The prevalence of
hyperuricemia and
chronic kidney disease (CKD) has been steadily increasing. The role of
hyperuricemia and efficacy of
uric acid-lowering agents against CKD progression remain controversial. This study aimed to evaluate the effect of
hyperuricemia and
uric acid-lowering agents on the progression of CKD. A total 2042 patients with CKD were analyzed in the KoreaN cohort Study for Outcomes in patients With
Chronic Kidney Disease (KNOW-CKD), a prospective cohort study. Patients were classified into quartiles on the basis of their serum
uric acid level and the prevalence of advanced CKD was higher in patients with a high
uric acid level. A composite renal outcome was defined as one or more of the following: initiation of dialysis or
transplantation, a two-fold increase in baseline serum
creatinine levels, or a 50% decline in the estimated glomerular filtration rate during the follow-up period. A Cox proportional hazard ratio model was applied to analyze the relationship between composite renal outcome and
uric acid levels. The risk of progression to
renal failure increased by 28% (hazard ratio [HR], 1.277; 95% confidence interval [CI], 1.212-1.345) for each 1 mg/dl increase in the baseline
uric acid level. In multivariate models, an association was found between the highest quartile of
uric acid and increased risk of composite renal outcome (HR, 3.590; 95% CI, 2.546-5.063). A propensity score matching analysis was performed to survey the effect of
uric acid lowering agent. Both
allopurinol and
febuxostat did not affect the renal outcome. In conclusion,
hyperuricemia appears to be an independent risk factor for composite renal outcome, but
allopurinol and
febuxostat did not show reno-protective effect.