Urate-lowering therapy may not improve kidney and cardiovascular outcomes
Urate-lowering therapy did not produce benefits on the clinical outcomes, including major adverse cardiovascular events, all-cause mortality, and kidney failure according to recent research published in the Clinical Journal of the American Society of Nephrology.
Several
clinical practice guidelines noted the potential benefits of urate-lowering
therapy on cardiovascular disease and CKD progression; however, the effect of
this regimen remains uncertain.
"In this systematic review, we aimed to evaluate the efficacy of
urate-lowering therapy on major adverse cardiovascular events, all-cause
mortality, kidney failure events, BP, and GFR", describes Qi Chen and
colleagues from the Department of Nephrology, Dongzhimen Hospital, The First
Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China.
"We systematically searched MEDLINE,
Embase, and the Cochrane databases for trials published through July 2020. We
included prospective, randomized, controlled trials assessing the effects of
urate-lowering therapy for at least 6 months on cardiovascular or kidney
outcomes. Relevant information was extracted into a spreadsheet by two authors
independently. Treatment effects were summarized using random-effects
meta-analysis", they further explained.
By analyzing 28 trials comprising 6,458 participants, researchers investigated
whether urate-lowering therapy has efficacy on major adverse cardiovascular
events, all-cause death, kidney failure events, BP, and GFR.
Based on the design and the methodology of the study, the following findings were observed-
1. Overall
urate-lowering therapy did not show benefits on major adverse cardiovascular
events (risk ratio, 0.93; 95% confidence interval, 0.74 to 1.18) and all-cause
mortality (risk ratio, 1.04; 95% confidence interval, 0.78 to 1.39) or kidney
failure (risk ratio, 0.97; 95% confidence interval, 0.61 to 1.54).
2.Urate-lowering therapy attenuated the decline in the slope of GFR (weighted
mean difference, 1.18 ml/min per 1.73 m2 per year; 95% confidence interval,
0.44 to 1.91) and lowered the mean BP.
3.There was no significant difference (risk ratio, 1.01; 95% confidence
interval, 0.94 to 1.08) in the risk of adverse events between the participants
receiving urate-lowering therapy and the control group.
Therefore, the authors then concluded by saying that, "urate-lowering
therapy did not produce benefits on the clinical outcomes, including major
adverse cardiovascular events, all-cause mortality, and kidney failure. Thus,
there is insufficient evidence to support urate-lowering in patients to improve
kidney and cardiovascular outcomes."