Abstract: TH-PO493

The Efficacy of Febuxostat in CKD Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 305 CKD: Clinical Trials and Tubulointerstitial Disorders

Authors

  • Hong, Daqing, Sichuan Provincial People's Hospital, CHENGDU, China
  • Wang, Ying, None, Epping, New South Wales, Australia
Background

Uric acid is considered as an independent risk factor for kidney disease. Hyperuricemia is associated with progression of renal dysfunction. Febuxostat, a xanthine oxidase (XO) inhibitor, is used to treat hyperuricemia in patients with gout. However, its effects on renal functions remain unclear. We aimed to systematically evaluate the efficacy and safety of febuxostat in patients with chronic kidney disease (CKD).

Methods

Cochrane library, MEDLINE, EMBASE and trial register system were searched for randomized controlled trials to May 18, 2017 with the terms of “febuxostat” and “chronic kidney disease”. The primary outcomes were serum creatinine level, while secondary outcomes included serum uric acid level, eGFR, hsCRP, HDL-C, LDL-C, SBP and DBP. Fixed effects model analysis was used to explore the effect size of febuxostat versus control.

Results

Eight studies involving 981 participants were eventually included in this review. All studies were high quality studies. Compared with the control group, febuxostat significantly reduced the serum uric acid levels (WMD=-2.71, 95%CI: -3.68, -1.73, P<0.01,I2=96%), with a nonsignificant effect on renal functions (a reduction in serum creatinine levels by 0.07mg/dl (WMD, 95%CI: -0.34, 0.20, P=0.60, I2=90%), and an increase in the level of eGFR by 3.15ml/min/1.73 m2 (WMD, 95%CI: -1.40, 7.71, P=0.17, I2=83%)). Subgroup analysis show that febuxostat significantly increase in the level of eGFR by 6.58ml/min/1.73 m2 compared with placebo (WMD, 95%CI: 5.04, 8.13, P<0.01, I2=0%). Fixed effect model analysis showed that febuxostat can significantly reduce hsCRP levels by 0.24mg/L (WMD, 95%CI: -0.38, -0.09, P=0.001, I2=31%), reduce HDL-C levels by 0.77mg/dl (WMD, 95%CI: -4.52, 2.98, P=0.69, I2=0%) and reduce LDL-C levels by 5.95mg/dl (WMD, 95%CI: -11.89, -0.01, P=0.05, I2=18%).There was no significant difference in the blood pressure between the febuxostat group and the control group.

Conclusion

Conclusions: Febuxostat can significantly reduce serum uric acid levels in patients with CKD with hyperuricemia with potential beneficial impact on renal function as compare to placebo. Further large RCTs are needed to assess the effect of febuxostat on renal outcomes as compared to other active uric acid lowering treatment.