The urate-lowering efficacy of febuxostat and its effect on renal function in hyperuricemic patients with chronic kidney disease stages 3-5
10.3760/cma.j.issn.1001-7097.2017.10.001
- VernacularTitle:非布司他治疗慢性肾脏病3~5期伴高尿酸血症患者的疗效分析及对肾功能的影响
- Author:
Huifang WANG
1
;
Wei ZHANG
;
Ning LI
;
Tingting ZHAI
;
Xuemei LIU
;
Yan XU
Author Information
1. 266003,青岛大学附属医院肾内科
- Keywords:
Renal insufficiency;
chronic;
Hyperuricemia;
Allopurinol;
Febuxostat
- From:
Chinese Journal of Nephrology
2017;33(10):721-728
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the urate-lowering efficacy and renal effect of febuxostat in hyperuricemic patients with chronic kidney disease (CKD) stages 3-5. Methods A prospective, randomized, controlled trial of CKD stages 3-5 patients with hyperuricemia was conducted from June 2015 to June 2016. Patients were randomly assigned to either febuxostat group (treatment group) or allopurinol group (control group). Patients in treatment group received febuxostat 40 mg/d after study initiation, and the dosage was changed to 20 mg/d if serum uric acid (sUA)<360 μmol/L. Patients in control group were administered a dose of 100 mg/d of allopurinol. Serum uric acid, serum creatinine and other clinical parameters were measured at baseline and 1-6 months after treatment. The rate of achieving target sUA level and the change of eGFR in two groups were performed using SPSS 21.0. Results A total of 98 patients met the inclusion criteria and completed the trial. The treatment group and the control group had 51 cases and 47 cases, respectively. There was no significant difference between the two groups in age, sex, body mass index (BMI), blood pressure, serum creatinine, eGFR, sUA and renal diseases (P>0.05). At month 1-6, there were significant differences between treatment group and control group in the rate of achieving target sUA level (P<0.01). At month 1 and month 3, no statistical difference was observed in the change of eGFR between the two groups (P=0.624, P=0.319). At month 6, the changes in eGFR were +2.23 ml·min-1·(1.73 m2)-1 and-4.36 ml·min-1·(1.73 m2)-1 in the treatment and control group, respectively, and the difference between the two groups was significant (P=0.037). In patients with CKD stages 3-5, generalized estimating equation showed that after adjusting for confounding variables, the eGFR increased 1.149 ml·min-1·(1.73 m2)-1 (P=0.003) and 24-hour urinary protein decreased 0.019 g/d (P=0.037) when per 60 μmol/L decreased in sUA. Febuxostat 20 mg/d was able to keep target sUA levels in 90.2% patients with CKD stages 3-5 within half a year and no serious adverse effects appeared. Conclusions Febuxostat performs better than allopurinol in lowering urate and delaying progression of renal function in patients with CKD stages 3-5 and HUA. Febuxostat 20 mg/d may be the effective and safe maintenance dose to maintain target sUA level in patients with CKD stages 3-5, but whether it can be used as the best long-term maintenance dose needs to be further studied.
