Thread by @Ralph_Wendt

@DamianFog @CMClase @Roxytonin @kidneydoc101 @hswapnil @drpaddymark @kidney_boy @arvindcanchi @NavTangri @NephJC @THKC1 I can't think of just one good reason to treat asymptomatik hyperuricemia. It does not slow progression of CKD progression.
All trials that were randomized AND placebo controlled were negativ (red underlined)

@DamianFog @CMClase @Roxytonin @kidneydoc101 @hswapnil @drpaddymark @kidney_boy @arvindcanchi @NavTangri @NephJC @THKC1 citation for picture above: PMID: 25928556

@DamianFog @CMClase @Roxytonin @kidneydoc101 @hswapnil @drpaddymark @kidney_boy @arvindcanchi @NavTangri @NephJC @THKC1 best study so far is the FEATHER trial. RCT, 467 patients, CKD 3,asymptomatic hyperuricemia, Feboxostat versus placebo. outcome: febuxostat does nothing good for the kidneys. ncbi.nlm.nih.gov/pubmed/30177485

@DamianFog @CMClase @Roxytonin @kidneydoc101 @hswapnil @drpaddymark @kidney_boy @arvindcanchi @NavTangri @NephJC @THKC1 So there is no proove it does anything good, but we all know so much harm it can do. Among the worst it triggers Steven-Johnson Syndrom and Lyell Syndrom and is amongst the most causative drugs for those conditions jidonline.org/article/S0022-…

@DamianFog @CMClase @Roxytonin @kidneydoc101 @hswapnil @drpaddymark @kidney_boy @arvindcanchi @NavTangri @NephJC @THKC1 And feboxostat seems to raise the number of cardiovascular events (compared to Allopurinol). HR 1,34 (1,03 - 1,73). Also no good. nejm.org/doi/full/10.10…

@DamianFog @CMClase @Roxytonin @kidneydoc101 @hswapnil @drpaddymark @kidney_boy @arvindcanchi @NavTangri @NephJC @THKC1 If you still want to treat asymptomatic hyperuricemia, go to India and get some Terminalia bellerica from the trees. There is an randomized, double-blind, placebo-, and positive-controlled clinical pilot study. It lowers uric acid and does no harm. :-)
ncbi.nlm.nih.gov/pubmed/27382337

@DamianFog @CMClase @Roxytonin @kidneydoc101 @hswapnil @drpaddymark @kidney_boy @arvindcanchi @NavTangri @NephJC @THKC1 There two RCTs coming up: CKD Fix trial and The PERL Consortium trial (CKD progression in Typ 1 D.m.), both with allopurinol. Until they proove something, I highly recommend no patient should be put on an XO inhibitor

@DamianFog @CMClase @Roxytonin @kidneydoc101 @hswapnil @drpaddymark @kidney_boy @arvindcanchi @NavTangri @NephJC @THKC1 And for all fans of association studies with hyperuricaemia beeing associated with pretty much everything, I recommend not only the neg RCTs above, but also the two following mendelian randomisation studies:
bmj.com/content/347/bm…
kidney-international.org/article/S0085-…

@DamianFog @CMClase @Roxytonin @kidneydoc101 @hswapnil @drpaddymark @kidney_boy @arvindcanchi @NavTangri @NephJC @THKC1 And please remember uric acid is a (dynamic) marker of volume status, as nicely shown in this old but fabulous work:
citeseerx.ist.psu.edu/viewdoc/downlo…

@DamianFog @CMClase @Roxytonin @kidneydoc101 @hswapnil @drpaddymark @kidney_boy @arvindcanchi @NavTangri @NephJC @THKC1 And as a final remark: please do not use uricosuric agents like probenecid to lower asymptomativ hyperuricaemia. Uric Acid is not the target nor the problem, if at all, it is the Xanthin Oxidase. Wonderful paper in Circulation on this:
ncbi.nlm.nih.gov/pubmed/17130343