Abstract
ABSTRACTObjective:To investigate the efficacy and safety of febuxostat on renal function in CKD stage 3 diabetic nephropathy patients.Methods:Patients in our hospital with chronic kidney disease (CKD) stage 3 diabetic nephropathy (DN) complicated by high serum uric acid (360 µmol/L) were recruited. Patients were then divided into treatment group and control group according to the random number table method. All the patients received low purine diet, renin-angiotensin-aldosterone system (RAAS) inhibitors, and adequate routine hypoglycemic treatment. Febuxostat was employed only in the treatment group. The levels of blood uric acid (sUA), serum creatinine (Scr), cystatin C (cys-c), eGFR, 24-hour urine protein quantification, albuminuria, and creatinine ratio (ACR) were evaluated in all patients before and after treatment at 4, 8, 12, and 24 week.Results:No difference was found before treatment between the two groups. After treatment at 4, 8, 12, and 24 week, the levels of sUA, SCr, cys-c, and eGFR between the two groups were significant different (P<0.05). There was no difference in 24-hour urine protein quantification, albuminuria, and creatinine ratio between two groups before treatment, and significant differences were observed after treatment. Fifty percent of patients from the treatment group achieved the treatment goal with 20 mg febuxostat at 4 weeks. Tubular markers were also decreased with the treatment.Conclusions:Febuxostat can reduce uric acid and improve renal function effectively in patients with CKD stage 3 diabetic nephropathy, while being well tolerated. However, the conclusion is still uncertain due to the short term of the study.
Highlights
Diabetic nephropathy is the leading cause of renal failure, of which morbidity is still very high
Criteria for inclusion, exclusion and drop out Inclusion criteria were age from 18 to 70 years, in line with the diagnostic criteria of diabetic nephropathy (DN) according to the guidelines of prevention and control of type 2 diabetes mellitus of China (2013 edition), eGFR ranging from 59 to 30 mL/min/1.73m2 according to the 2012 chronic kidney disease (CKD)-EPI equation (Chronic Kidney Disease Epidemiology Collaboration (CKDEPI) equation): eGFR=130×(SCr/0.7)‒0.601×(Cys C/0.8)‒0.711×0.995age, eGFR=135×(SCr/0.9)‒0.601×(Cys C/0.8)‒0.711×0.995age, units of eGFR, SCr, Cys C are mL/(min∙1.73m2), mg/dL, mg/L, respectively), serum uric acid greater than 6 mg/mL (360μmol/L)
Drop-out criteria were participants who failed to follow the research program, or who could not finish the research according to the research program, participants who quitted the research, elevation of ALT, AST, or bilirubin to 2 times the upper normal limit for 2 weeks during the use of febuxostat, increase of blood creatinine greater than 50% of the base value, allergy, pregnancy, patients who were intolerant of gastrointestinal discomfort, unexplained serious complications, and missing person
Summary
Diabetic nephropathy is the leading cause of renal failure, of which morbidity is still very high. According to recent surveys[1], diabetic nephropathy now is the most common cause of hospitalization of chronic renal failure. The treatment of diabetic nephropathy is still the dilemma confronting the nephrologist. Uric acid treatment in diabetic nephropathy patients has been a focus of nephrology for a long time. There is a reciprocal effect between elevation of uric acid and diabetic nephropathy, a vicious cycle ensues, as evidenced by some research[3]. Epidemiological investigations and animal research show that hyperuricemia (HUA) poses an independent risk for chronic kidney disease in the setting of diabetes[4]
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