#5341 EFFECTS OF URIC ACID-LOWERING THERAPY ON RENAL OUTCOMES IN CKD PATIENTS WITH ASYMPTOMATIC HYPERURICEMIA: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract

Abstract Background and Aims It is well known that hyperuricemia and gout play an important role in the adverse cardiovascular and renal events both in patients with and without renal disease. However, the effect of uric acid-lowering therapy (ULT) on renal outcomes of CKD patients with asymptomatic hyperuricemia remains controversial. Therefore, our study summarized reliable results draw from published randomized controlled trials (RCTs) to evaluate the effects of ULT on renal and cardiovascular outcomes in CKD patients with asymptomatic hyperuricemia. Method Pubmed, EMBASE, China National Knowledge Internet (CNKI) and the Cochrane Library were searched systematically for trials up to October 2021. RCTs assessing the effects of uric acid-lowering agents on renal and/or cardiovascular outcomes in CKD patients complicated with asymptomatic hyperuricemia were included. Both the fixed-effect and the random-effect models were used. Results A total of 17 RCTs (one trial1 divided patients into two groups according to CKD stages). including CKD patients with asymptomatic hyperuricemia were included in this meta-analysis. Compared with placebo or no treatment group, ULT group showed a higher estimated glomerular filtration rate (eGFR) with a weighted mean difference (WMD) of 3.679 mL/min/1.73 m2, 95%CI [1.592, 5.766] (p = 0.001) and a lower serum creatinine (Scr) with a WMD of -46.131umol/L, 95% CI [-65.643, -26.619] (p<0.0001). Subgroup analysis demonstrated a significant benefit from ULT in patients with CKD stage 1-3 (p = 0.035), from Asian countries (p = 0.005) and those younger than 60 years (p = 0.002). At the same time, ULT was associated with lower incidence of events of doubling of Scr without dialysis (relative risk (RR) 0.314[0.203, 0.485] (p< 0.0001)). However, no difference was found for all-cause mortality, incidence of AKI, progression to end-stage kidney disease (ESKD), and cardiovascular events. In addition, ULT with allopurinol was associated with lower cardiovascular events (RR 0.678[0.473, 0.971] (p = 0.034)). Conclusion ULT could slow down the progression of renal impairment in CKD patients complicated with asymptomatic hyperuricemia, especially for patients under 60 years old, early CKD stage(1-3) and the Asian descent.