Meta-analysis of observational cohort studies on the relationships of asymptomatic hyperuricemia with chronic kidney disease


DOI: https://dx.doi.org/10.18565/therapy.2023.10.21-39

Mazurov V.I., Drapkina O.M., Martynov А.I., Sayganov S.А., Bashkinov R.A., Gaydukova I.Z., Sapozhnikov K.V., Tolkacheva D.G., Sableva N.A., Tsinserling А.Yu.

1) I.I. Mechnikov North-West State Medical University of the Ministry of Healthcare of Russia, Saint Petersburg; 2) Clinical Rheumatology Hospital No. 25, Saint Petersburg; 3) National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Healthcare of Russia, Moscow; 4) A.I. Yevdokimov Moscow State University of Medicine and Dentistry of the Ministry of Healthcare of Russia; 5) Russian Presidential Academy of National Economy and Public Administration, Moscow
Abstract. Studying the relationship between the level of uric acid (UA) and glomerular filtration rate (GFR) is a pressing interdisciplinary problem in the clinic of internal medicine.
Objective: to evaluate the effect of serum UA levels on GFR in patients with initially normal and reduced renal function using a systematic review of cohort observational studies and evaluation of its results based on meta-analysis.
Material and methods. A systematic search and selection of publications was carried out in the Embase, PubMed, Cochrane Library, and eLibrary databases. During the first stage of the study, the relationship between the level of UA in the blood serum and GFR was determined based on the initial data of patients when included in observation. At the second stage, the dynamics of GFR was analyzed in a population of patients mixed by the presence of chronic kidney disease (CKD) over observation periods of up to 6 years and from 6 to 10 years. The meta-analysis assessed the clinical and methodological heterogeneity of the included studies, as well as publication bias and risk of bias.
Results. The meta-analysis included 23 eligible clinical trials (involving 216,479 patients). As a result of the analysis, it was revealed that an increase in the level of UA in the blood serum by 1 mg/dL leads to a decrease in GFR by 1,18 (95% CI from -1,24 to -1,12) ml/min/1,73 m2 in individuals with initially normal renal function and by 1,87 (95% CI from -1,90 to -1,83) ml/min/1,73 m2 in a cohort of patients mixed by the presence of CKD. Moreover, data were obtained that demonstrated a statistically significant decrease in GFR by 4,44 (95% CI from -7,65 to -1,23) ml/min/1,73 m2 during 6 years of follow-up and by 6,21 (95% CI from -8,09 to -4,34) ml/min/1,73 m2 over a follow-up period of more than 6 years in a mixed CKD population of patients suffering from asymptomatic hyperuricemia (AHU).
Conclusion. The results of this meta-analysis showed a statistically significant negative effect of increasing serum UA levels on GFR both in individuals with initially normal renal function and in a cohort of patients mixed in terms of the presence of CKD. Along with this, it was found that a decrease in the filtration function of the kidneys against the background of hyperuricemia in a population of patients mixed in terms of the presence of CKD tends to progress with a longer period of observation. Thus, therapeutic measures aimed at reducing the level of sUA in the blood serum in individuals with AHU can serve as an additional factor of nephroprotection to prevent the development and progression of kidney pathology.
Keywords: meta-analysis of observational studies, asymptomatic hyperuricemia, urate-lowering therapy, nephroprotection, chronic kidney disease
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About the Autors

Vadim I. Mazurov, MD, professor, academician of RAS, principal scientific advisor, director of the Research institute of rheumatology and head of the Department of therapy, rheumatology, examination of temporary disability and quality of medical care named after E.E. Eichwald of I.I. Mechnikov North-West State Medical University of the Ministry of Healthcare of Russia; head of autoimmune center of Clinical Rheumatology Hospital No. 25 (Saint Petersburg); Honored Worker of Science of the Russian Federation. Address: 191014, Saint Petersburg, 41 Kirochnaya St.
E-mail: maz.nwgmu@yandex.ru
ORCID: https://orcid.org/0000-0002-0797-2051
SPIN: 6823-5482. SCOPUS: 16936315400
Oksana M. Drapkina, MD, professor, academician of RAS, director and head of the Department of basic and applied aspects of obesity, National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Healthcare of Russia; chief external specialist in therapy and general medical practice of the Ministry of Healthcare of Russia; president of Russian Society for the Prevention of Non-Infectious Diseases. Adress: 101000, Moscow, 10/3 Petroverigsky Lane.
E-mail: drapkina@bk.ru
https://orcid.org/0000-0002-4453-8430
SPIN: 4456-1297. SCOPUS: 57208852308
Anatoly I. Martynov, MD, professor, academician of RAS, professor of the Department of hospital therapy No. 1, A.I. Yevdokimov Moscow State University of Medicine and Dentistry Ministry of Healthcare of Russia; president of Russian Scientific Medical Society of Internal Medicine. Address: 127473, Moscow, 20/1 Delegatskaya St.
E-mail: idjema@gmail.com
https://orcid.org/0000-0002-0783-488X
SPIN: 5271-3173. SCOPUS: 7102769644
Sergey А. Sayganov, MD, professor, rector and head of the Department of hospital therapy and cardiology named after M.S. Kushakovsky, I.I. Mechnikov North-West State Medical University of the Ministry of Healthcare of Russia. Address: 191014, Saint Petersburg, 41 Kirochnaya St.
E-mail: sergey.saiganov@szgmu.ru
ORCID: https://orcid.org/0000-0001-8325-1937
SPIN: 2174-6400. SCOPUS: 36140532200
Roman A. Bashkinov, postgraduate student of the Department of therapy, rheumatology, examination of temporary disability and quality of medical care named after E.E. Eichwald, I.I. Mechnikov North-West State Medical University of the Ministry of Healthcare of Russia; rheumatologist at Clinical Rheumatology Hospital No. 25 (Saint Petersburg). Address: 191014, Saint Petersburg, 41 Kirochnaya St.
E-mail: bashkinov-roman@mail.ru
ORCID: https://orcid.org/0000-0001-9344-1304
SPIN: 5169-5066. SCOPUS: 57221994610
Inna Z. Gaydukova, MD, professor, deputy director of the Research institute of rheumatology and professor of the Department of therapy, rheumatology, examination of temporary disability and quality of medical care named after E.E. Eichwald, I.I. Mechnikov North-West State Medical University of the Ministry of Healthcare of Russia; rheumatologist at Clinical Rheumatology Hospital No. 25» (Saint-Petersburg). Address: 191014, Saint Petersburg, 41 Kirochnaya St.
E-mail: ubp1976@list.ru
ORCID: https://orcid.org/0000-0003-3500-7256
SPIN: 3083-7996. SCOPUS: 55237525900
Kirill V. Sapozhnikov, PhD in Medical Sciences, independent expert on research projects of Project Office of the North-West Institute of Management – a branch office of Russian Presidential Academy of National Economy and Public Administration». Address: 119571, Moscow, 82/1 Vernadskogo Avenue.
E-mail: marinheira@rambler.ru
ORCID: https://orcid.org/0000-0002-2476-7666
SPIN: 2707-0339. SCOPUS: 57200810332
Daria G. Tolkacheva, independent expert on research projects of Project Office of the North-West Institute of Management – a branch office of Russian Presidential Academy of National Economy and Public Administration». Address: 119571, Moscow, 82/1 Vernadskogo Avenue.
E-mail: tolkacheva.d@gmail.com
ORCID: https://orcid.org/0000-0002-6314-4218
SCOPUS: 57221817074
Natalia A. Sableva, independent expert on research projects of Project Office of the North-West Institute of Management – a branch office of Russian Presidential Academy of National Economy and Public Administration. Address: 119571, Moscow, 82/1 Vernadskogo Avenue.
E-mail: sablevana@gmail.com
ORCID: https://orcid.org/0000-0002-5809-9221
SCOPUS: 57712944300
Alexandra Yu. Tsinserling, senior laboratory assistant at the Department of therapy, rheumatology, examination of temporary disability and quality of medical care named after E.E. Eichwald, I.I. Mechnikov North-West State Medical University of the Ministry of Healthcare of Russia rheumatologist at Clinical Rheumatology Hospital No. 25» (Saint-Petersburg). Address: 191014, Saint Petersburg, 41 Kirochnaya St.
E-mail: aleksa.fonturenko@mail.ru
ORCID: https://orcid.org/0000-0003-4860-0518
SPIN: 5613-9035


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