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Kidney Week

Abstract: PO0566

Renoprotective Effects of Febuxostat and Allopurinol in Patients with Hyperuricemia and CKD: A Meta-Analysis

Session Information

Category: CKD (Non-Dialysis)

  • 2102 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

  • Edding, Sherida Naing, St. Luke's Medical Center - Global City, Taguig City, Philippines
  • Cating-Cabral, Monica Therese, St. Luke's Medical Center - Global City, Taguig City, Philippines
  • Cabral, Brian Michael I., St. Luke's Medical Center - Global City, Taguig City, Philippines
Background

Hyperuricemia is associated with rapid deterioration of renal function in patients with chronic kidney disease (CKD). The two most common urate-lowering drugs available are allopurinol and febuxostat. Randomized controlled trials and observational studies have shown that the individual drugs have potential to slow down deterioration of renal function in CKD patients. However, it is unclear which drug is more effective because of insufficient direct comparison between the two. Hence our study aims to perform a meta-analysis to assess the renoprotective and urate-lowering effects between the two drugs in patients with CKD and hyperuricemia.

Methods

A comprehensive literature search using PubMed was performed with the following search terms: febuxostat, allopurinol, chronic kidney disease, renoprotection. Five relevant studies were selected and analyzed using Cochrane Revman v5.3. Outcomes assessed were changes in estimated glomerular filtration rate, serum creatinine, level of proteinuria and/or albuminuria and change in serum uric acid levels.

Results

Five studies comprising 606 patients were selected – 304 treated with febuxostat and 302 with allopurinol. No significant differences were found in the changes in serum creatinine (mean difference (MD) -0.02; CI -0.07, 0.03; P = 0.39) and eGFR (MD 2.09; CI -0.67, 4.84; P = 0.14) from baseline to 3 months between the two group. Significant difference in the change in eGFR, favoring Febuxostat, was observed after 6 months (MD 4.94; CI 2.25, 7.64, P = 0.003). Significant decrease in proteinuria (MD -0.24; CI -0.42, -0.07, P = 0.007) and albuminuria (MD -80.47, CI -149.29, -11.64, P = 0.02) were observed more in the febuxostat group after 3 months; however these changes were not significant after 6 months. Serum uric acid levels were significantly more reduced in the febuxostat group both after 3 (MD -0.90; CI -1.14, -0.67, P < 0.00001) and 6-months (MD -1.50; CI -1.70, -1.30, P < 0.00001).

Conclusion

Our study showed that febuxostat might be more renoprotective (as measured by eGFR change in 6 months) and offers a better anti-proteinuric and urate-lowering effect. However, more studies are needed to assess its efficacy across the spectrum of CKD, including those requiring hemodialysis and post-transplant patients.