Health
Uric acid lowering therapy may increase the risk of CKD
Uric acid lowering therapy has shown an increased risk of developing newly developed chronic kidney disease (CKD) in patients with baseline serum uric acid levels of 8 mg / d or less. Treatment did not change the risk of individuals with high baseline serum uric acid levels.
269,651 patients (94% male) with an estimated baseline glomerular filtration rate (eGFR) of at least 60 mL / min / 1.73 m2 From 2004 to 2019, no albuminuria was treated at the US Department of Veterans Affairs medical facility, and a total of 29,501 patients (10.9%) started uric acid lowering therapy. The majority (99.7%) received allopurinol. Of the total cohort, 21.7% eventually reduced eGFR to less than 60 mL / min / 1.73 m.225.5% of newly-onset albuminuria, and 0.2% of end-stage renal disease (ESKD).
After propensity score matching, the use and non-use of uric acid lowering therapy was associated with a 15% increased risk of eGFR falling below 60 mL / min / 1.73 m.2 5% higher risk of albuminuria across the Memphis VA Medical Center Cohort, Tennessee, Csaba P. Kovesdy, MD, and colleagues JAMA network open.. The use of allopurinol ESKD..
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In individuals with baseline serum uric acid levels below 8 mg / dL, uric acid lowering therapy was significantly associated with a 24% and 7% increase in risk of eGFR below 60 mL / min / 1.73 m.2 Albuminuria, respectively. Researchers have not found these associations among people with high baseline serum uric acid levels.
“These results do not support the direct benefit of lowering uric acid for the development of newly developed CKD, and support the results of recent large randomized clinical trials in which no benefit of allopurinol was seen. Delay the progression of established CKD“Dr. Kobesdi and his colleagues wrote.
Researchers noted that allopurinol can be induced Acute interstitial nephritis It causes acute kidney injury, which is the main cause of chronic kidney disease.
Disclosure: Some research authors have declared partnerships with biotechnology, pharmaceutical, and / or device companies. See the original reference for a complete list of author disclosures.
reference
Hassan W, Shrestha P, Sumida K, et al. Association of uric acid lowering therapy with accidental chronic kidney disease.. JAMA Netw Open.. Published online June 1, 2022. doi: 10.1001 / jamanetworkopen.2022.15878
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