Febuxostat in patients with hyperuricemia and severe chronic kidney disease

Abstract

Febuxostat is a non-purine, selective inhibitor of both isoforms of xanthine oxido-reductase (XOR).Its pharmacokinetics is not dependent on renal clearance, and it may be advantageous in patients with chronic kidney disease (CKD). Although febuxostat is effective in patients with mild-to-moderate CKD, its efficacy and safety in patients with severe CKD remain unclear. This retrospective study included patients with an estimated glomerular filtration rate (eGFR) of < 30 ml/min/1.73 m 2 and hyperuricemia, who received febuxostat. The study was performed at Kaohsiung Medical University Hospital between January, 2015 and December, 2015. Changes were observed in the serum uric acid level, rate of achieving the target uric acid level (<6.0 mg/dL), changes in the eGFR, treatment dosage, and adverse events. 217 patients (65.9 ± 15.1 yrs, 145 males and 72 females) with severe CKD and hyperuricemia were included. Febuxostat significantly lowered the serum uric acid level (9.4 ± 1.9 at baseline and 5.6 ± 1.9 ml/min after treatment, P < 0.001). The serum uric acid level was <6 mg/dl in 126 patients (58.1%). There were no significant changes in eGFR (17.6 ± 7.4 at baseline and 17.8 ± 8.9 ml/min after treatment, P = 0.642) or indices of liver dysfunction. Adverse events were found in 5 patients, all adverse events improved after discontinuing febuxostat. This study demonstrated that febuxostat is efficacious and well tolerated in severe CKD patients with hyperuricemia, although renal function monitoring may be needed.

Outcome of Febuxostat treatment in hyperuricemic pre-dialysis chronic kidney disease patients

“…10 But, no difference of eGFR after 12 weeks therapy in CKD stage 4 and 5. 15 In our study, we found significant improvement of eGFR after one month and it continued till the end of study period. However, subgroup analysis had shown the significant increment of eGFR only in CKD stage 3 and 4 and insignificant increment in CKD stage 5.…”