials has been assessed as well as publication bias and risk of systematic error. Synthesis has been performed using bivariate meta-analysis assessing residual statistical heterogeneity.
7 selected randomized controlled trials (1203 patients) have been included in the meta-analysis. This analysis revealed that medication urate-lowering therapy (allopurinol or febuxostat) was associated with higher glomerular filtration rate (+3.0 ml/min/1.73 m2; 95% confidence interval +0.4 to +5.6; p = 0.022) compared with the controls (placebo/no urate-lowering therapy) at 3–15 months of follow-up. Along with this, medication urate-lowering therapy (allopurinol or febuxostat) has been found to result in lower serum uric acid (−3.3 mg/dl; 95% confidence interval −3.8 to −2.8; р < 0.001) compared to the controls (placebo / no urate-lowering therapy) at 3–15 months of follow-up.
The results of the meta-analysis have demonstrated a positive role of allopurinol and febuxostat in increasing glomerular filtration rate and decreasing serum uric acid in patients with chronic kidney disease and asymptomatic hyperuricemia. The presented data suggest that therapeutic measures aimed at the elimination of asymptomatic hyperuricemia, including the use of xanthine oxidase inhibitors, may be important in slowing the progression of chronic kidney failure and may be additional factors of nephroprotection.
全文:
作者简介
Vadim Mazurov
North-Western State Medical University named after I.I. Mechnikov; Clinical Rheumatology Hospital No. 25
Email: maz.nwgmu@yandex.ru
ORCID iD: 0000-0002-0797-2051
SPIN 代码: 6823-5482
Scopus 作者 ID: 16936315400
MD, Dr. Sci. (Med.), Professor, Academician of the RAS, Honored Scientist of the Russian Federation
俄罗斯联邦, 41 Kirochnaya St., Saint Petersburg, 191015; Saint PetersburgSergey Sayganov
North-Western State Medical University named after I.I. Mechnikov
Email: ssayganov@gmail.com
ORCID iD: 0000-0001-8325-1937
SPIN 代码: 2174-6400
Scopus 作者 ID: 36140532200
MD, Dr. Sci. (Med.), Professor
俄罗斯联邦, 41 Kirochnaya St., Saint Petersburg, 191015Anatoly Martynov
A.I. Yevdokimov Moscow State University of Medicine and Dentistry
Email: idjema@gmail.com
ORCID iD: 0000-0002-0783-488X
SPIN 代码: 5271-3173
Scopus 作者 ID: 7102769644
MD, Dr. Sci. (Med.), Professor, Academician of the RAS
俄罗斯联邦, MoscowRoman Bashkinov
North-Western State Medical University named after I.I. Mechnikov; Clinical Rheumatology Hospital No. 25
编辑信件的主要联系方式.
Email: bashkinov-roman@mail.ru
ORCID iD: 0000-0001-9344-1304
SPIN 代码: 5169-5066
Scopus 作者 ID: 57221994610
MD, postgraduate student
俄罗斯联邦, 41 Kirochnaya St., Saint Petersburg, 191015; Saint PetersburgInna Gaydukova
North-Western State Medical University named after I.I. Mechnikov; Clinical Rheumatology Hospital No. 25
Email: ubp1976@list.ru
ORCID iD: 0000-0003-3500-7256
SPIN 代码: 3083-7996
Scopus 作者 ID: 55237525900
MD, Dr. Sci. (Med.), Professor
俄罗斯联邦, 41 Kirochnaya St., Saint Petersburg, 191015; Saint PetersburgKirill Sapozhnikov
Russian Presidential Academy of National Economy and Public Administration
Email: marinheira@rambler.ru
ORCID iD: 0000-0002-2476-7666
SPIN 代码: 2707-0339
Scopus 作者 ID: 57200810332
MD, Cand. Sci. (Med.)
俄罗斯联邦, МоскваDaria Tolkacheva
Russian Presidential Academy of National Economy and Public Administration
Email: tolkacheva.d@gmail.com
ORCID iD: 0000-0002-6314-4218
Scopus 作者 ID: 57221817074
Independent expert on research projects of Project Office of the North-West Institute of Management - branch office FSBEI HE «Russian Presidential Academy of National Economy and Public Administration»
俄罗斯联邦, MoscowNatalia Sableva
Russian Presidential Academy of National Economy and Public Administration
Email: sablevana@gmail.com
ORCID iD: 0000-0002-5809-9221
Scopus 作者 ID: 57712944300
Independent expert on research projects of Project Office of the North-West Institute of Management - branch office FSBEI HE «Russian Presidential Academy of National Economy and Public Administration»
俄罗斯联邦, MoscowAlexandra Tsinzerling
Clinical Rheumatology Hospital No. 25
Email: aleksa.fonturenko@mail.ru
ORCID iD: 0000-0003-4860-0518
SPIN 代码: 5613-9035
Senior laboratory assistant of the Department of therapy, rheumatology, examination of temporary disability and quality of medical care named after E.E. Eichwald, rheumatologist
俄罗斯联邦, Saint Petersburg参考
- Shalnova SA, Deev AD, Artamonova GV, et al. Hyperuricemia and its correlates in the Russian population (results of ESSE-RF epidemiological study). Rational Pharmacotherapy in Cardiology. 2014;10(2):153–159. (In Russ.) doi: 10.20996/1819-6446-2014-10-2-153-159
- Chen-Xu M, Yokose C, Rai SK, et al. Contemporary prevalence of gout and hyperuricemia in the United States and decadal trends: The National Health and Nutrition Examination Survey, 2007–2016. Arthritis Rheumatol. 2019;71(6):991–999. doi: 10.1002/art.40807
- Trifirò G, Morabito P, Cavagna L, et al. Epidemiology of gout and hyperuricaemia in Italy during the years 2005-2009: a nationwide population-based study. Ann Rheum Dis. 2013;72(5):694–700. doi: 10.1136/annrheumdis-2011-201254
- Mazurov VI, Bashkinov RA, Gaidukova IZ, Fonturenko AYu. The effect of asymptomatic hyperuricemia on comorbidities and the possibility of its correction. RMJ. 2021;7:24–30. (In Russ.)
- Yip K, Cohen RE, Pillinger MH. Asymptomatic hyperuricemia: is it really asymptomatic? Curr Opin Rheumatol. 2020;32(1):71–79. doi: 10.1097/BOR.0000000000000679
- Zhang S, Wang Y, Cheng J, et al. Hyperuricemia and cardiovascular disease. Curr Pharm Des. 2019;25(6):700–709. doi: 10.2174/1381612825666190408122557
- Borghi C, Agabiti-Rosei E, Johnson RJ, et al. Hyperuricaemia and gout in cardiovascular, metabolic and kidney disease. Eur J Intern Med. 2020;80:1–11. doi: 10.1016/j.ejim.2020.07.006
- Wang H, Zhang H, Sun L, Guo W. Roles of hyperuricemia in metabolic syndrome and cardiac-kidney-vascular system diseases. Am J Transl Res. 2018;10(9):2749–2763.
- Borghi C, Tykarski A, Widecka K, et al. Expert consensus for the diagnosis and treatment of patient with hyperuricemia and high cardiovascular risk. Cardiol J. 2018;25(5):545–563. doi: 10.5603/CJ.2018.0116
- Borghi C, Domienik-Karłowicz J, Tykarski A, et al. Expert consensus for the diagnosis and treatment of patient with hyperuricemia and high cardiovascular risk: 2021 update. Cardiol J. 2021;28(1):1–14. doi: 10.5603/CJ.a2021.0001
- Chazova IE, Zhernakova YuV, Kislyak OA, et al. Consensus on patients with hyperuricemia and high cardiovascular risk treatment: 2022. Systemic Hypertension. 2022;19(1):5–22. (In Russ.) doi: 10.38109/2075-082X-2022-1-5-22
- Sánchez-Lozada LG. The Pathophysiology of Uric Acid on Renal Diseases. Contrib Nephrol. 2018;192:17–24. doi: 10.1159/000484274
- Kuwabara M, Niwa K, Hisatome I, et al. Asymptomatic hyperuricemia without comorbidities predicts cardiometabolic diseases: Five-Year Japanese Cohort Study. Hypertension. 2017;69(6):1036–1044. doi: 10.1161/HYPERTENSIONAHA.116.08998
- Koo BS, Jeong HJ, Son CN, et al. J-shaped relationship between chronic kidney disease and serum uric acid levels: a cross-sectional study on the Korean population. J Rheum Dis. 2021;28(4):225–233. doi: 10.4078/jrd.2021.28.4.225
- Tsai CW, Lin SY, Kuo CC, Huang CC. Serum uric acid and progression of kidney disease: a longitudinal analysis and mini-review. PLoS One. 2017;12(1):e0170393. doi: 10.1371/journal.pone.0170393
- Li L, Yang C, Zhao Y, et al. Is hyperuricemia an independent risk factor for new-onset chronic kidney disease?: A systematic review and meta-analysis based on observational cohort studies. BMC Nephrol. 2014;15:122. doi: 10.1186/1471-2369-15-122
- Zhu P, Liu Y, Han L, et al. Serum uric acid is associated with incident chronic kidney disease in middle-aged populations: a meta-analysis of 15 cohort studies. PLoS One. 2014;9(6):e100801. doi: 10.1371/journal.pone.0100801
- Li YL, Wang L, Li J, et al. The correlation between uric acid and the incidence and prognosis of kidney diseases: a systematic review and meta-analysis of cohort studies. Zhonghua Nei Ke Za Zhi. 2011;50(7):555–561. (In Chinese)
- Sharma G, Dubey A, Nolkha N, Singh JA. Hyperuricemia, urate-lowering therapy, and kidney outcomes: a systematic review and meta-analysis. Ther Adv Musculoskelet Dis. 2021;13:1759720X211016661. doi: 10.1177/1759720X211016661
- Xia X, Luo Q, Li B, et al. Serum uric acid and mortality in chronic kidney disease: A systematic review and meta-analysis. Metabolism. 2016;65(9):1326–1341. doi: 10.1016/j.metabol.2016.05.009
- Luo Q, Xia X, Li B, et al. Serum uric acid and cardiovascular mortality in chronic kidney disease: a meta-analysis. BMC Nephrol. 2019;20(1):18. doi: 10.1186/s12882-018-1143-7
- GBD Chronic Kidney Disease Collaboration. Global, regional, and national burden of chronic kidney disease, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2020;395(10225):709–733. doi: 10.1016/S0140-6736(20)30045-3
- Levey AS, Atkins R, Coresh J, et al. Chronic kidney disease as a global public health problem: approaches and initiatives – a position statement from Kidney Disease Improving Global Outcomes. Kidney Int. 2007;72(3):247–259. doi: 10.1038/sj.ki.5002343
- Clinical recommendations. Chronic kidney disease (CKD). Nephrology (Saint-Petersburg). 2021;25(5):10–82. (In Russ.)
- Chewcharat A, Chen Y, Thongprayoon C, et al. Febuxostat as a renoprotective agent for treatment of hyperuricaemia: a meta-analysis of randomised controlled trials. Intern Med J. 2021;51(5):752–762. doi: 10.1111/imj.14814
- Sampson AL, Singer RF, Walters GD. Uric acid lowering therapies for preventing or delaying the progression of chronic kidney disease. Cochrane Database Syst Rev. 2017;10(10):CD009460. doi: 10.1002/14651858.CD009460.pub2
- Liu X, Liu K, Sun Q, et al. Efficacy and safety of febuxostat for treating hyperuricemia in patients with chronic kidney disease and in renal transplant recipients: A systematic review and meta-analysis. Exp Ther Med. 2018;16(3):1859–1865. doi: 10.3892/etm.2018.6367
- Liu X, Zhai T, Ma R, et al. Effects of uric acid-lowering therapy on the progression of chronic kidney disease: a systematic review and meta-analysis. Ren Fail. 2018;40(1):289–297. doi: 10.1080/0886022X.2018.1456463
- Wang H, Wei Y, Kong X, Xu D. Effects of urate-lowering therapy in hyperuricemia on slowing the progression of renal function: a meta-analysis. J Ren Nutr. 2013;23(5):389–396. doi: 10.1053/j.jrn.2012.08.005
- Zhang YF, He F, Ding HH, et al. Effect of uric-acid-lowering therapy on progression of chronic kidney disease: a meta-analysis. J Huazhong Univ Sci Technolog Med Sci. 2014;34(4):476–481. doi: 10.1007/s11596-014-1302-4
- Bayram D, Tuğrul Sezer M, İnal S, et al. The effects of allopurinol on metabolic acidosis and endothelial functions in chronic kidney disease patients. Clin Exp Nephrol. 2015;19(3):443–449. doi: 10.1007/s10157-014-1012-z
- Goicoechea M, de Vinuesa SG, Verdalles U, et al. Effect of allopurinol in chronic kidney disease progression and cardiovascular risk. Clin J Am Soc Nephrol. 2010;5(8):1388–1393. doi: 10.2215/CJN.01580210
- Mukri MNA, Kong WY, Mustafar R, et al. Role of febuxostat in retarding progression of diabetic kidney disease with asymptomatic hyperuricemia: A 6-months open-label, randomized controlled trial. EXCLI J. 2018;17:563–575. doi: 10.17179/excli2018-1256
- Sircar D, Chatterjee S, Waikhom R, et al. Efficacy of febuxostat for slowing the GFR decline in patients with CKD and asymptomatic hyperuricemia: a 6-month, double-blind, randomized, placebo-controlled trial. Am J Kidney Dis. 2015;66(6):945–950. doi: 10.1053/j.ajkd.2015.05.017
- Shi Y, Chen W, Jalal D, et al. Clinical outcome of hyperuricemia in IgA nephropathy: a retrospective cohort study and randomized controlled trial. Kidney Blood Press Res. 2012;35(3):153–160. doi: 10.1159/000331453
- Badve SV, Pascoe EM, Tiku A, et al. Effects of allopurinol on the progression of chronic kidney disease. N Engl J Med. 2020;382(26):2504–2513. doi: 10.1056/NEJMoa1915833
- Kimura K, Hosoya T, Uchida S, et al. Febuxostat therapy for patients with stage 3 CKD and asymptomatic hyperuricemia: a randomized trial. Am J Kidney Dis. 2018;72(6):798–810. doi: 10.1053/j.ajkd.2018.06.028
- Bose B, Badve SV, Hiremath SS, et al. Effects of uric acid-lowering therapy on renal outcomes: a systematic review and meta-analysis. Nephrol Dial Transplant. 2014;29(2):406–413. doi: 10.1093/ndt/gft378
- Zhang L, An K, Mou X, et al. Effect of urate-lowering therapy on the progression of kidney function in patients with asymptomatic hyperuricemia: a systematic review and meta-analysis. Front Pharmacol. 2022;12:795082. doi: 10.3389/fphar.2021.795082
- Doria A, Galecki AT, Spino C, et al. Serum urate lowering with allopurinol and kidney function in type 1 diabetes. N Engl J Med. 2020;382(26):2493–2503. doi: 10.1056/NEJMoa1916624
- Higgins JPT, Thomas J, (editors). Cochrane Handbook for Systematic Reviews of Interventions version 6.3 [Internet]. Cochrane. 2022. Available from: https://training.cochrane.org/handbook/archive/v6.3. Accessed: 07.07.2023.
- Nashar K, Fried LF. Hyperuricemia and the progression of chronic kidney disease: is uric acid a marker or an independent risk factor? Adv Chronic Kidney Dis. 2012;19(6):386–391. doi: 10.1053/j.ackd.2012.05.004
- Piani F, Johnson RJ. Does gouty nephropathy exist, and is it more common than we think? Kidney Int. 2021;99(1):31–33. doi: 10.1016/j.kint.2020.10.015
- Bardin T, Nguyen QD, Tran KM, et al. A cross-sectional study of 502 patients found a diffuse hyperechoic kidney medulla pattern in patients with severe gout. Kidney Int. 2021;99(1):218–226. doi: 10.1016/j.kint.2020.08.024
- Kim YJ, Oh SH, Ahn JS, et al. The crucial role of xanthine oxidase in CKD progression associated with hypercholesterolemia. Int J Mol Sci. 2020;21(20):7444. doi: 10.3390/ijms21207444
- Sato Y, Feig DI, Stack AG, et al. The case for uric acid-lowering treatment in patients with hyperuricaemia and CKD. Nat Rev Nephrol. 2019;15(12):767–775. doi: 10.1038/s41581-019-0174-z
- Zeng XX, Tang Y, Hu K, et al. Efficacy of febuxostat in hyperuricemic patients with mild-to-moderate chronic kidney disease: a meta-analysis of randomized clinical trials: A PRISMA-compliant article. Medicine (Baltimore). 2018;97(13):e0161. doi: 10.1097/MD.0000000000010161
- Lin TC, Hung LY, Chen YC, et al. Effects of febuxostat on renal function in patients with chronic kidney disease: A systematic review and meta-analysis. Medicine (Baltimore). 2019;98(29):e16311. doi: 10.1097/MD.0000000000016311
- Zheng Y, Sun J. Febuxostat improves uric acid levels and renal function in patients with chronic kidney disease and hyperuricemia: a meta-analysis. Appl Bionics Biomech. 2022;2022:9704862. doi: 10.1155/2022/9704862
- Tien YY, Shih MC, Tien CP, et al. To treat or not to treat? Effect of urate-lowering therapy on renal function, blood pressure and safety in patients with asymptomatic hyperuricemia: a systematic review and network meta-analysis. J Am Board Fam Med. 2022;35(1):140–151. doi: 10.3122/jabfm.2022.01.210273
- Sapankaew T, Thadanipon K, Ruenroengbun N, et al. Efficacy and safety of urate-lowering agents in asymptomatic hyperuricemia: systematic review and network meta-analysis of randomized controlled trials. BMC Nephrol. 2022;23(1):223. doi: 10.1186/s12882-022-02850-3
- Kanji T, Gandhi M, Clase CM, Yang R. Urate lowering therapy to improve renal outcomes in patients with chronic kidney disease: systematic review and meta-analysis. BMC Nephrol. 2015;16:58. doi: 10.1186/s12882-015-0047-z
- Chazova IE, Zhernakova JuV, Kisliak OA, et al. Consensus on patients with hyperuricemia and high cardiovascular risk treatment. Systemic Hypertension. 2019;16(4):8–21. (In Russ). doi: 10.26442/2075082X.2019.4.190686
- Drapkina OM, Mazurov VI, Martynov AI, et al. “Focus on hyperuricemia”. The resolution of the Expert Council. Cardiovascular Therapy and Prevention. 2023;22(4):3564. (In Russ.) doi: 10.15829/1728-8800-2023-3564