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Efficacy of Urate–Lowering Therapy in Patients With Chronic Kidney Disease: A Network Meta-Analysis of Randomized Controlled Trials

  • Author Footnotes
    ⁎ Drs Yu and Gu contributed equally to this work and should be considered joint first authors.
    Xiang Yu
    Footnotes
    ⁎ Drs Yu and Gu contributed equally to this work and should be considered joint first authors.
    Affiliations
    Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu, China
    Search for articles by this author
  • Author Footnotes
    ⁎ Drs Yu and Gu contributed equally to this work and should be considered joint first authors.
    Mingjia Gu
    Footnotes
    ⁎ Drs Yu and Gu contributed equally to this work and should be considered joint first authors.
    Affiliations
    Changshu Hospital affiliated to Nanjing University of Chinese Medicine, Jiangsu, China
    Search for articles by this author
  • Yiye Zhu
    Affiliations
    Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu, China
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  • Lixiang Zhang
    Affiliations
    Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu, China
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  • Wei Kong
    Affiliations
    Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Jiangsu, China
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  • Yanqin Zou
    Correspondence
    Address correspondence to: Yanqin Zou, BS, Affiliated Hospital of Nanjing University of Chinese Medicine, No. 155, Hanzhong Rd, Qinhuai District of Nanjing, Jiangsu 210029 China.
    Affiliations
    Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu, China
    Search for articles by this author
  • Author Footnotes
    ⁎ Drs Yu and Gu contributed equally to this work and should be considered joint first authors.

      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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