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Reply to ‘The case for evidence-based medicine for the association between hyperuricaemia and CKD’

Nature Reviews Nephrology volume 16, pages 422–423 (2020)Cite this article

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In our Perspectives article (The case for uric acid-lowering treatment in patients with hyperuricaemia and CKD. Nat. Rev. Nephrol. 15, 767–775; 2019)1 we proposed that individuals with hyperuricaemia and chronic kidney disease (CKD) with worsening kidney function should be considered for urate-lowering therapy (ULT) to slow progression of CKD1. When reviewing the literature, we argued that a trial was only interpretable if the control group showed clinically meaningful worsening of kidney function, which we defined as a reduction in estimated glomerular filtration rate (eGFR) of at least 4–5 ml/min/1.73 m2. In their Correspondence article (The case for evidence-based medicine for the association between hyperuricaemia and CKD. Nat Rev. Nephrol. https://doi.org/10.1038/s41581-020-0288-3 (2020))2, Steiger and colleagues state that we omitted a post-hoc analysis of two negative randomized clinical trials (RCTs)3 but these trials would be considered to be ‘non-interpretable’ by our criteria (ΔeGFR 2.7 ml/min/1.73 m2 in controls)3. Steiger et al. also expressed concerns about our inclusion of five RCTs published in peer-reviewed Chinese journals, which were summarized in a systematic review and meta-analysis4. Although one of these articles contained an error in the English abstract5, we contend that their data should not be ignored simply because they are not indexed in PubMed.

Steiger et al. also argue that CKD progression should be evaluated according to the rate of eGFR decline rather than the absolute change in eGFR during the trial. However, we believe that absolute changes in ΔeGFR are most relevant to clinicians. Our study was not ‘self-fulfilling’ as it was based on whether the controls progressed. Indeed, it is self-fulfilling to report that a study is negative when it is inconclusive.

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References

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Authors and Affiliations

  1. Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, CO, USA

    Yuka Sato, Miguel A. Lanaspa & Richard J. Johnson

  2. Division of Pediatric Nephrology, University of Alabama, Birmingham, AL, USA

    Daniel I. Feig

  3. Division of Nephrology, Department of Medicine, University Hospital Limerick, Limerick, Ireland

    Austin G. Stack

  4. Graduate Entry Medical School, University of Limerick, Limerick, Ireland

    Austin G. Stack

  5. Division of Nephrology Department of Internal Medicine, Ewha Womans University College of Medicine Ewha Medical Research Center, Seoul, Korea

    Duk-Hee Kang

  6. Division of Nephrology, Hypertension and Renal Transplantation, University of Florida, Gainesville, FL, USA

    A. Ahsan Ejaz

  7. Dept. Cardio-Renal Physiopathology, INC Ignacio Chavez, Mexico City, Mexico

    L. Gabriela Sánchez-Lozada

  8. Department of Cardiology and Intensive Care Unit, Toranomon Hospital, Tokyo, Japan

    Masanari Kuwabara

  9. Department of Medicine, University of Bologna, Bologna, Italy

    Claudio Borghi

  10. Rocky Mountain Regional VA Medical Center, Aurora, CO, USA

    Richard J. Johnson

Authors
  1. Yuka Sato
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  10. Richard J. Johnson
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Corresponding author

Correspondence to Richard J. Johnson.

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Competing interests

A.G.S. has had an unrestricted educational grant from Menarini International Operations Luxemburg and has consulted for Menarini and Grunenthal Pharma. G.S.-L. has had funding from Relburn Metabolomic and Danone Research Foundation; R.J.J. has equity with XORT Therapeutics, which is developing novel xanthine oxidase inhibitors, is an inventor on several patents on the role of uric acid in hypertension, metabolic syndrome and diabetic nephropathy that resulted from research (US Patent No. 7,799,794; US Patent No. 8,236,488; US Patent No. 8,557,831; US Patent No. 9,155,740 B), and has consulted for Danone Research Foundation, Horizon Pharmaceuticals and Astra Zeneca.

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Sato, Y., Feig, D.I., Stack, A.G. et al. Reply to ‘The case for evidence-based medicine for the association between hyperuricaemia and CKD’. Nat Rev Nephrol 16, 422–423 (2020). https://doi.org/10.1038/s41581-020-0289-2

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