06 Jun Study Evaluates Association of Uric Acid Lowering Medications with Chronic Kidney Disease
MedicalResearch.com Interview with:
Csaba P Kovesdy MD FASN
Fred Hatch Professor of Medicine
Director, Clinical Outcomes and Clinical Trials Program
Division of Nephrology, University of Tennessee Health Science Center
Nephrology Section Chief, Memphis VA Medical Center
Memphis TN, 38163
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Hyperuricemia has unfavorable metabolic effects and has been associated with higher risk of progressive kidney disease and mortality. Despite this, earlier clinical trials have failed to prove a beneficial impact on kidney disease progression from uric acid lowering therapy in patients with preexisting CKD.
The effect of uric acid lowering therapy on the development of new onset CKD in patients with normal kidney function has not been well studied. In our large observational study we did not find a beneficial association between newly initiated uric acid lowering therapy (the majority of which was in the form of allopurinol).
On the contrary, uric acid lowering therapy was associated with a slightly higher risk of new onset low eGFR and new onset albuminuria, especially in patients with less elevated baseline serum acid levels.
MedicalResearch.com: What should readers take away from your report?
Response: Uric acid lowering therapies are mainly used in patients with gout, but they could be applied to lower elevated serum uric acid levels even in the absence of gout, in the hope that this could prevent deleterious metabolic consequences of hyperuricemia. Our findings suggest that in patients with normal kidney function such a strategy may not help prevent the development of chronic kidney disease, and in some patients it may even be harmful.
It is possible that allopurinol (which was the uric acid lowering agent used in the vast majority of the patients in our cohort) may have harmful effects on kidney function such as acute kidney injury. The fact that the higher risk of CKD in our study was limited to patients with lower baseline serum uric acid level could potentially mean that in this group the putative benefits of uric acid lowering are less and are possibly overshadowed by potential harmful effects of the treatment.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Previous clinical trials have examined the effects of uric acid lowering therapies on progression of kidney disease in patients with preexisting CKD. It would be ideal to test the effects of these therapies in patients with normal kidney function. Based on our findings, it seems prudent to target patients with serum uric acid levels >8 mg/dl in such trials.
MedicalResearch.com: Is there anything else you would like to add?
Response: Short of clinical trials, the preponderance of evidence suggests that uric acid lowering therapy may not be beneficial towards reducing the development and progression of chronic kidney disease. It appears prudent to limit such treatments to patients with strong indications for therapy (e.g., gout) and to those with severe elevations in serum uric acid level.
I have no relevant conflicts of interest.
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