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The case for evidence-based medicine for the association between hyperuricaemia and CKD

Nature Reviews Nephrology volume 16, page 422 (2020)Cite this article

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We write in response to the Perspectives article by Y. Sato et al. (The case for uric acid-lowering treatment in patients with hyperuricaemia and CKD. Nat. Rev. Nephrol. 15, 767–775; 2019)1, which advocated treating asymptomatic hyperuricaemia to attenuate the progression of chronic kidney disease (CKD), based on small randomized control trials (RCTs) categorized as either ‘interpretable’ or ‘non-interpretable’. The majority of interpretable RCTs suggested a treatment effect, whereas non-interpretable RCTs did not. The authors concluded that “treatment of so-called asymptomatic hyperuricaemia to slow or delay the progression of CKD should be a key management strategy”1. We have several objections to this statement.

First, 5 of 14 ‘interpretable’ studies that reported positive results were not retrievable via Pubmed, Medline or Google Scholar and were only available from one Chinese repository of research literature. Q.M., who is a native Chinese speaker, analysed these publications and found variations between the full text and the English abstract — for example, urate-lowering therapy (ULT) with benzbromarone was mentioned in the English abstract but not in the full text of one study2, which might lead to misinterpretation of the study. By contrast, a post-hoc analysis of two replicate phase III RCTs that was published open access in English and fulfilled the interpretable criteria established by the authors but reported negative results3 was omitted from their analysis1, suggesting a selection bias towards the concept proposed by the authors.

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References

  1. Sato, Y. et al. The case for uric acid-lowering treatment in patients with hyperuricaemia and CKD. Nat. Rev. Nephrol. 15, 767–775 (2019).

    Article  CAS  Google Scholar 

  2. Tan, Y., Fu, J., Liang, M., Lin, Z. & Huang, J. Clinical observation of the effect of allopurinol to protect renal function in patients with diabetic nephropathy. Mod. Hosp. 11, 36–38 (2011).

    Google Scholar 

  3. Yood, R. A., Ottery, F. D., Irish, W. & Wolfson, M. Effect of pegloticase on renal function in patients with chronic kidney disease: a post hoc subgroup analysis of 2 randomized, placebo-controlled, phase 3 clinical trials. BMC Res. Notes 7, 54 (2014).

    Article  Google Scholar 

  4. Downing, N. S., Aminawung, J. A., Shah, N. D., Krumholz, H. M. & Ross, J. S. Clinical trial evidence supporting FDA approval of novel therapeutic agents, 2005–2012. JAMA 311, 368–377 (2014).

    Article  CAS  Google Scholar 

  5. Djulbegovic, B. & Guyatt, G. H. Progress in evidence-based medicine: a quarter century on. Lancet 390, 415–423 (2017).

    Article  Google Scholar 

  6. Badve, S. et al. Effect of allopurinol on the progression of CKD: the CKD-FIX study[abstract TH-PO1198]. ASN Kidney Week https://www.asn-online.org/education/kidneyweek/2019/program-abstract.aspx?controlId=3261360 (2019).

  7. Doria, A., Gelecki, A., Spino, C. & Maurer, M. Preventing Early Renal Loss in Diabetes (PERL) study: outcome of a 3-year trial of serum uric acid reduction with allopurinol [abstract FR-OR137] ASN Kidney Week https://www.asn-online.org/education/kidneyweek/2019/program-abstract.aspx?controlId=3274268 (2019).

  8. Ahola, A. J. et al. The serum uric acid concentration is not causally linked to diabetic nephropathy in type 1 diabetes. Kidney Int. 91, 1178–1185 (2017).

    Article  CAS  Google Scholar 

  9. Jordan, D. M. et al. No causal effects of serum urate levels on the risk of chronic kidney disease: a Mendelian randomization study. PLoS Med. 16, e1002725 (2019).

    Article  Google Scholar 

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Acknowledgements

This work was supported by the Deutsche Forschungsgemeinschaft (STE2437/2-1 and AN372/24-1) and by LMUexcellent initiative (S.S.). Q.M. was supported by the Chinese Scholarship Council.

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  1. Department of Medicine IV, University Hospital, LMU Munich, Munich, Germany

    Stefanie Steiger, Qiuyue Ma & Hans-Joachim Anders

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  1. Stefanie Steiger
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  2. Qiuyue Ma
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Correspondence to Hans-Joachim Anders.

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Steiger, S., Ma, Q. & Anders, HJ. The case for evidence-based medicine for the association between hyperuricaemia and CKD. Nat Rev Nephrol 16, 422 (2020). https://doi.org/10.1038/s41581-020-0288-3

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