Ng Derek K, Matheson Matthew B, Schwartz George J, Kurgansky Katherine E, Warady Bradley A, Furth Susan L
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Department of Pediatrics, University of Rochester Medical Center, Rochester, NY.
Kidney Med. 2025 May 8;7(7):101021. doi: 10.1016/j.xkme.2025.101021. eCollection 2025 Jul.
RATIONALE & OBJECTIVE: Clinical trials have shown that serum uric acid reduction does not slow chronic kidney disease (CKD) progression in adults, but it is uncertain whether these findings apply to children.
An observational cohort study.
SETTING & POPULATION: The Chronic Kidney Disease in Children cohort with participants who initiated allopurinol with a comparison group matched on age, sex, uric acid, CKD diagnosis, estimated glomerular filtration rate (eGFR), and proteinuria.
Allopurinol initiation.
Uric acid, eGFR, and proteinuria before and after initiation, and longitudinal changes over time.
Allopurinol initiators were matched to noninitiators at a 1:3 ratio. Nonparametric tests compared levels before and after initiation and within-person changes. Linear mixed effects models characterized baseline and longitudinal differences between treatment groups.
A total of 27 participants initiated allopurinol, and these were matched to 81 participants who did not initiate allopurinol. Allopurinol was associated with a 15.9% lower serum uric acid (95% CI, -21.1% to -10.4%) relative to the matched comparison group ( < 0.001) after initiation. There were no significant differences in eGFR or proteinuria over time by group.
Observational study designed for comparative effectiveness and relatively small sample size; effectiveness of allopurinol initiated at lower levels of uric acid could not be estimated.
Allopurinol was effective at significantly lowering serum uric acid in children with CKD but was not associated with CKD progression measured by longitudinal eGFR and proteinuria.
临床试验表明，降低血清尿酸并不能减缓成人慢性肾脏病（CKD）的进展，但这些发现是否适用于儿童尚不确定。
一项观察性队列研究。
儿童慢性肾脏病队列，参与者开始使用别嘌醇，并与年龄、性别、尿酸、CKD诊断、估计肾小球滤过率（eGFR）和蛋白尿相匹配的对照组进行比较。
开始使用别嘌醇。
开始使用别嘌醇前后的尿酸、eGFR和蛋白尿，以及随时间的纵向变化。
别嘌醇使用者与未使用者按1:3的比例进行匹配。非参数检验比较开始使用前后的水平以及个体内的变化。线性混合效应模型描述了治疗组之间的基线和纵向差异。
共有27名参与者开始使用别嘌醇，这些参与者与81名未开始使用别嘌醇的参与者相匹配。与匹配的对照组相比，开始使用别嘌醇后血清尿酸降低了15.9%（95%CI，-21.1%至-10.4%）（P<0.001）。两组随时间的eGFR或蛋白尿无显著差异。
为比较疗效而设计的观察性研究，样本量相对较小；无法估计在较低尿酸水平开始使用别嘌醇的疗效。
别嘌醇能有效显著降低CKD儿童的血清尿酸，但与通过纵向eGFR和蛋白尿测量的CKD进展无关。
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