Medications to lower urate levels effective in CKD patients

All urate-lowering therapies work to reduce uric acid concentrations in patients with chronic kidney disease (CKD), although it is unclear whether this benefit extends to those with renal disease, according to the results of a meta-analysis.

Researchers conducted a systematic review, searching multiple online databases for randomized clinical trials that evaluate the efficacy of urate-lowering therapy in CKD. They applied a Bayesian network model in their analysis.

The primary endpoint was the change in uric acid or estimated glomerular filtration rate (eGFR) levels, while the safety endpoints were the incidence of death, a renal event, a cardiovascular event, or a gastrointestinal event.

The network meta-analysis included 17 randomized clinical trials, which involved a total of 2,059 patients. Pooled data indicated that urate-lowering therapy performed well in terms of reducing urate levels in patients with CKD. Of note, febuxostat emerged as the most effective treatment for lowering uric acid concentration, according to the ranking probability.

Urate-lowering therapy showed a tendency to delay the decline of eGFR, but the difference was not statistically significant. Compared with placebo, medications such as benzbromarone, febuxostat, and allopurinol all performed better at reducing the eGFR decline.

In terms of safety, there were no statistically significant differences noted in the incidence of all adverse effects.