Bose Bhadran, Badve Sunil V, Hiremath Swapnil S, Boudville Neil, Brown Fiona G, Cass Alan, de Zoysa Janak R, Fassett Robert G, Faull Randall, Harris David C, Hawley Carmel M, Kanellis John, Palmer Suetonia C, Perkovic Vlado, Pascoe Elaine M, Rangan Gopala K, Walker Robert J, Walters Giles, Johnson David W
Department of Nephrology, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia.
Nephrol Dial Transplant. 2014 Feb;29(2):406-13. doi: 10.1093/ndt/gft378. Epub 2013 Sep 15.
Non-randomized studies suggest an association between serum uric acid levels and progression of chronic kidney disease (CKD). The aim of this systematic review is to summarize evidence from randomized controlled trials (RCTs) concerning the benefits and risks of uric acid-lowering therapy on renal outcomes.
Medline, Excerpta Medical Database and Cochrane Central Register of Controlled Trials were searched with English language restriction for RCTs comparing the effect of uric acid-lowering therapy with placebo/no treatment on renal outcomes. Treatment effects were summarized using random-effects meta-analysis.
Eight trials (476 participants) evaluating allopurinol treatment were eligible for inclusion. There was substantial heterogeneity in baseline kidney function, cause of CKD and duration of follow-up across these studies. In five trials, there was no significant difference in change in glomerular filtration rate from baseline between the allopurinol and control arms [mean difference (MD) 3.1 mL/min/1.73 m2, 95% confidence intervals (CI) -0.9, 7.1; heterogeneity χ2=1.9, I2=0%, P=0.75]. In three trials, allopurinol treatment abrogated increases in serum creatinine from baseline (MD -0.4 mg/dL, 95% CI -0.8, -0.0 mg/dL; heterogeneity χ2=3, I2=34%, P=0.22). Allopurinol had no effect on proteinuria and blood pressure. Data for effects of allopurinol therapy on progression to end-stage kidney disease and death were scant. Allopurinol had uncertain effects on the risks of adverse events.
Uric acid-lowering therapy with allopurinol may retard the progression of CKD. However, adequately powered randomized trials are required to evaluate the benefits and risks of uric acid-lowering therapy in CKD.
非随机研究表明血清尿酸水平与慢性肾脏病（CKD）进展之间存在关联。本系统评价的目的是总结来自随机对照试验（RCT）的证据，以探讨降尿酸治疗对肾脏结局的益处和风险。
在限制为英文的情况下，检索了医学文献数据库（Medline）、医学文摘数据库（Excerpta Medical Database）和Cochrane对照试验中心注册库，以查找比较降尿酸治疗与安慰剂/未治疗对肾脏结局影响的RCT。使用随机效应荟萃分析总结治疗效果。
八项评估别嘌醇治疗的试验（476名参与者）符合纳入标准。这些研究在基线肾功能、CKD病因和随访时间方面存在很大异质性。在五项试验中，别嘌醇组和对照组之间肾小球滤过率相对于基线的变化无显著差异[平均差（MD）3.1 mL/（min/1.73 m²），95%置信区间（CI）-0.9，7.1；异质性χ²=1.9，I²=0%，P=0.75]。在三项试验中，别嘌醇治疗消除了血清肌酐相对于基线的升高（MD -0.4 mg/dL，95%CI -0.8，-0.0 mg/dL；异质性χ²=3，I²=34%，P=0.22）。别嘌醇对蛋白尿和血压无影响。关于别嘌醇治疗对进展至终末期肾病和死亡影响的数据很少。别嘌醇对不良事件风险的影响尚不确定。
别嘌醇降尿酸治疗可能会延缓CKD的进展。然而，需要有足够样本量的随机试验来评估CKD降尿酸治疗的益处和风险。
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