Beside reducing serum uric acid in patients with chronic kidney disease (CKD), febuxostat may preserve kidney function, investigators report.
In a trial, investigators randomly assigned 84 patients with stage 3-4 CKD and asymptomatic hyperuricemia to receive febuxostat (40 mg/d) or matching placebo. Half of patients also received stable antihypertensive therapy; few were taking sodium glucose cotransporter-2 inhibitors.
Over 8 weeks, febuxostat reduced mean serum uric acid levels significantly more than placebo: -3.40 vs -0.35 mg/dL, Bancha Satirapoj, MD, of Phramongkutklao Hospital and College of Medicine in Bangkok, Thailand, and colleagues reported in Scientific Reports.
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In the subgroup of patients with decreased serum uric acid levels after febuxostat treatment, estimated glomerular filtrate rate (eGFR) increased by a significant 2.01 mL/min/1.73 m2 from baseline, whereas the control group had no significant change, the investigators reported. Albuminuria, high sensitivity-C-reactive protein levels, and endothelial function (assessed via serum asymmetric dimethylarginine) did not differ between groups.
Drug-related adverse events occurred in 4.7% of febuxostat recipients, but none were serious.
“Febuxostat is a potent and selective xanthine oxidase inhibitor among subjects with hyperuricemia and gout, including those with mild to moderately impaired renal function,” Dr Satirapoj’s team stated. The “major effects of febuxostat on renal outcome might be uric acid dependent effects.”
Larger and longer trials are needed to determine the long term-effects of febuxostat on endothelial function and CKD progression.
Reference
Nata N, Ninwisut N, Inkong P, Supasyndh O, Satirapoj B. Effects of febuxostat on markers of endothelial dysfunction and renal progression in patients with chronic kidney disease. Sci Rep. Published online August 18, 2023. 13(1):13494. doi:10.1038/s41598-023-40767-5