Hyperuricaemia is common among patients with chronic kidney disease (CKD), and increases in severity with the deterioration of kidney function. Although existing guidelines for CKD management do not recommend testing for or treatment of hyperuricaemia in the absence of a diagnosis of gout or urate nephrolithiasis, an emerging body of evidence supports a direct causal relationship between serum urate levels and the development of CKD. Here, we review randomized clinical trials that have evaluated the effect of urate-lowering therapy (ULT) on the rate of CKD progression. Among trials in which individuals in the control arm experienced progressive deterioration of kidney function (which we define as ≥4 ml/min/1.73 m² over the course of the study - typically 6 months to 2 years), treatment with ULT conferred consistent clinical benefits. In contrast, among trials where clinical progression was not observed in the control arm, treatment with ULT was ineffective, but this finding should not be used as an argument against the use of uric acid-lowering therapy. Although additional studies are needed to identify threshold values of serum urate for treatment initiation and to confirm optimal target levels, we believe that sufficient evidence exists to recommend routine measurement of serum urate levels in patients with CKD and consider initiation of ULT among those who are hyperuricaemic with evidence of deteriorating renal function, unless specific contraindications exist.

中文翻译：

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高尿酸血症合并CKD患者降尿酸治疗的案例[J].

高尿酸血症在慢性肾病（CKD）患者中很常见，并且随着肾功能的恶化而加重。尽管现有的 CKD 管理指南不建议在没有痛风或尿酸盐肾结石诊断的情况下检测或治疗高尿酸血症，但新出现的证据支持血清尿酸盐水平与 CKD 发展之间的直接因果关系。在这里，我们回顾了评估降尿酸治疗 (ULT) 对 CKD 进展率影响的随机临床试验。在对照组个体经历肾功能进行性恶化（我们定义为在研究​​过程中≥4 ml/min/1.73 m² - 通常为 6 个月至 2 年）的试验中，ULT 治疗具有一致的临床益处. 相比之下，在对照组未观察到临床进展的试验中，ULT 治疗无效，但这一发现不应作为反对使用降尿酸治疗的论据。尽管需要更多的研究来确定治疗开始时的血清尿酸阈值并确认最佳目标水平，但我们认为有足够的证据推荐对 CKD 患者的血清尿酸水平进行常规测量，并考虑在高尿酸血症患者中开始 ULT有肾功能恶化的证据，除非存在特定的禁忌症。