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Effects of febuxostat on delaying chronic kidney disease progression: a randomized trial in China
Hongtao Yang1, Rong Li2, Qing Li3
1Department of Nephrology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China.
Insights
Febuxostat treatment significantly slowed estimated glomerular filtration rate (eGFR) decline in patients with chronic kidney disease (CKD) stages 3-4 and hyperuricemia over 12 months. This intervention offers a promising approach for managing advanced CKD progression.
Area of Science:
- Nephrology
- Pharmacology
- Internal Medicine
Background:
- Previous studies on febuxostat for delaying chronic kidney disease (CKD) progression in hyperuricemia yielded controversial results.
- This study addresses the need for robust evidence in Chinese patients with advanced CKD.
Purpose of the Study:
- To evaluate the efficacy of febuxostat in slowing CKD progression in patients with advanced CKD and asymptomatic hyperuricemia.
- To assess the impact of febuxostat on estimated glomerular filtration rate (eGFR) decline over a 12-month period.
Main Methods:
- A prospective randomized controlled study involving 100 CKD patients (stages 3-4) with asymptomatic hyperuricemia.
- Patients were assigned to either a control group or a febuxostat group, with the latter receiving titrated febuxostat to achieve serum uric acid (SUA) < 6 mg/dL.
- Primary outcomes included eGFR decline (≥30% or ≥50%), dialysis, and CKD-related death; secondary outcome was the change in eGFR.
Main Results:
- Febuxostat treatment resulted in a significantly higher mean eGFR change (0.50 mL/min/1.73 m²/month) compared to the control group (-4.46 mL/min/1.73 m²/month; p=0.006) after 12 months.
- Fewer patients in the febuxostat group experienced a 30% or 50% decline in eGFR or required dialysis compared to the control group.
- Adverse events were comparable between the febuxostat and control groups.
Conclusions:
- Febuxostat effectively slows the decline of eGFR in patients with advanced CKD (stages 3-4) and asymptomatic hyperuricemia.
- The findings support febuxostat as a therapeutic option for managing hyperuricemia and potentially delaying CKD progression.
Background:
A few studies have tested febuxostat for its usefulness in delaying chronic kidney disease (CKD) progression by treating hyperuricemia and results were controversial. Thus, we attempted to conduct a randomized controlled study using the Chinese population with advanced grade of CKD.
Methods:
One hundred CKD patients in stages 3 and 4 with asymptomatic hyperuricemia from seven medical centers were included in this prospective randomized controlled study and assigned to the control and febuxostat group, the latter of which received febuxostat to titrate to achieve serum uric acid (SUA) < 6 mg/dL. The observation period was 12 months. The primary outcomes included the event of estimated glomerular filtration rate (eGFR) decline ≥ 30% or 50% from baseline at 12 months, dialysis and death from CKD; secondary outcome was the change in eGFR. Safety analysis was also performed.
Results:
Forty-seven patients and 45 patients in the febuxostat and control groups, respectively completed the study. Seven of 47 (14.9%) participants reached 30% decline in eGFR in the febuxostat group, while 1 (2.1%) and 2 (4.3%) patients reached 50% decline in eGFR or dialysis. Thirteen (28.9%), 10 (22.2%) and 3 (6.7%) of 45 patients reached primary kidney outcomes separately in the control group. The change in eGFR after 12 months from baseline in the febuxostat group was 0.50 mL/min/1.73 m2, which was significantly higher than that in the control group - 4.46 mL/min/1.73 m2 (p = 0.006). Adverse events did not differ between two groups.
Conclusions:
Febuxostat effectively slowed eGFR decline in patients with CKD stages 3 and 4 and asymptomatic hyperuricemia.
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