JS-HR-11: HOT TOPICS IN URIC ACID RESEARCH

Abstract

The mechanism between hyperuricemia, arteriosclerosis, hypertension, chronic kidney disease, and cardiovascular disease is becoming clearer (Figure cited from the article ‘Update on Hypertension Research in 2021’, Hypertension Research. 2022;45(8):1276 to 1297). However, it remains unclear whether treatment of hyperuricemia improves these diseases. In this session, we will introduce some recent topics of uric acid research. The PERL (Preventing Early Renal Loss in Diabetes) trial and the CKD-FIX (Controlled Trial of Slowing of Kidney Disease Progression from the Inhibition of Xanthine Oxidase) showed that urate-lowering treatment with allopurinol, one of xanthine oxidase (XO) inhibitors, did not slow the decline in eGFR as compared with placebo. These results were similar with the results of FEATHER (Febuxostat Versus Placebo Randomized Controlled Trial Regarding Reduced Renal Function in Patients with Hyperuricemia Complicated by Chronic Kidney Disease Stage 3) from Japan. Furthermore, the PRIZE (Program of Vascular Evaluation Under Uric Acid Control by the Xanthine Oxidase Inhibitor Febuxostat: Multicenter, Randomized, Controlled) study showed that febuxostat did not delay progression of carotid atherosclerosis in patients with asymptomatic hyperuricemia. These results suggest that treatment of hyperuricemia could not directly prevent chronic kidney disease (CKD) and/or arteriosclerosis. In contrast, there are many studies that showed the positive relationship between uric acid and hypertension. Lowering serum uric acid levels could reduce blood pressure, but it is unclear that lowering serum uric aclid levels might be directly causing the results in preventing CKD progression, arteriosclerosis, and cardiovascular events. These results suggest that we should carefully choose the treatable patients with hyperuricemia and hypertension.