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Enthusiasm For Johnson's Fructose Hypothesis
- Joel Topf recounts being captivated by Richard Johnson's fructose-urate hypothesis and becoming an early proponent.
- He waited years for definitive RCT proof and felt compelled when trials finally answered the question.
Allopurinol Failed To Slow CKD Progression
- Two large randomized trials (PERL and CKD-FIX) tested allopurinol for slowing CKD progression and found no kidney-protective effect.
- Consistent negative results challenge the hypothesis that lowering urate prevents CKD progression.
Trial Design Focused On Rapid Progressors
- PERL and CKD-FIX enrolled faster-progressing CKD patients and used measured or estimated GFR slope as primary outcomes.
- Both trials achieved urate lowering but showed no benefit on GFR slope or secondary kidney outcomes.