Effects of uric acid-lowering therapy in patients with chronic kidney disease: A meta-analysis

PLoS One. 2017 Nov 2;12(11):e0187550. doi: 10.1371/journal.pone.0187550. eCollection 2017.


Background and objectives: The effects of uric acid-lowering therapy in patients with chronic kidney disease (CKD) remain uncertain. Therefore, we undertook a systematic review and meta-analysis to investigate the effects of uric acid-lowering agents on major clinical outcomes of CKD.

Design, setting, participants, and measurements: According to the pre-specified protocol that was registered with PROSPERO (No. CRD42016038030), we searched systematically in MEDLINE, EMBASE, and the Cochrane Library for trials up to February 2016. Prospective, randomized, controlled trials assessing the effects of uric acid-lowering agents on cardiovascular and kidney outcomes in patients with CKD were included. Random-effects analytical methods were used.

Results: Sixteen eligible trials were identified, providing data for 1,211 patients with CKD, including 146 kidney failure events and 69 cardiovascular events. Uric acid-lowering therapy produced a 55% relative risk (RR) reduction (95% confidence interval [95% CI], 31-64) for kidney failure events (P < 0.001), and a 60% RR reduction (95% CI, 17-62) for cardiovascular events (P < 0.001), but had no significant effect on the risk of all-cause death (RR, 0.86; 95% CI, 0.50-1.46). The mean differences in rate of decline in the estimated glomerular filtration rate (4.10 mL/min/1.73 m2 per year slower in uric acid-lowering therapy recipients, 95% CI, 1.86-6.35) and the standardized mean differences in the change in proteinuria or albuminuria (-0.23 units of standard deviation greater in uric acid-lowering therapy recipients; 95% CI, -0.43 to -0.04) were also statistically significant.

Conclusions: Uric acid-lowering therapy seemed to improve kidney outcomes and reduce the risk of cardiovascular events in adults with CKD.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Humans
  • Kidney Failure, Chronic / drug therapy*
  • Uric Acid / blood*


  • Uric Acid

Grants and funding

Support was provided by the Science and Technology Project of Shanxi Province (Grant No. 20140313013-5), Natural Science Foundation of Shanxi Province (Grant No. 201701D221173), [http://www.sxinfo.gov.cn/]; Shanxi Province Health and Family Planning Commission, Science and Technology (Grant No. 201601054), [http://www.sxwsjs.gov.cn/]. The funders had no role in decision to publish and preparation of the manuscript.