Xanthine Oxidase Inhibitors for Improving Renal Function in Chronic Kidney Disease Patients: An Updated Systematic Review and Meta-Analysis

• Published in: International journal of molecular sciences Vol. 18; no. 11; p. 2283
• Main Authors: Pisano, Anna, Cernaro, Valeria, Gembillo, Guido, D’Arrigo, Graziella, Buemi, Michele, Bolignano, Davide
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 31.10.2017; MDPI
• Subjects: Aged; Allopurinol - therapeutic use; Chronic illnesses; Enzyme Inhibitors - therapeutic use; Febuxostat - therapeutic use; Female; Humans; Kidney diseases; Male; Meta-analysis; Middle Aged; Nitriles - therapeutic use; Pyridines - therapeutic use; Randomized Controlled Trials as Topic; Renal Insufficiency, Chronic - drug therapy; Review; Systematic review; Xanthine Oxidase - antagonists & inhibitors; topiroxostat; xanthine oxidase inhibitors; chronic kidney disease; end-stage kidney disease; febuxostat; allopurinol
• ISSN: 1422-0067; 1661-6596; 1422-0067
• DOI: 10.3390/ijms18112283

Background: Accruing evidence suggests that Xanthine Oxidase inhibitors (XOis) may bring direct renal benefits, besides those related to their hypo-uricemic effect. We hence aimed at performing a systematic review of randomized controlled trials (RCTs) to verify if treatment with XOis may improve renal outcomes in individuals with chronic kidney disease (CKD). Methods: Ovid-MEDLINE, PubMed and CENTRAL databases were searched for RCTs comparing any XOi to standard therapy or placebo. The primary endpoint of interest was progression to End-Stage Kidney Disease (ESKD); secondary endpoints were changes in serum creatinine, glomerular filtration rate (eGFR), proteinuria and albuminuria. Results: XOis treatment significantly reduced the risk of ESKD compared to the control (3 studies, 204 pts; RR = 0.42; 95% CI, 0.22, 0.80) and also improved eGFR in data pooled from RCTs with long follow-up times (>3 mo.) (4 studies, 357 pts; mean difference (MD) 6.82 mL/min/1.73 m2; 95% CI, 3.50, 10.15) and high methodological quality (blind design) (3 studies, 400 pts; MD 2.61 mL/min/1.73 m2; 95% CI, 0.23, 4.99). Conversely, no definite effects were apparently noticed on serum creatinine, proteinuria and albuminuria. Conclusions: XOis may represent a promising tool for retarding disease progression in CKD patients. Future trials are awaited to confirm the generalizability of these findings to the whole CKD population.