Abstract: FR-PO304
Comparative Renoprotective Effect of Febuxostat and Allopurinol in Pre-Dialysis Stage 5 CKD Patients: A Nationwide Database Analysis
Session Information
- CKD: Epidemiology and Risk Factors
November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention
Authors
- Hsu, Yun-Shiuan (Olivia), Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Yang, Huang-Yu, Chang Gung Memorial Hospital, Taoyuan, Taiwan
Background
Hyperuricemia has been associated with chronic kidney disease (CKD) progression. Slowed CKD progression has also been observed in stage 1-3 CKD patients treated with the anti-hyperuricemic febuxostat. Large-scale studies comparing the renoprotective potential of febuxostat and allopurinol in pre-dialysis stage 5 CKD are lacking.
Methods
In our population-based retrospective cohort study, we used the National Health Insurance Research Database in Taiwan from 2012 to 2015 to select eligible pre-dialysis stage 5 CKD patients. Patients were included and grouped based on the prescription of allopurinol (n=3424) or febuxostat (n=2633) within 90 days after first-time erythropoiesis-stimulating agents (ESA) prescriptions. Long-term dialysis and all-cause mortality or dialysis (composite outcome) among febuxostat users and allopurinol users were analyzed and compared using the Cox proportional hazards model. Propensity-score matching and subgroup analysis were additionally performed.
Results
We identified 6057 anti-hyperuricemic users. 69.57% of allopurinol users and 42.01% febuxostat users required long-term dialysis (p<.0001). The adjusted hazard ratio was 0.65 (95% confidence interval, 0.60-0.70), indicating near 35% lower hazards of long-term dialysis from febuxostat compared with allopurinol use. The renal benefit of febuxostat use was consistent across most patient subgroups and/or using the propensity score-matched cohort. Similarly, the adjusted hazard ratio was 0.66 (95% confidence interval, 0.61-0.70) for the composite outcome of long-term dialysis or death.
Conclusion
Compared to allopurinol, febuxostat was associated with lower risk of progression to dialysis in pre-dialysis stage 5 CKD patients. Febuxostat's associated renal benefit does not compromise patient survival.
Risks of study outcomes in patients using febuxostat and allopurinol
| No. of Events (%) | Incidence Rate Per 100 Patient-years | Study Outcome, Hazard Ratio (95% Confidence Interval) | ||||||
| Treatment (No. of Patients) | Long-term dialysis | Dialysis or death | Long-term dialysis | Dialysis or death | Long-term dialysis | Dialysis or death | ||
| Unadjusted | Adjusted | Unadjusted | Adjusted | |||||
| Febuxostat (n=2633) | 1106 (42.01) | 1388 (52.72) | 49.60 | 62.24 | 0.59 (0.55-0.64) | 0.65 (0.60-0.70) | 0.64 (0.60-0.68) | 0.66 (0.61-0.70) |
| Allopurinol (n=3424) | 2382 (69.57) | 2805 (81.92) | 76.17 | 89.70 | 1 (ref.) | 1 (ref.) | 1 (ref.) | 1 (ref.) |
Funding
- Private Foundation Support