title: Challenges of conducting a trial of uric-acid-lowering therapy in CKD.
abstract: 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.
authors.affiliation: Australian Kidney Trials Network, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, QLD 4102, Australia. sunil_badve@health.qld.gov.au
authors.forename: Sunil V
authors.initials: SV
authors.lastname: Badve
authors.forename: Fiona
authors.initials: F
authors.lastname: Brown
authors.forename: Carmel M
authors.initials: CM
authors.lastname: Hawley
authors.forename: David W
authors.initials: DW
authors.lastname: Johnson
authors.forename: John
authors.initials: J
authors.lastname: Kanellis
authors.forename: Gopala K
authors.initials: GK
authors.lastname: Rangan
authors.forename: Vlado
authors.initials: V
authors.lastname: Perkovic
mesh_terms: D000493:Allopurinol / Q000627:therapeutic use*; D006074:Gout Suppressants / Q000627:therapeutic use*; D006801:Humans; D033461:Hyperuricemia / Q000188:drug therapy* / Q000453:epidemiology / Q000378:metabolism; D007676:Kidney Failure, Chronic / Q000188:drug therapy* / Q000453:epidemiology / Q000378:metabolism; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D012107:Research Design; D012307:Risk Factors; D014527:Uric Acid / Q000097:blood*
chemical_list: D006074:Gout Suppressants; D014527:Uric Acid; D000493:Allopurinol