Urate-lowering therapy and kidney outcomes in patients with chronic kidney disease and hyperuricemia

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Urate-lowering therapy and kidney outcomes in patients with chronic kidney disease and hyperuricemia

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Co-author 1

Shiyu Zhou zsygaza@163.com Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Multi-organ Injury Prevention and Treatment, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research Nephrology Guangzhou China *

Co-author 2

Ruixuan Chen chenrx114@163.com Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Multi-organ Injury Prevention and Treatment, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research Nephrology Guangzhou China -

Co-author 3

Sheng Nie niesheng0202@126.com Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Multi-organ Injury Prevention and Treatment, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research Nephrology Guangzhou China -

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Introduction

Hyperuricemia has been considered as a modifiable risk factor for the development and progression of chronic kidney disease (CKD). There remains controversy over the effects of urate-lowering therapy (ULT) on kidney outcomes in the patients with CKD and hyperuricemia.

Methods

We conducted a cohort study using sequential target trial emulation framework to evaluate the composite kidney outcomes in patients with CKD and hyperuricemia initiating ULT versus supportive care alone (control).

Results

A total of 269,831 eligible person-trials (56,936 unique persons) with CKD and hyperuricemia who had received supportive care were included from the China Renal Data System database. The primary outcome was a composite kidney outcome defined as more than 40% decline in the estimated GFR or end-stage kidney disease (ESKD). The three-year cumulative incidence of the composite kidney outcomes was 20.42% and 25.95% in the ULT group and the control group, respectively, with a risk difference of −5.53% (95% CI, −8.23% to −2.18%). The estimated three-year risk differences for ESKD, all-cause mortality, and cardiovascular mortality were −1.70% (−2.93% to -0.32%), −2.39 % (−3.04% to −1.80%), and −0.71% (−1.19% to −0.16%), respectively, all favoring the ULT group. Estimates from the subgroup and the sensitivity analyses were consistent with the primary analysis.

Conclusion

ULT is associated with a significantly lower risk of kidney disease progression and mortality in the patients with stage 3 or higher CKD and hyperuricemia. Large randomized clinical trials with refined designs are needed to assess the effect of ULT in these patients.

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