Uric acid in CKD: has the jury come to the verdict?

J Nephrol. 2020 Aug;33(4):715-724. doi: 10.1007/s40620-020-00702-7. Epub 2020 Jan 13.

Abstract

Epidemiological studies show that hyperuricemia independently predicts the development of chronic kidney disease (CKD) in individuals with normal kidney function both in the general population and in subjects with diabetes. As a matter of fact, an unfavorable role of uric acid may somewhat be harder to identify in the context of multiple risk factors and pathogenetic mechanisms typical of overt CKD such as proteinuria and high blood pressure. Although the discrepancy in clinical results could mean that urate lowering treatment does not provide a constant benefit in all patients with hyperuricemia and CKD, we believe that the inconsistency in the results from available meta-analysis is mainly due to inadequate sample size, short follow-up times and heterogeneity in study design characterizing the randomized controlled trials included in the analyses. Therefore, available data support the view that hyperuricemia has a damaging impact on kidney function, while preliminary evidence suggests that treatment of so-called asymptomatic hyperuricemia may be helpful to slow or delay the progression of chronic kidney.

Keywords: Cardiovascular disease; Chronic kidney disease; Urate lowering treatment; Uric acid.

Publication types

  • Meta-Analysis
  • Review

MeSH terms

  • Disease Progression
  • Humans
  • Hyperuricemia*
  • Randomized Controlled Trials as Topic
  • Renal Insufficiency, Chronic*
  • Risk Factors
  • Uric Acid* / blood

Substances

  • Uric Acid