ABSTRACT
Purpose
The goal of this study was to systematically review the efficacy and safety of urate-lowering
therapy in patients with chronic kidney disease (CKD).
Methods
PubMed, the Cochrane Central Registration of Controlled Trials, and EMBASE databases
and several websites were electronically searched to collect randomized clinical trials
on the efficacy of urate-lowering therapy in CKD from inception to December 31, 2020.
The key primary end points were uric acid or estimated glomerular filtration rate
(eGFR) levels; the safety end points were death, renal event, cardiovascular event,
and gastrointestinal event. A Bayesian network meta-analysis was conducted with the
use of ADDIS and R software.
Findings
A total of 17 randomized clinical trials involving 2059 patients were included. The
results of network meta-analysis showed that urate-lowering therapy could reduce urate
levels in patients with CKD. Febuxostat was the most effective treatment in lowering
urate levels according to the rank probability. Urate-lowering therapy has the tendency
to delay the decline of eGFR, but the difference was not statistically significant.
Ranking probability showed that benzbromarone, febuxostat, and allopurinol ranked
higher than placebo in reducing the decline of eGFR. There were no statistically significant
differences between groups in the incidence of all adverse effects.
Implications
All urate-lowering therapies could reduce the urate level in patients with CKD, but
the benefit of such therapy in renal disease is still unclear. PROSPERO identifier:
CRD42020222601.
Key words
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Article info
Publication history
Published online: May 22, 2022
Accepted:
March 28,
2022
Identification
Copyright
© 2022 Elsevier Inc.
