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Hyperuricemia in Kidney Disease: A Major Risk Factor for Cardiovascular Events, Vascular Calcification, and Renal Damage. | LitMetric

AI Article Synopsis

  • Kidney disease is linked to higher serum urate (uric acid) levels, but this may be a secondary issue rather than a direct cause of chronic kidney disease.
  • Genetic studies typically show no causal relationship between serum urate and chronic kidney disease, yet many other studies suggest uric acid could play a significant role in both kidney and cardiovascular diseases.
  • The main benefit of reducing serum urate in chronic kidney disease patients appears to be lowering cardiovascular events and mortality rather than slowing kidney disease progression, indicating a need for more large-scale clinical trials.

Article Abstract

Kidney disease, especially when it is associated with a reduction in estimated glomerular filtration rate, can be associated with an increase in serum urate (uric acid), suggesting that hyperuricemia in subjects with kidney disease may be a strictly secondary phenomenon. Mendelian randomization studies that evaluate genetic scores regulating serum urate also generally have not found evidence that serum urate is a causal risk factor in chronic kidney disease. Nevertheless, this is countered by a large number of epidemiologic, experimental, and clinical studies that have suggested a potentially important role for uric acid in kidney disease and cardiovascular disease. Here, we review the topic in detail. Overall, the studies strongly suggest that hyperuricemia does have an important pathogenic role that likely is driven by intracellular urate levels. An exception may be the role of extracellular uric acid in atherosclerosis and vascular calcification. One of the more striking findings on reviewing the literature is that the primary benefit of lowering serum urate in subjects with CKD is not by slowing the progression of renal disease, but rather by reducing the incidence of cardiovascular events and mortality. We recommend large-scale clinical trials to determine if there is a benefit in lowering serum urate in hyperuricemic subjects in acute and chronic kidney disease and in the reduction of cardiovascular morbidity and mortality in subjects with end-stage chronic kidney disease.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7951176PMC
http://dx.doi.org/10.1016/j.semnephrol.2020.12.004DOI Listing

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