Abstract
Whether the clinical trial treatment effect of urate-lowering therapy (ULT) in patient with chronic kidney disease (CKD) is generalizable to real-word settings is unclear. This study aimed to compare febuxostat with allopurinol for uric acid reduction and renal protection in patients with CKD. Adult CKD patients newly treated with ULT were identified using electronic health records from 2010 to 2015 from a large healthcare delivery system in Taiwan. Patients with renal replacement therapy or undergoing ULT for <3 months were excluded. Propensity score–matched cohort study design was conducted to compare outcomes between patients initiated with febuxostat or allopurinol therapy. Cox regression analyses were employed to compare the adjusted hazards ratio (aHR) of incident event of estimated glomerular filtration rate (eGFR) ≥ 30% decrease, and the difference in longitudinal changes in serum uric acid (SUA) and eGFR between groups was analyzed using linear mixed model. Overall, 1050 CKD patients who initiated febuxostat (n = 525) or allopurinol (n = 525) treatment were observed for 2.5 years. Compared with allopurinol, febuxostat use was associated with higher rate of patients maintaining SUA target <6 mg/dL in >80% of follow-up time with a reduction in mean SUA change. There were no significant differences in the mean eGFR changes over time between the febuxostat and allopurinol groups or in the risk of eGFR decline ≥30% of baseline. Febuxostat was associated with greater reduction in SUA level than allopurinol in patients with CKD. However, febuxostat and allopurinol showed no difference in renal function changes during study follow-up. These findings require further investigation with long-term follow up in CKD patients with hyperuricemia.
Highlights
Whether the clinical trial treatment effect of urate-lowering therapy (ULT) in patient with chronic kidney disease (CKD) is generalizable to real-word settings is unclear
A recent randomized placebo control trial suggested that febuxostat was not associated with renal protection in patients with asymptomatic hyperuricemia complicated by CKD stage 318
Compared with patients who initiated with allopurinol, those patients who initiated with febuxostat had higher estimated glomerular filtration rate (eGFR)
Summary
Whether the clinical trial treatment effect of urate-lowering therapy (ULT) in patient with chronic kidney disease (CKD) is generalizable to real-word settings is unclear. A recent randomized placebo control trial suggested that febuxostat was not associated with renal protection in patients with asymptomatic hyperuricemia complicated by CKD stage 318 These discrepancies possibly can be explained by the baseline CKD stage, comorbid conditions, and magnitude of changes in eGFR from baseline on renal disease progression. The allopurinol-controlled Febuxostat for Cerebral and CaRdiorenovascular Event PrEvEntion StuDy (FREED) in elderly patients with CKD stage 3 suggested that stronger lowering uric acid with febuxostat was associated with indirect renal outcomes (i.e. albuminuria or proteinuria) but not the risks of eGFR decline, cardiovascular or mortality[22]. The aim of the present study was to study the effectiveness of febuxostat compared with allopurinol for changes in SUA, achievement of SUA goal, and eGFR decline between two groups of patients with CKD in a practice setting. As evidence directly comparing allopurinol to febuxostat among patients with CKD is limited, we hypothesized that there is no important differences in CKD progression between patients taking febuxostat and those taking allopurinol
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