Urate-Lowering Therapy Not Renoprotective When Kidney Function is Normal

Urate-lowering therapy (ULT) for hyperuricemia in patients with normal kidney function and no proteinuria is not associated with a decreased risk of incident chronic kidney disease (CKD), according to findings presented at the American Society of Nephrology’s Kidney Week 2021.

“These results confirm and complement the results of existing clinical trials showing no renal benefit from ULT in patients with pre-existing CKD,” Waleed Hassan, MD, of the University of Tennessee Health Science Center in Memphis, and colleagues concluded in a poster presentation.

The investigators noted that hyperuricemia is associated with development of CKD independent of established metabolic risk factors, and ULT for hyperuricemia did not improve renal outcomes in clinical trials that included patients with CKD. The effects of ULT on incident CKD in patients with no pre-existing CKD has been unclear.

From a national cohort of 3,562,882 US veterans, Dr Hassan and colleagues identified 268,567 patients with normal kidney function (estimated glomerular filtration rate of 60 mL/min/1.73 m² or more and no proteinuria) and available serum uric acid measurements. The investigators examined the association between new ULT use and incident CKD, defined as 2 measurements of eGFR less than 60 mL/min/1.73 m² or urine albumin-to-creatinine ratio above 30 mg/g at least 90 days apart. The cohort, which had a mean age of 58 years and was 94% male, included 30,593 patients (11.4%) with new ULT use and 237,974 (88.6%) untreated patients.

The investigators found no significant difference between ULT users and non-users with respect to incident eGFR, incident proteinuria, or end-stage kidney disease. ULT use, however, was significantly associated with 17% lower odds of all-cause mortality.

REFERENCE

Hassan W, Potukuchi PK, Dashputre AA, et al. Treatment of hyperuricemia and incident chronic kidney disease in patients with normal kidney function. Presented at: Kidney Week 2021, November 2-7, 2021. Poster PO2380.

This article originally appeared on Renal and Urology News