Observational studies have shown that asymptomatic hyperuricemia is associated with increased risks of hypertension, chronic kidney disease (CKD), end-stage renal disease, cardiovascular events, and mortality. Whether these factors represent cause, consequence or incidental associations, however, remains uncertain. Hyperuricemia could be a consequence of impaired kidney function, diuretic therapy or oxidative stress, such that elevated serum urate level represents a marker, rather than a cause, of CKD. On the other hand, small, short-term, single-center studies have shown improvements in blood-pressure control and slowing of CKD progression following serum urate lowering with allopurinol. An adequately powered randomized controlled trial is required to determine whether uric-acid-lowering therapy slows the progression of CKD. This article discusses the rationale for and the feasibility of such a trial. International collaboration is required to plan and conduct a large-scale multicenter trial in order to better inform clinical practice and public health policy about the optimal management of asymptomatic hyperuricemia in patients with CKD.
AD - Australian Kidney Trials Network, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, QLD 4102, Australia. AN - 21321568 BT - Nature Reviews Nephrology ET - 2011/02/16 LA - eng M1 - 5 N1 - Badve, Sunil VBrown, FionaHawley, Carmel MJohnson, David WKanellis, JohnRangan, Gopala KPerkovic, VladoEnglandNature reviews. NephrologyNat Rev Nephrol. 2011 May;7(5):295-300. Epub 2011 Feb 15. N2 -Observational studies have shown that asymptomatic hyperuricemia is associated with increased risks of hypertension, chronic kidney disease (CKD), end-stage renal disease, cardiovascular events, and mortality. Whether these factors represent cause, consequence or incidental associations, however, remains uncertain. Hyperuricemia could be a consequence of impaired kidney function, diuretic therapy or oxidative stress, such that elevated serum urate level represents a marker, rather than a cause, of CKD. On the other hand, small, short-term, single-center studies have shown improvements in blood-pressure control and slowing of CKD progression following serum urate lowering with allopurinol. An adequately powered randomized controlled trial is required to determine whether uric-acid-lowering therapy slows the progression of CKD. This article discusses the rationale for and the feasibility of such a trial. International collaboration is required to plan and conduct a large-scale multicenter trial in order to better inform clinical practice and public health policy about the optimal management of asymptomatic hyperuricemia in patients with CKD.
PY - 2011 SN - 1759-507X (Electronic)1759-5061 (Linking) SP - 295 EP - 300 T2 - Nature Reviews Nephrology TI - Challenges of conducting a trial of uric-acid-lowering therapy in CKD VL - 7 ER -