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Urate-lowering therapy for CKD patients with asymptomatic hyperuricemia without proteinuria elucidated by

Hiroshi Kataoka1,2, Toshio Mochizuki3,4, Mamiko Ohara5

  • 1Department of Nephrology, Tokyo Women's Medical University, Tokyo, 162-8666, Japan. kataoka@twmu.ac.jp.

Scientific Reports
|March 9, 2022
PubMed

Insights

Febuxostat slowed kidney function decline in chronic kidney disease (CKD) patients with asymptomatic hyperuricemia, particularly those without proteinuria. This attribute-based approach identifies specific CKD patient groups benefiting from urate-lowering therapy.

Area of Science:

  • Nephrology
  • Pharmacology
  • Internal Medicine

Background:

  • Attribute-based medicine is crucial for personalized patient care.
  • Identifying specific patient subgroups for urate-lowering therapy in chronic kidney disease (CKD) remains a clinical challenge.

Purpose of the Study:

  • To evaluate the efficacy of febuxostat in patients with stage 3 CKD and asymptomatic hyperuricemia using an attribute-based approach.
  • To identify patient characteristics that predict response to febuxostat therapy.

Main Methods:

  • Post hoc analysis of a multicenter, randomized, double-blind, placebo-controlled trial involving 395 patients.
  • Patients were stratified and cross-classified by proteinuria and serum creatinine levels.
  • Estimated glomerular filtration rate (eGFR) slopes were analyzed between febuxostat and placebo groups.

Main Results:

  • Febuxostat treatment was associated with significantly higher mean eGFR slopes in patients without proteinuria compared to placebo (P=0.007).
  • A significant interaction was observed between febuxostat treatment and the presence of proteinuria regarding eGFR slope (P for interaction=0.019).
  • In cross-classified subgroups without proteinuria and with serum creatinine ≥ median, eGFR slopes significantly differed between febuxostat and placebo groups (P=0.040).

Conclusions:

  • Febuxostat mitigated the decline in kidney function in stage 3 CKD patients with asymptomatic hyperuricemia, specifically in those without proteinuria.
  • Attribute-based analysis, considering proteinuria and creatinine levels, is valuable for identifying patient subgroups that benefit from febuxostat.

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