Table 3.
Association of the ULT use with the kidney function (the ULT question).
| Comparisons¶ | Change in eGFR | Change in serum creatinine | Change in proteinuria or albuminuria | Kidney failure (patient numbers) |
|---|---|---|---|---|
| ULT versus control (⩾1 year of follow-up) | MD 1.81 ml/min per 1.73 m2, 95% CI 0.26–3.35, p = 0.02, I2 = 68%*; very low certainty evidence (n = 8) | MD −0.33 mg/dl, 95% CI −0.47 to −0.19, p < 0.00001, I2 of 92%*; low certainty evidence (n = 11) | MD −5.44 mg/day, 95% CI −8.49 to −2.39, p = 0.0005, I2 of 0%*; low certainty evidence (n = 6) | RR 0.61, 95% CI 0.34–1.12, p = 0.11, I2 of 61%‡; very low certainty evidence (n = 8) |
| ULT versus control (<1 year of follow-up) | MD 1.43 ml/min per 1.73 m2, 95% CI −0.67 to 3.53, p = 0.18, I2 of 86%*; very low certainty evidence (n = 16) | MD −0.01 mg/dl, 95% CI −0.07 to 0.04, p = 0.63, I2 of 34%*; low certainty evidence (n = 7) | MD −201.12 mg/day, 95% CI −418.98 to 16.73, p = 0.07, I2 of 24%‡; low certainty evidence (n = 6) | RR 1.60, 95% CI 0.48– 5.30, p = 0.44, I2 not applicable‡; low certainty evidence (n = 1) |
| Allopurinol 100–300 mg/day versus control (⩾1 year) | MD 2.10 ml/min per 1.73 m2, 95% CI −0.47 to 4.67, p = 0.11, I2 of 52%*; very low certainty evidence (n = 6) | MD −0.61 mg/dl, 95% CI −0.91 to −0.32, p < 0.0001, I2 = 94%*; low certainty evidence (n = 9) | MD −5.44 mg/day, 95% CI −8.49 to −2.39, p = 0.0005, I2 of 0%*; low certainty evidence (n = 6) | RR 0.61, 95% CI 0.34–1.12, p = 0.11, I2 of 61‡; low certainty evidence (n = 8) |
| Allopurinol 100–300 mg/day versus control (<1 year) | MD 2.68 ml/min per 1.73 m2, 95% CI 0.17 to 5.20, p = 0.04, I2 of 58%*; very low certainty evidence (n = 9) | MD −0.06 mg/dl, 95% CI −0.25 to 0.13, p = 0.52, I2 0%*; low certainty evidence (n = 2) | MD −113.32 mg/day, 95% CI −331.34 to 104.38, p = 0.31, I2 of 2%‡; low certainty evidence (n = 5) | No data |
| Febuxostat 10–60 mg/day versus control (⩾1 year) | MD 2.32 ml/min per 1.73 m2, 95% CI 1.75 to 2.89, p < 0.00001, I2 = 0%‡; moderate certainty evidence (n = 2) | MD −0.09 mg/dl, 95% CI −0.14 to −0.04, p = 0.0005, I2 = 17%‡; moderate certainty evidence (n = 2) | No data | No data |
| Febuxostat 10–60 mg/day versus control (<1 year) | MD 0.40 ml/min per 1.73 m2, 95% CI −2.18 to 2.97, p = 0.50, I2 of 17 %*; low certainty evidence (n = 5) | MD 0.01 mg/dl, 95% CI −0.06 to 0.09, p = 0.82, I2 of 0%*; low certainty evidence (n = 3) | MD −430.00 mg/day, 95% CI −759.97 to −100.03, I2 not applicable, p = 0.01‡; low certainty evidence (n = 1) | RR 1.60, 95% CI 0.48 to 5.30, p = 0.44, I2 not applicable‡; low certainty evidence (n = 1) |
| Allopurinol versus febuxostat (⩾1 year) | MD −0.20 ml/min per 1.73 m2, 95% CI −6.92 to 6.52, p = 0.95, I2 not applicable‡; low certainty evidence (n = 1) | No data | MD 65.40 mg/day, 95% CI −12.15 to 142.95, p = 0.10, I2 not applicable‡; low certainty evidence (n = 1) | RR 1.26, 95% CI 0.98–1.63, p = 0.07, n = 1, low certainty evidence |
| Allopurinol versus febuxostat (<1 year) | MD −0.89 ml/min per 1.73 m2, 95% CI −3.83 to 2.05, p = 0.55, I2 not applicable*; low certainty evidence (n = 1) | MD 0.12 mg/dl, 95% CI 0.00–0.24, p = 0.04, I2 not applicable; low certainty evidence (n = 1) | MD 100.70 mg/day, 95% CI 37.66–163.74, p = 0.002, I2 not applicable‡; low certainty evidence (n = 1) | No data |
| Febuxostat 10 mg/day versus topiroxostat 40 mg/day (<1 year) | MD 0.60 ml/min per 1.73 m2, 95 % CI −4.58 to 5.78, p = 0.82, I2 not applicable, very low certainty of evidence (n = 1) | No data | No data | No data |
| Topiroxostat (up to 160 mg/day) versus control (<1 year) | MD −1.42 ml/min per 1.73 m2, 95% CI −6.22 to 3.38, p = 0.56, I2 = 96%‡; low certainty evidence (n = 2) | No data | No data | No data |
| Benzbromarone 50 mg/day versus control (<1 year) | No data | MD 0.00 mg/dl, 95% CI −0.01 to 0.01, p = 0.73, I2 not applicable†; low certainty evidence (n = 1) | MD −4.20 mg/l, 95% CI −4.50 to −3.90, p < 0.00001, I2 not applicable†; low certainty evidence (n = 1)§ | No data |
| Rasburicase 4.5 mg single dose versus control (<1 year) | No data | MD −0.63 mg/dl, 95% CI −1.11 to −0.15, p = 0.01, I2 not applicable; low certainty evidence (n = 1) | No data | No data |
*
Regardless of baseline kidney function.
†
Normal baseline kidney function.
‡
Abnormal kidney function.
§
Benzbromarone albuminuria data units in mg/l, could not be included in all ULT combined versus control (<1 year) proteinuria/albuminuria analysis.
¶The control group consisted of placebo (n=20), usual care (n=9), no active treatment (n=3), or a direct comparison of two ULTs (n=6).
CI, confidence interval; MD, mean difference; RR, risk ratio; ULT, urate-lowering therapy.