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Abstract：
BACKGROUND: It is well known that asymptomatic hyperuricemia and gout play an important role in patients with chronic kidney disease (CKD). However, the effect of uric acid-lowering therapy (ULT) on the prognosis of CKD patients with asymptomatic hyperuricemia remains controversial. Therefore, we aim to investigate the influence of ULT on renal outcomes in these patients.
METHODS: Comprehensive searches were conducted in PubMed, EMBASE, China National Knowledge Internet (CNKI), and the Cochrane Library, up until January 2024. We included randomized controlled trials (RCTs) that evaluated the effects of ULT on renal outcomes in CKD patients with asymptomatic hyperuricemia.
RESULTS: A total of 17 studies were included in the meta-analysis. Compared with placebo or no treatment, ULT preserved the loss of estimated glomerular filtrating rate (eGFR) (Weighted mean difference [WMD] and its 95% confidence intercal(CI): 2.07 [0.15,3.98] mL/min/1.73m2) at long-term subgroup. At the same time, short-term subgroup also proved the preserved loss of eGFR (WMD 5.74[2.09, 9.39] mL/min/1.73m2). Compared with placebo or no treatment, ULT also reduced the increase in serum creatinine (Scr) at short-term (WMD -44.48[-84.03,-4.92]μmol/L) subgroup and long-term (WMD -46.13[-65.64,-26.62]μmol/L) subgroup. ULT was associated with lower incidence of the events of doubling of Scr without dialysis (relative risk (RR) 0.32 [0.21, 0.49], p < 0.001). However, no difference was found for lower incidence of acute kidney injury (AKI) (p = 0.943).
CONCLUSIONS: According to our study, ULT is beneficial for slowing CKD progression both in short to long-term follow-ups. Additionally, in patients younger than 60 years old, the protective effect of ULT on renal outcome is more pronounced. However, it showed no significant difference in the incidence of AKI. These findings underscore the importance of considering ULT in clinical strategies for CKD patients with asymptomatic hyperuricemia.
METHODS: Comprehensive searches were conducted in PubMed, EMBASE, China National Knowledge Internet (CNKI), and the Cochrane Library, up until January 2024. We included randomized controlled trials (RCTs) that evaluated the effects of ULT on renal outcomes in CKD patients with asymptomatic hyperuricemia.
RESULTS: A total of 17 studies were included in the meta-analysis. Compared with placebo or no treatment, ULT preserved the loss of estimated glomerular filtrating rate (eGFR) (Weighted mean difference [WMD] and its 95% confidence intercal(CI): 2.07 [0.15,3.98] mL/min/1.73m2) at long-term subgroup. At the same time, short-term subgroup also proved the preserved loss of eGFR (WMD 5.74[2.09, 9.39] mL/min/1.73m2). Compared with placebo or no treatment, ULT also reduced the increase in serum creatinine (Scr) at short-term (WMD -44.48[-84.03,-4.92]μmol/L) subgroup and long-term (WMD -46.13[-65.64,-26.62]μmol/L) subgroup. ULT was associated with lower incidence of the events of doubling of Scr without dialysis (relative risk (RR) 0.32 [0.21, 0.49], p < 0.001). However, no difference was found for lower incidence of acute kidney injury (AKI) (p = 0.943).
CONCLUSIONS: According to our study, ULT is beneficial for slowing CKD progression both in short to long-term follow-ups. Additionally, in patients younger than 60 years old, the protective effect of ULT on renal outcome is more pronounced. However, it showed no significant difference in the incidence of AKI. These findings underscore the importance of considering ULT in clinical strategies for CKD patients with asymptomatic hyperuricemia.
摘要：
背景：众所周知，无症状性高尿酸血症和痛风在慢性肾脏病（CKD）患者中发挥重要作用。然而,降尿酸治疗(ULT)对伴有无症状高尿酸血症的CKD患者预后的影响仍存在争议.因此,我们旨在探讨ULT对这些患者肾脏结局的影响.
方法：在PubMed，EMBASE,中国国民知识互联网(CNKI),还有Cochrane图书馆,直到2024年1月。我们纳入了随机对照试验（RCT），评估了ULT对无症状高尿酸血症CKD患者肾脏结局的影响。
结果：共有17项研究纳入荟萃分析。与安慰剂或不治疗相比，ULT保留了长期亚组的估计肾小球滤过率（eGFR）的损失（加权平均差[WMD]及其95％置信区间（CI）：2.07[0.15,3.98]mL/min/1.73m2）。同时,短期亚组也证明了eGFR的保留损失(WMD5.74[2.09,9.39]mL/min/1.73m2)。与安慰剂或不治疗相比，ULT还降低了短期（WMD-44.48[-84.03，-4.92]μmol/L）亚组和长期（WMD-46.13[-65.64，-26.62]μmol/L）亚组的血清肌酐（Scr）升高。ULT与无透析时Scr加倍事件的发生率较低相关(相对风险(RR)0.32[0.21,0.49],p<0.001)。然而,急性肾损伤(AKI)发生率较低无差异(p=0.943).
结论：根据我们的研究，ULT在短期到长期随访中都有利于减缓CKD进展。此外,在60岁以下的患者中，ULT对肾脏结局的保护作用更为明显。然而,AKI的发生率无显著差异。这些发现强调了在无症状高尿酸血症的CKD患者的临床策略中考虑ULT的重要性。
方法：在PubMed，EMBASE,中国国民知识互联网(CNKI),还有Cochrane图书馆,直到2024年1月。我们纳入了随机对照试验（RCT），评估了ULT对无症状高尿酸血症CKD患者肾脏结局的影响。
结果：共有17项研究纳入荟萃分析。与安慰剂或不治疗相比，ULT保留了长期亚组的估计肾小球滤过率（eGFR）的损失（加权平均差[WMD]及其95％置信区间（CI）：2.07[0.15,3.98]mL/min/1.73m2）。同时,短期亚组也证明了eGFR的保留损失(WMD5.74[2.09,9.39]mL/min/1.73m2)。与安慰剂或不治疗相比，ULT还降低了短期（WMD-44.48[-84.03，-4.92]μmol/L）亚组和长期（WMD-46.13[-65.64，-26.62]μmol/L）亚组的血清肌酐（Scr）升高。ULT与无透析时Scr加倍事件的发生率较低相关(相对风险(RR)0.32[0.21,0.49],p<0.001)。然而,急性肾损伤(AKI)发生率较低无差异(p=0.943).
结论：根据我们的研究，ULT在短期到长期随访中都有利于减缓CKD进展。此外,在60岁以下的患者中，ULT对肾脏结局的保护作用更为明显。然而,AKI的发生率无显著差异。这些发现强调了在无症状高尿酸血症的CKD患者的临床策略中考虑ULT的重要性。
