Does Altered Uric Acid Metabolism Contribute to Diabetic Kidney Disease Pathophysiology?
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Purpose of Review
Multiple experimental and clinical studies have identified pathways by which uric acid may facilitate the development and progression of chronic kidney disease (CKD) in people with diabetes. However, it remains uncertain if the association of uric acid with CKD represents a pathogenic effect or merely reflects renal impairment.
In contrast to many published reports, a recent Mendelian randomization study did not identify a causal link between uric acid and CKD in people with type 1 diabetes. Two recent multicenter randomized control trials, Preventing Early Renal Function Loss in Diabetes (PERL) and FEbuxostat versus placebo rAndomized controlled Trial regarding reduced renal function in patients with Hyperuricemia complicated by chRonic kidney disease stage 3 (FEATHER), were recently designed to assess if uric acid lowering slows progression of CKD.
We review the evidence supporting a role for uric acid in the pathogenesis of CKD in people with diabetes and the putative benefits of uric acid lowering.
KeywordsUric acid Hyperuricemia Diabetic nephropathy Kidney disease Type 1 diabetes Type 2 diabetes
We would like to thank Ms. Leslie Firkins and Ms. Serena Cumber for their help in preparation of this manuscript. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Dialysis Clinic, Inc.
Compliance with Ethical Standards
Conflict of Interest
Ambreen Gul is an employee of Dialysis Clinic, Inc.
Philip Zager is an employee of the University of New Mexico and Dialysis Clinic, Inc.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
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