Background Research on the safety and effects of febuxostat in stage 4 or 5 CKD patients is very limited. There are some studies where research on hyperuricemia patients with gout history has been conducted [1, 2], but there is little data on cases of application to patients actually in order to treat gout.
Objectives This study aims to examine the clinical effects of febuxostat in cases of allopurinol-refractory hyperuricemia during treatment of gout in dialysis patients or stage 4 CKD patients.
Methods Patients selected had been administered febuxostat for six months or longer because of allopurinol-refractory hyperuricemia during treatment of gout from May 2012 to February 2014. The patients met the American College of Rheumatology criteria for acute gout. The age, gender, duration of gout, cause of CKD, serum uric acid (SUA), estimated glomerular filtration rate (eGFR), creatinine, and doses of febuxostat were investigated in patients whose eGFR had been less than 45 mL/min per 1.73 m2 among the patients before the initiation of febuxostat administration
Results A total of 25 patients were enrolled. The number of stage 3b (30 ≤ eGFR <45) CKD patients, stage 4 (15 ≤ eGFR <30) patients, and stage 5 (eGFR <15) patients was 13, 6, and 6, respectively, and all six patients at stage 5 CKD were undergoing hemodialysis or peritoneal dialysis. During the six-month observation period, gout recurred in none of the patients. The six stage 5 patients' SUA decreased from 7.2±0.7 mg/dL at baseline to 4.9±2.2 mg/dL (p<0.05), the stage 4 CKD patients' SUA reduced from 8.9±2.8 mg/dL at baseline to 6.7±4.4 mg/dL (p<0.05), and the stage 3b CKD patients' SUA dropped from 8.8±1.9 mg/dL to 5.6±2.1 mg/dL (p<0.05) six months after the administration of febuxostat. In addition, the eGFR did not statistically change in the CKD stage 3b and 4 patients.
Conclusions In gout treatment of dialysis patients or CKD stage 4 patients with allopurinol-refractory hyperuricemia, febuxostat inhibited gout recurrence and effectively decreased SUA during a period of six months.
Horikoshi, et al. Clin Exp Nephrol. 2013:17;149-50.
Shibagaki, et al. Hypertens Res. 2014:37;919-25.
Disclosure of Interest None declared