Effect of Urate-lowering Therapy on Slowing the Progression of Renal Function: a Meta Analysis of Randomized Controlled Trials
|Keywords||Allopurino Meta-analysis Renal function Serum uric acid (SUA) Urate-loweringtherapy (ULT)|
BackgroundUric acid is generally regarded as an independent risk factor for poor prognosis of patients with kidney disease. However, urate-lowering therapy (ULT) in asymptomatic hyperuricemia is conservative. Whether the beneficial effect on renal function can be achieved by lowering uric acid remains uncertain. Our intention was to systematically evaluate the effect of ULT on slowing the progression of renal function.MethodsA compound search for randomized controlled trials (RCTs) was conducted in databases consisting of MEDLINE, EMBASE, the Cochrane Library, Chinese Biomedical Literature Database (CBM), Chinese Science and Technology periodicals Databases (CNKI). Two investigators independently screened studies, assessed the included trials and extracted data. Meta-analyses were performed with STATA11.0on the pooled effect of serum uric acid and renal function. In these studies, the renal function was represented either by glomerular filtration rate (GFR), creatinine clearance rate(Ccr)or serum creatinine (Scr).ResultsEleven articles with a total number of753participants met the criteria and were included in our meta-analysis. The results showed that ULT was associated with the decrease of Scr (SMD=-1.253mg/dl,95%CI-1.985to-0.520,I2=93.0%), and the increase of GFR (SMD=0.412,95%CI0.142to0.682,I2=30.6%). Sources of heterogeneity were not found by meta-regression or subgroup analyses. No statistically significant association was found between the effect of hypouricemic therapy and age of patients (p=0.098), gender of patients (p=0.317), baseline serum uric acid (p=0.246), baseline serum creatinine (p=0.309), baseline systolic pressure (p=0.079),baseline diastolic pressure(p=0.515), urate-lowering strategy (p=0.100).ConclusionUrate-lowering therapy may have beneficial effect on slowing the progression of renal function. This effect seems to have little association with age, gender, baseline blood pressure or ULT strategy. The adverse events of gastrointestinal symptoms are more likely to be occurred in ULT group.