Tahir Kanji, Mandark Gandhi, Catherine M Clase, Robert Yang
BACKGROUND: Hyperuricemia may contribute to renal injury. We do not know whether use of treatments that lower urate reduce the progression of chronic kidney disease (CKD) and cardiovascular disease. We performed a systematic review and meta-analysis of randomized controlled trials to assess the benefits and risks of treatments that lower urate in patients with stages 3-5 CKD. METHODS: We searched MEDLINE, EMBASE, CENTRAL, Web of Science and trial registers for randomized controlled trials (RCTs) without language restriction...
April 19, 2015: BMC Nephrology
Kenichi Tanaka, Masaaki Nakayama, Makoto Kanno, Hiroshi Kimura, Kimio Watanabe, Yoshihiro Tani, Yoshimitsu Hayashi, Koichi Asahi, Hiroyuki Terawaki, Tsuyoshi Watanabe
BACKGROUND: Hyperuricemia is associated with the onset of chronic kidney disease (CKD) and renal disease progression. Febuxostat, a novel, non-purine, selective xanthine oxidase inhibitor, has been reported to have a stronger effect on hyperuricemia than conventional therapy with allopurinol. However, few data are available regarding the clinical effect of febuxostat in patients with CKD. METHODS: A prospective, randomized, open-label, parallel-group trial was conducted in hyperuricemic patients with stage 3 CKD...
December 2015: Clinical and Experimental Nephrology
Marian Goicoechea, Soledad Garcia de Vinuesa, Ursula Verdalles, Eduardo Verde, Nicolas Macias, Alba Santos, Ana Pérez de Jose, Santiago Cedeño, Tania Linares, Jose Luño
BACKGROUND: Asymptomatic hyperuricemia increases renal and cardiovascular (CV) risk. We previously conducted a 2-year, single-blind, randomized, controlled trial of allopurinol treatment that showed improved estimated glomerular filtration rate and reduced CV risk. STUDY DESIGN: Post hoc analysis of a long-term follow-up after completion of the 2-year trial. SETTING & PARTICIPANTS: 113 participants (57 in the allopurinol group and 56 in the control group) initially followed up for 2 years and 107 participants followed up to 5 additional years...
April 2015: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Hiromichi Suzuki, Kazuyuki Shimada, Kenji Fujiwara
OBJECTIVES: The guidelines for hypertension require the presence of compelling indications for pharmacological management of hypertension associated with various diseases. Data mainly obtained through randomized controlled trials have provided evidence supporting effectiveness of the combination of losartan (Lo) and hydrochlorothiazide (HCTZ) for management of hypertensive patients. However, there have been few reports discussing the effectiveness of Lo/HTCZ (losartan 50 mg/hydrochlorothizide 12...
February 2015: Therapeutic Advances in Cardiovascular Disease
Ye-Fang Zhang, Fan He, Hong-Hui Ding, Wei Dai, Qian Zhang, Hong Luan, Yong-Man Lv, Hong-Bing Zeng
The efficacy and safety of uric-acid-lowering therapy (UALT) on slowing the progression of chronic kidney disease (CKD) accompanied by hyperuricemia were assessed. We searched Cochrane Library, PubMed, EMbase, CNKI, Wanfang and Vip databases up to November 15, 2012 for randomized controlled trials (RCTs) which compared the effect of UALT to control therapy in hyperuricemic patients secondary to CKD, and then performed quality evaluation and meta-analysis on the included studies. Seven RCTs involving 451 cases were included...
August 2014: Journal of Huazhong University of Science and Technology. Medical Sciences
Kunal Chaudhary, Kunal Malhotra, James Sowers, Annayya Aroor
Elevated serum uric acid levels are a frequent finding in persons with obesity, hypertension, cardiovascular and kidney disease as well as in those with the cardiorenal metabolic syndrome (CRS). The increased consumption of a fructose-rich Western diet has contributed to the increasing incidence of the CRS, obesity and diabetes especially in industrialized populations. There is also increasing evidence that supports a causal role of high dietary fructose driving elevations in uric acid in association with the CRS...
October 2013: Cardiorenal Medicine
Tatsuo Hosoya, Kenjiro Kimura, Sadayoshi Itoh, Masaaki Inaba, Shunya Uchida, Yasuhiko Tomino, Hirofumi Makino, Seiichi Matsuo, Tetsuya Yamamoto, Iwao Ohno, Yugo Shibagaki, Satoshi Iimuro, Naohiko Imai, Masanari Kuwabara, Hiroshi Hayakawa
BACKGROUND: Hyperuricemia is a risk factor for the onset of chronic kidney disease (CKD) and is significantly associated with the progression of CKD. However, there is no sufficient evidence by interventional research supporting a cause-effect relationship. Hyperuricemic patients without gouty arthritis, whose serum urate (SUA) concentration is ≥8.0 mg/dL and who have a complication, are treated by pharmacotherapy in addition to lifestyle guidance. Nevertheless, there is no evidence that rationalizes pharmacotherapy for patients with hyperuricemia who have no complication and whose SUA concentration is below 9...
January 16, 2014: Trials
Daniel I Feig
PURPOSE OF REVIEW: To discuss the evolving data regarding uric acid as a potential cause of hypertension and progressive renal dysfunction and its clinical and research implications. RECENT FINDINGS: The potential mechanisms by which uric acid could cause vasoconstriction and a progressive ateriolopathy were established in animal models between 1999 and 2004. Since then, there has been a growing interest in the topic and numerous retrospective and prospective observational studies...
March 2014: Current Opinion in Rheumatology
Liang Li, Alexander Chang, Stephen G Rostand, Lee Hebert, Lawrence J Appel, Brad C Astor, Michael S Lipkowitz, Jackson T Wright, Cynthia Kendrick, Xuelei Wang, Tom H Greene
Recent data suggest that nonlinear GFR trajectories are common among patients with CKD, but the modifiable risk factors underlying these changes in CKD progression rate are unknown. Analyses relating baseline risk factors to subsequent GFR decline are suboptimal because these relationships often attenuate as follow-up time increases and these analyses do not account for temporal changes in risk factors. We identified 74 participants in the African American Study of Kidney Disease and Hypertension who had both a period of rapid GFR decline and an extended period of stability during a follow-up period of ≥12 years...
March 2014: Journal of the American Society of Nephrology: JASN
Bhadran Bose, Sunil V Badve, Swapnil S Hiremath, Neil Boudville, Fiona G Brown, Alan Cass, Janak R de Zoysa, Robert G Fassett, Randall Faull, David C Harris, Carmel M Hawley, John Kanellis, Suetonia C Palmer, Vlado Perkovic, Elaine M Pascoe, Gopala K Rangan, Robert J Walker, Giles Walters, David W Johnson
BACKGROUND: Non-randomized studies suggest an association between serum uric acid levels and progression of chronic kidney disease (CKD). The aim of this systematic review is to summarize evidence from randomized controlled trials (RCTs) concerning the benefits and risks of uric acid-lowering therapy on renal outcomes. METHODS: Medline, Excerpta Medical Database and Cochrane Central Register of Controlled Trials were searched with English language restriction for RCTs comparing the effect of uric acid-lowering therapy with placebo/no treatment on renal outcomes...
February 2014: Nephrology, Dialysis, Transplantation
Yuan-Mei He, Li Feng, Dong-Mei Huo, Zhen-Hua Yang, Yun-Hua Liao
AIM: Both enalapril and losartan are effective and widely used in patients with chronic kidney disease (CKD). This review aimed to evaluate the benefits of enalapril and losartan in adults with CKD. METHODS: PubMed, EMBASE, the Cochrane Library and were searched, without language limitations, for randomized controlled trials (RCT), in which enalapril and losartan were compared in adults with CKD. Standard methods, consistent with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, were used...
September 2013: Nephrology
Abdul A Abdellatif, Naser Elkhalili
Chronic kidney disease (CKD) is a comorbid condition that affects, based on recent estimates, between 47% and 54% of patients with gouty arthritis. However, data from randomized controlled trials in patients with gouty arthritis and CKD are limited, and current gouty arthritis treatment guidelines do not address the challenges associated with managing this patient population. Nonsteroidal anti-inflammatory drugs and colchicine are recommended first-line treatments for acute gouty arthritis attacks. However, in patients with CKD, nonsteroidal anti-inflammatory drugs are not recommended because their use can exacerbate or cause acute kidney injury...
November 2014: American Journal of Therapeutics
Vassilis Filiopoulos, Dimitrios Hadjiyannakos, Dimosthenis Vlassopoulos
Hyperuricemia is particularly common in patients with arterial hypertension, metabolic syndrome, or kidney disease. Its role, however, as a risk factor for both renal and cardiovascular outcomes and in the context of the well-established interrelationship between cardiovascular disease and chronic kidney disease (CKD) is debated. For decades high serum uric acid levels were mainly considered the result of renal dysfunction and not a true mediator of renal disease development and progression. However, recent epidemiological studies suggest an independent association between asymptomatic hyperuricemia and increased risk of arterial hypertension, CKD, cardiovascular events, and mortality...
2012: Renal Failure
Sunil V Badve, Fiona Brown, Carmel M Hawley, David W Johnson, John Kanellis, Gopala K Rangan, Vlado Perkovic
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...
May 2011: Nature Reviews. Nephrology
Gerasimos S Filippatos, Mustafa I Ahmed, James D Gladden, Marjan Mujib, Inmaculada B Aban, Thomas E Love, Paul W Sanders, Bertram Pitt, Stefan D Anker, Ali Ahmed
AIM: To determine if the association between hyperuricaemia and poor outcomes in heart failure (HF) varies by chronic kidney disease (CKD). METHODS AND RESULTS: Of the 2645 systolic HF patients in the Beta-Blocker Evaluation of Survival Trial with data on baseline serum uric acid, 1422 had hyperuricaemia (uric acid ≥6 mg/dL for women and ≥8 mg/dL for men). Propensity scores for hyperuricaemia, estimated for each patient, were used to assemble a matched cohort of 630 pairs of patients with and without hyperuricaemia who were balanced on 75 baseline characteristics...
March 2011: European Heart Journal
A Ahsan Ejaz, Thomas M Beaver, Michiko Shimada, Puneet Sood, Vijaykumar Lingegowda, Jesse D Schold, Tad Kim, Richard J Johnson
BACKGROUND: Uric acid has been reported to be a risk factor for the development of chronic kidney disease; however, no study has examined whether uric acid may confer a risk for acute kidney injury. METHODS: We investigated the relation between serum uric acid and the incidence of postoperative acute kidney injury in patients undergoing high-risk cardiovascular surgery (cardiac valve and aneurysm surgery). RESULTS: Following cardiovascular surgery, 18 of 58 patients (31%) developed acute kidney injury, with 11 of 24 (45...
2009: American Journal of Nephrology
Magdalena Madero, Mark J Sarnak, Xuelei Wang, Tom Greene, Gerald J Beck, John W Kusek, Allan J Collins, Andrew S Levey, Vandana Menon
BACKGROUND: Hyperuricemia is prevalent in patients with chronic kidney disease (CKD); however, data are limited about the relationship of uric acid levels with long-term outcomes in this patient population. STUDY DESIGN: Cohort study. SETTING & PARTICIPANTS: The Modification of Diet in Renal Disease (MDRD) Study was a randomized controlled trial (N = 840) conducted from 1989 to 1993 to examine the effects of strict blood pressure control and dietary protein restriction on progression of stages 3 to 4 CKD...
May 2009: American Journal of Kidney Diseases
Z Avram, E Krishnan
Rheumatologists care for patients with gouty arthritis, a condition caused by chronic and uncontrolled hyperuricaemia. Hyperuricaemia, gout and renal dysfunction are often bedfellows, raising the possibility of the former causing the latter. We sought the answer to the question 'Among patients with normal measures of glomerular filtration, does hyperuricaemia predict future renal disease'? We identified prospective cohort studies evaluating the relationship between serum uric acid and chronic kidney function from the past 20 yrs, through MEDLINE, Cochrane Library and EMBASE searches and bibliography cross-referencing...
July 2008: Rheumatology
Yui-Pong Siu, Kay-Tai Leung, Matthew Ka-Hang Tong, Tze-Hoi Kwan
BACKGROUND: Hyperuricemia is associated strongly with the development of hypertension, renal disease, and progression. Allopurinol decreases serum uric acid levels by inhibiting the enzyme xanthine oxidase. We hypothesized that administrating allopurinol to decrease serum uric acid levels to the normal range in hyperuricemic patients with chronic kidney disease may be of benefit in decreasing blood pressure and slowing the rate of renal disease progression in these patients. METHODS: We conducted a prospective, randomized, controlled trial of 54 hyperuricemic patients with chronic kidney disease...
January 2006: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
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