Gyoumeikan Hospital, Osaka, Japan.
Nara Medical University, Kashihara, Japan.
Clin Exp Nephrol. 2024 Aug;28(8):764-772. doi: 10.1007/s10157-024-02483-w. Epub 2024 Mar 26.
We investigate whether Intensive uric acid (UA)-lowering therapy (ULT) provides increased renal protection compared with standard therapy in chronic kidney disease (CKD) patients.
This was a multicenter randomized controlled trial. Only CKD patients with hyperuricemia were included in this study. The participants were randomly assigned to either the Intensive therapy group (target serum UA level ≥ 4.0 mg/dL and < 5.0 mg/dL) or the standard therapy group (serum UA level ≥ 6.0 mg/dL and < 7.0 mg/dL). ULT was performed using topiroxostat, a non-purine-type selective xanthine oxidase inhibitor. The primary endpoint was change in the logarithmic value of urine albumin to the creatinine ratio (ACR) between baseline and week 52 of the treatment.
Three hundred fifty-two patients were included in the full analysis set. In the Standard therapy group, mean serum UA was 8.23 mg/dL at baseline and 6.13 mg/dL at 52 weeks. In the Intensive therapy group, mean serum UA was 8.15 mg/dL at baseline and 5.25 mg/dL at 52 weeks. There was no significant difference in changes in log ACR at 52 weeks between the Intensive therapy and the Standard therapy groups.
This study did not reveal the benefit of Intensive ULT to improve albuminuria levels. (UMIN000026741 and jRCTs051180146).
我们研究了强化尿酸（UA）降低治疗（ULT）与标准治疗相比是否能为慢性肾脏病（CKD）患者提供更多的肾脏保护。
这是一项多中心随机对照试验。只有高尿酸血症的 CKD 患者才被纳入本研究。参与者被随机分配到强化治疗组（目标血清 UA 水平≥4.0mg/dL 且<5.0mg/dL）或标准治疗组（血清 UA 水平≥6.0mg/dL 且<7.0mg/dL）。ULT 使用别嘌醇醇，一种非嘌呤类选择性黄嘌呤氧化酶抑制剂。主要终点是治疗 52 周时尿白蛋白与肌酐比值（ACR）的自然对数变化。
共有 352 例患者被纳入全分析集。在标准治疗组，基线时血清 UA 平均为 8.23mg/dL，52 周时为 6.13mg/dL。在强化治疗组，基线时血清 UA 平均为 8.15mg/dL，52 周时为 5.25mg/dL。强化治疗组与标准治疗组在第 52 周时的 ACR 对数变化无显著差异。
本研究未显示强化 ULT 改善蛋白尿水平的益处。（UMIN000026741 和 jRCTs051180146）。
