COMPARISON BETWEEN RENOPROTECTIVE EFFECTS OF FEBUXOSTAT AND ALLOPURINOL IN CHRONIC KIDNEY DISEASE PATIENTS WITH HYPERURICEMIA
DOI:
https://doi.org/10.22159/ajpcr.2023.v16i10.48016Keywords:
Chronic kidney disease, Hyperuricemia, Febuxostat, Allopurinol, RenoprotectiveAbstract
Objective: The objective of the study was to compare the renoprotective effects of febuxostat versus allopurinol in chronic kidney disease patients with hyperuricemia.
Methods: One hundred and ten patients were divided randomly into two equal groups: group F (febuxostat) and group A (allopurinol). Group F patients received tablet febuxostat 40 mg OD for 4 months and group A patients received tablet allopurinol 100 mg TDS for 4 months. Following parameters such as estimated glomerular filtration (eGFR) assessment, serum creatinine, serum uric acid (SUA), total serum protein, urine creatinine, urine protein, blood urea, and number of dialysis were carried out and repeated at the end of 1st–4th month to check for the effect of the test drugs on the status of kidney function.
Observations: Febuxostat caused more rise in eGFR than allopurinol. Meanwhile, the number of patients with eGFR ≤15/mL/min/1.73 m2 showed no difference between the groups. No patient showed >10% decrease in the eGFR values. Febuxostat showed more decline in SUA levels than allopurinol, although the number of patients reaching the target SUA levels was the same in both groups. Febuxostat led to a more reduction in serum creatinine levels than allopurinol. Urine creatinine and urine albumin levels decline were associated more with febuxostat. No remarkable difference in comparison of both the groups in terms of total serum protein and serum globulin, although a significant rise was seen with febuxostat in serum albumin levels. Both drugs had a similar sequel in declining blood urea nitrogen levels. No discernible difference in the number of dialysis sessions needed by patients in the previous month was seen in the study groups.
Conclusion: The present study concluded that febuxostat appears to be a better alternative to allopurinol for chronic kidney disease patients with hyperuricemia. Febuxostat has a superior renoprotective effect than allopurinol.
Downloads
References
Kuwabara M, Niwa K, Hisatome I, Nakagawa T, Roncal-Jimenez CA, Andres-Hernando A, et al. Asymptomatic hyperuricemia without comorbidities predicts cardiometabolic diseases: Five-year Japanese Cohort Study. Hypertension 2017;69:1036-44. doi: 10.1161/ HYPERTENSIONAHA.116.08998, PMID 28396536
Lee Y, Hwang J, Desai SH, Li X, Jenkins C, Kopp JB, et al. Efficacy of xanthine oxidase inhibitors in lowering serum uric acid in chronic kidney disease: A systematic review and meta-analysis. J Clin Med 2022;11:2468-72. doi: 10.3390/jcm11092468, PMID 35566594
Kielstein JT, Pontremoli R, Burnier M. Management of hyperuricemia in patients with chronic kidney disease: A focus on renal protection. Curr Hypertens Rep 2020;22:102. doi: 10.1007/s11906-020-01116-3, PMID 33128170
Chen TK, Knicely DH, Grams ME. Chronic kidney disease diagnosis and management: A review. JAMA Intern Med 2019;322:1294-304. doi: 10.1001/jama.2019.14745, PMID 31573641
Liu X, Wang H, Ma R, Shao L, Zhang W, Jiang W, et al. The urate-lowering efficacy and safety of febuxostat versus allopurinol in Chinese patients with asymptomatic hyperuricemia and with chronic kidney disease stages 3–5. Clin Exp Nephrol 2019;23:362-70. doi: 10.1007/ s10157-018-1652-5, PMID 30291473
Lee JW, Lee KH. Comparison of renoprotective effects of febuxostat and allopurinol in hyperuricemic patients with chronic kidney disease. Int Urol Nephrol 2019;51:467-73. doi: 10.1007/s11255-018-2051-2, PMID 30604229
Kimura K, Hosoya T, Uchida S, Inaba M, Makino H, Maruyama S, et al. Febuxostat therapy for patients with stage 3 CKD and asymptomatic hyper uricemia: A randomized trial. Am J Kidney Dis 2018;72:798-810. doi: 10.1053/j.ajkd.2018.06.028, PMID 30177485
Park S, Lee JP, Kim DK, Kim YS, Lim CS. Superior effect of allopurinol compared to febuxostat on the retardation of chronic kidney disease progression. PLoS One 2022;17:e0264627. doi: 10.1371/journal. pone.0264627, PMID 35226683
Sircar D, Chatterjee S, Waikhom R, Golay V, Raychaudhury A, Chatterjee S, et al. Efficacy of febuxostat for slowing the GFR decline in patients with CKD and asymptomatic hyperuricemia: A 6-month, double blind, randomized, placebo-controlled trial. Am J Kidney Dis 2015;66:945-50. doi: 10.1053/j.ajkd.2015.05.017, PMID 26233732
Sakai Y, Otsuka T, Ohno D, Murasawa T, Sato N, Tsuruoka S. Febuxostat for treating allopurinol-resistant hyperuricemia in patients with chronic kidney disease. Ren Fail 2014;36:225-31. doi: 10.3109/0886022X.2013.844622, PMID 24152124
Peng YL, Tain YL, Lee CT, Yang YH, Huang YB, Wen YH, et al. Comparison of uric acid reduction and renal outcomes of febuxostat vs allopurinol in patients with chronic kidney disease. Sci Rep 2020;10:10734. doi: 10.1038/s41598-020-67026-1, PMID 32612180
Sarvepalli PS, Fatima M, Quadri AK, Taher AR, Habeeb A, Amreen F, et al. Study of therapeutic efficacy of febuxostat in chronic kidney disease Stage IIIA to stage VD. Saudi J Kidney Dis Transpl 2018;29:1050-6. doi: 10.4103/1319-2442.243953, PMID 30381500
Krishnamurthy A, Lazaro D, Stefanov DG, Blumenthal D, Gerber D, Patel S. The effect of allopurinol on renal function. J Clin Rheumatol 2017;23:1-5. doi: 10.1097/RHU.0000000000000480, PMID 28002149
Zheng Y, Sun J. Febuxostat improves uric acid levels and renal function in patients with chronic kidney disease and hyperuricemia: A meta-analysis. Appl Bionics Biomech 2022;2022:9704862.
Badve SV, Pascoe EM, Tiku A, Boudville N, Brown FG, Cass A, et al. Effects of allopurinol on the progression of chronic kidney disease. N Engl J Med 2020;382:2504-13. doi: 10.1056/NEJMoa1915833, PMID 32579811
Lang J, Katz R, Ix JH, Gutierrez OM, Peralta CA, Parikh CR, et al. Association of serum albumin levels with kidney function decline and incident chronic kidney disease in elders. Nephrol Dial Transplant 2018;33:986-92. doi: 10.1093/ndt/gfx229, PMID 28992097
Wu PP, Hsieh YP, Kor CT, Chiu PF. Association between albumin-globulin ratio and mortality in patients with chronic kidney disease. J Clin Med 2019;8:1990-1. doi: 10.3390/jcm8111991, PMID 31731708
Huda M, Pralampita PW, Agustina D, Abrori C, Wahyudi SS. The effect of allopurinol on blood urea nitrogen and creatinine serum levels in patients with chronic kidney disease. J Agromedicine 2021;7:8-15. doi: 10.19184/ams.v7i1.10928
Hosten AO, Walker KH, Hall WD. BUN and creatinine. In: National Center for Biotechnology Information. United States National Library of Medicine; 2022. Available from: https://pubmed.ncbi.nlm.nih. gov/21250147 [Last accessed on 2022 Nov 01].
Published
How to Cite
Issue
Section
Copyright (c) 2023 saksham matta, Garima Bhutani, Tarun Arora, Renu Garg, seema rani, Rahul Saini
This work is licensed under a Creative Commons Attribution 4.0 International License.
The publication is licensed under CC By and is open access. Copyright is with author and allowed to retain publishing rights without restrictions.