# Multicenter randomized controlled trial of intensive uric acid lowering therapy for CKD patients with hyperuricemia: TARGET-UA

## TL;DR

A clinical trial found that intensive uric acid lowering therapy did not provide better kidney protection than standard therapy in patients with chronic kidney disease and high uric acid levels.

## Contribution

This study is the first multicenter randomized controlled trial to evaluate the renal benefits of intensive uric acid lowering therapy in CKD patients with hyperuricemia.

## Key findings

- Intensive uric acid lowering therapy did not significantly reduce albuminuria compared to standard therapy.
- Serum uric acid levels were successfully lowered in both treatment groups over 52 weeks.
- No additional renal protection was observed with more intensive uric acid management.

## Abstract

We investigate whether Intensive uric acid (UA)-lowering therapy (ULT) provides increased renal protection compared with standard therapy in chronic kidney disease (CKD) patients.

This was a multicenter randomized controlled trial. Only CKD patients with hyperuricemia were included in this study. The participants were randomly assigned to either the Intensive therapy group (target serum UA level ≥ 4.0 mg/dL and < 5.0 mg/dL) or the standard therapy group (serum UA level ≥ 6.0 mg/dL and < 7.0 mg/dL). ULT was performed using topiroxostat, a non-purine-type selective xanthine oxidase inhibitor. The primary endpoint was change in the logarithmic value of urine albumin to the creatinine ratio (ACR) between baseline and week 52 of the treatment.

Three hundred fifty-two patients were included in the full analysis set. In the Standard therapy group, mean serum UA was 8.23 mg/dL at baseline and 6.13 mg/dL at 52 weeks. In the Intensive therapy group, mean serum UA was 8.15 mg/dL at baseline and 5.25 mg/dL at 52 weeks. There was no significant difference in changes in log ACR at 52 weeks between the Intensive therapy and the Standard therapy groups.

This study did not reveal the benefit of Intensive ULT to improve albuminuria levels.

(UMIN000026741 and jRCTs051180146).

The online version contains supplementary material available at 10.1007/s10157-024-02483-w.