Jang-Wook Lee1, Kwang-Hoon Lee2. 1. Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, South Korea. 2. Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, South Korea. lkh24217@hanmail.net.
Abstract
PURPOSE: This study aimed to compare the renoprotective effect between febuxostat and allopurinol in hyperuricemic patients with chronic kidney disease (CKD), about which limited data are available. METHODS: 141 patients with stage 3 CKD and hyperuricemia were followed from June 2005 to April 2018. Thirty patients received febuxostat, 40 allopurinol and 71 conventional CKD management only (control group). We compared the mean serum uric acid levels, estimated glomerular filtration rate (eGFR) changes over time and renal survival time free from predefined renal disease progression among these 3 groups. RESULTS: Overall, mean age was 62.6 ± 13.3 years, baseline eGFR 42.1 ± 8.8 mL/min/1.73 m2, and serum uric acid 8.6 ± 1.5 mg/dL without intergroup difference. During the observation period (55.9 ± 31.8 months), febuxostat group, compared to both allopurinol and control group, had significantly lower mean serum uric acid levels (5.7 ± 1.0 vs. 7.1 ± 1.2 vs. 8.0 ± 0.8 mg/dL, p < 0.001) and maintained significantly higher mean eGFR values consistently for 4 years. Febuxostat group had significantly longer renal survival time free from renal disease progression than allopurinol and control group (87.7 (95% CI 71.2-104.2) vs. 77.6 (95% CI 60.2-94.9) vs. 48.7 (95% CI 39.3-58.1) months, respectively, p < 0.001). Cox proportional hazard model analysis adjusting for potent confounders revealed that febuxostat, with control group as reference, significantly reduced the risk of renal disease progression by 74.3% (hazard ratio 0.257 (95% CI 0.072-0.912), p = 0.036), while allopurinol showed insignificant result. CONCLUSIONS: Febuxostat seems to reduce serum uric acid level and to retard renal disease progression more effectively than allopurinol in hyperuricemic patients with CKD.
PURPOSE: This study aimed to compare the renoprotective effect between febuxostat and allopurinol in hyperuricemicpatients with chronic kidney disease (CKD), about which limited data are available. METHODS: 141 patients with stage 3 CKD and hyperuricemia were followed from June 2005 to April 2018. Thirty patients received febuxostat, 40 allopurinol and 71 conventional CKD management only (control group). We compared the mean serum uric acid levels, estimated glomerular filtration rate (eGFR) changes over time and renal survival time free from predefined renal disease progression among these 3 groups. RESULTS: Overall, mean age was 62.6 ± 13.3 years, baseline eGFR 42.1 ± 8.8 mL/min/1.73 m2, and serum uric acid 8.6 ± 1.5 mg/dL without intergroup difference. During the observation period (55.9 ± 31.8 months), febuxostat group, compared to both allopurinol and control group, had significantly lower mean serum uric acid levels (5.7 ± 1.0 vs. 7.1 ± 1.2 vs. 8.0 ± 0.8 mg/dL, p < 0.001) and maintained significantly higher mean eGFR values consistently for 4 years. Febuxostat group had significantly longer renal survival time free from renal disease progression than allopurinol and control group (87.7 (95% CI 71.2-104.2) vs. 77.6 (95% CI 60.2-94.9) vs. 48.7 (95% CI 39.3-58.1) months, respectively, p < 0.001). Cox proportional hazard model analysis adjusting for potent confounders revealed that febuxostat, with control group as reference, significantly reduced the risk of renal disease progression by 74.3% (hazard ratio 0.257 (95% CI 0.072-0.912), p = 0.036), while allopurinol showed insignificant result. CONCLUSIONS:Febuxostat seems to reduce serum uric acid level and to retard renal disease progression more effectively than allopurinol in hyperuricemicpatients with CKD.
Authors: Federica Piani; Fumihiko Sasai; Petter Bjornstad; Claudio Borghi; Ashio Yoshimura; Laura G Sanchez-Lozada; Carlos Roncal-Jimenez; Gabriela E Garcia; Ana Andres Hernando; Gabriel Cara Fuentes; Bernardo Rodriguez-Iturbe; Miguel A Lanaspa; Richard J Johnson Journal: J Bras Nefrol Date: 2021 Oct-Dec