Renal safety and urate-lowering efficacy of febuxostat in gout patients with stage 4–5 chronic kidney disease not yet on dialysis

BACKGROUND/AIMS: The safety and efficacy of febuxostat in patients with stage 4–5 chronic kidney disease (CKD) are still unclear owing to a lack of studies in these patients. Therefore, we aimed to evaluate the effect of febuxostat on renal function, general safety, and efficacy in gout patients with stage 4–5 CKD. METHODS: Among 739 patients who had been administered febuxostat from May 2012 to December 2016 at a single hospital in Korea, 370 patients who had been monitored for 1 year were analyzed. Serum uric acid levels and estimated glomerular filtration rate (eGFR) of patients with gouty arthritis were collected at baseline and 1 year after febuxostat administration. RESULTS: Among the 370 patients, 280 patients were stage 1–3 CKD, 63 patients were stage 4–5 CKD, and 27 patients were on dialysis. The eGFR of 63 patients with stage 4–5 CKD, excluding dialysis patients, was 19.84 ± 7.08 mL/min/1.73 m(2) when they began to take febuxostat and 23.49 ± 16.67 mL/min/1.73 m(2) after 12 months (p = 0.13). The urate-lowering effect after 12 months of febuxostat medication showed statistical significance (8.96 ± 2.31 mg/dL at baseline and 4.88 ± 1.68 mg/dL after 12 months, p < 0.01). The difference in incidence of adverse events among patients with stage 1–3 CKD, those with stage 4–5 CKD, and those on dialysis was not significant. CONCLUSIONS: Febuxostat demonstrated renal safety and good urate-lowering efficacy in gout patients with stage 4–5 CKD, who are not yet on dialysis.