A Randomised Prospective Study Analysing the Effects of Lowering Serum Uric Acid in Chronic Kidney Disease (CKD) Progression and Cardiovascular Outcomes

Uric acid is an independent risk factor for the development and progression of kidney disease. In last two decades number of observational studies has examined the potential link between management of hyperuricemia with CKD progression, having conflicted results. Hence, this prospective, randomised controlled study was conducted among stage 3-5 CKD patients in patients to evaluate the effect of lowering uric acid levels in reduction of hypertension, and kidney disease progression and cardiovascular risk. Patients were randomized into two groups, one group (n=100) receiving allopurinol with a dose of 100-300 mg/day plus standard treatment and other group (n=50) receiving only standard treatment. Patients were followed at 3, 6 and 12 months of treatment. After 12 months of allopurinol treatment, serum uric acid levels were significantly (p<0.0001) lowered (8.095 ± 0.877 mg/dL to 6.977 ± 0.569 mg/dL) in patients receiving allopurinol, whereas, the uric acid levels were significantly (p<0.0001) increased in control group (7.910 ± 0.701 mg/dL to 8.196 ± .741 mg/dL). A decrease in estimated glomerular filtration rate (eGFR) was observed at the end of 12 months in both the groups, but the decrease in eGFR was significantly more in the control group as compared to the allopurinol group (P<0.0001). There was no significant effect of allopurinol on cardiovascular outcomes. This study evaluated that lowering of serum uric acid was effective in slowing the renal disease progression and cardiovascular risk in patients with CKD as compared to the controls. However, no significant beneficial effect of allopurinol treatment was observed on hypertension and cardiovascular outcomes in these patients.