Kidney Res Clin Pract.  2017 Sep;36(3):274-281. 10.23876/j.krcp.2017.36.3.274.

Renoprotective effects of febuxostat compared with allopurinol in patients with hyperuricemia: A systematic review and meta-analysis

• Kim S
• Kim HJ
• Ahn HS
• Oh SW
• Han KH
• Um TH
• Cho CR
• Han SY

• KMID: 2416097
• DOI: http://doi.org/10.23876/j.krcp.2017.36.3.274

Abstract

BACKGROUND
Hyperuricemia is reported to be related to rapid progression of renal function in patients with chronic kidney disease (CKD). Allopurinol, a uric acid lowering agent, protects renal progression. However, it is not widely used in patients with CKD because of its serious adverse event. Febuxostat can be alternatively used for patients who are intolerable to allopurinol. We aimed to determine renoprotective effect and urate-lowering effect between the two drugs.
METHODS
We performed a systematic review and meta-analysis of randomized controlled trials to assess the effects of febuxostat compared to allopurinol in patients with hyperuricemia. MEDLINE, Embase, and Cochrane Library databases were searched to identify research publications.
RESULTS
Four relevant publications were selected from among 3,815 studies. No significant differences were found in the changes in serum creatinine from baseline between the febuxostat and allopurinol groups. Changes in estimated glomerular filtration rate (eGFR) were observed between the two groups at 1 month (mean difference 1.65 mL/min/1.73 m², 95% confidence interval [CI] 0.38, 2.91 mL/min/1.73 m²; heterogeneity χ² = 1.25, I² = 0%, P = 0.01); however, the changes in eGFR were not significantly different at 3 months. A significant difference did exist in the changes in albuminuria levels from baseline between the febuxostat and allopurinol groups (mean difference −80.47 mg/gCr, 95% CI −149.29, −11.64 mg/gCr; heterogeneity χ² = 0.81, I² = 0%, P = 0.02). A significant difference was also observed in the changes in serum uric acid from baseline between the febuxostat and allopurinol groups (mean difference −0.92 mg/dL, 95% CI −1.29, −0.56 mg/dL; heterogeneity χ² = 6.24, I² = 52%, P < 0.001).
CONCLUSION
Febuxostat might be more renoprotective than allopurinol.

Keyword

Chronic kidney disease; Febuxostat; Gout; Hyperuricemia; Meta-analysis

MeSH Terms

Albuminuria
Allopurinol*
Creatinine
Febuxostat*
Glomerular Filtration Rate
Gout
Humans
Hyperuricemia*
Population Characteristics
Renal Insufficiency, Chronic
Uric Acid
Allopurinol
Creatinine
Febuxostat
Uric Acid