Febuxostat is superior to traditional urate-lowering agents in reducing the progression of kidney function in chronic kidney disease patients

The prevalence of hyperuricemia in patients with chronic kidney disease (CKD) is high, but the management is suboptimal under traditional treatment. This study was conducted to clarify whether febuxostat achieves better renal survival and patient outcome compared with traditional urate-lowering agents (ULAs). In total, 2,460 adults who had continuously received ULAs for at least three months before enrollment were investigated. Three groups were compared prospectively including non-conversion (n = 2,214), conversion (n = 206), and febuxostat first (n = 40). We evaluated laboratory changes, estimated glomerular filtration rate (eGFR) change, eGFR decline, renal survival, and all-cause mortality. The Cox proportional hazard risk analysis were also used for risk prediction. Multiple prescriptions for ULAs were found in both the non-conversion and conversion groups. However, improved median eGFR was noted in the febuxostat group (p < 0.001), median serum uric acid (SUA) level decreased from 9.45 to 6.7 mg/dL in the febuxostat group (p = 0.010), and median SUA decreased from 8.5 to 6.3 mg/dL in the conversion group (p < 0.001). Decline rate was retarded in the conversion (p = 0.050). Using the Cox proportional model, the multivariate analysis showed conversion group, young *Corresponding author: Shuo-Chun Weng, Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan; Center for Geriatrics and Gerontology, Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, No.1650, Sec. 4, Taiwan Boulevard, Xitun Dist., Taichung City 40705, Taiwan (R.O.C.) E-mail: [email protected]