Su Xiaole, Xu Boyang, Yan Bingjuan, Qiao Xi, Wang Lihua
Renal Division, Shanxi Medical University Second Hospital, Taiyuan, Shanxi, China.
PLoS One. 2017 Nov 2;12(11):e0187550. doi: 10.1371/journal.pone.0187550. eCollection 2017.
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.
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.
Uric acid-lowering therapy seemed to improve kidney outcomes and reduce the risk of cardiovascular events in adults with CKD.
降尿酸治疗对慢性肾脏病（CKD）患者的影响仍不明确。因此，我们进行了一项系统评价和荟萃分析，以研究降尿酸药物对CKD主要临床结局的影响。
设计、研究地点、参与者及测量指标：根据在国际前瞻性系统评价注册库（PROSPERO，编号CRD42016038030）登记的预先指定方案，我们系统检索了MEDLINE、EMBASE和考克兰图书馆截至2016年2月的试验。纳入评估降尿酸药物对CKD患者心血管和肾脏结局影响的前瞻性、随机、对照试验。采用随机效应分析方法。
共识别出16项符合条件的试验，为1211例CKD患者提供了数据，包括146例肾衰竭事件和69例心血管事件。降尿酸治疗使肾衰竭事件的相对风险（RR）降低了55%（95%置信区间[95%CI]，31 - 64）（P < 0.001），心血管事件的RR降低了60%（95%CI，17 - 62）（P < 0.001），但对全因死亡风险无显著影响（RR，0.86；95%CI，0.50 - 1.46）。估算肾小球滤过率下降速率的平均差异（接受降尿酸治疗者每年慢4.10 mL/min/1.73 m²，95%CI，1.86 - 6.35）以及蛋白尿或白蛋白尿变化的标准化平均差异（接受降尿酸治疗者标准差高0.23单位；95%CI， - 0.43至 - 0.04）也具有统计学意义。
降尿酸治疗似乎可改善CKD成人患者的肾脏结局并降低心血管事件风险。
