title: Febuxostat for treating allopurinol-resistant hyperuricemia in patients with chronic kidney disease.
abstract: BACKGROUND
  Availability of the novel xanthine oxidase inhibitor febuxostat, which has multiple excretion pathways, enables investigation of the significance of serum uric acid control on renal function in patients with chronic kidney disease (CKD).
  
  
  METHODS
  This was an exploratory, retrospective, observational study conducted at a single Japanese center. Serum uric acid concentrations and serum creatinine levels in the 6 months before and after the start of febuxostat treatment were collected for CKD patients switched from allopurinol after failing to achieve serum uric acid concentrations ≤6.0 mg/dL.
  
  
  RESULTS
  Evaluable data were available for 60 patients, 67% of whom had advanced CKD (eGFR <30 mL/min/1.73 m2). Mean dose of febuxostat was 15.9 (± 8) mg/day. Mean serum uric acid concentration decreased from 8.4 (±1.4) mg/dL at baseline to 6.2 (±1.2) mg/dL at 6 months; 47.5% of patients achieved a level ≤6.0 mg/dL. The change from baseline in eGFR was positive at all time points during febuxostat treatment and the increase of 2.3 (±5.6) mL/min/1.73 m2 at 6 months was significant (p = 0.0027). Whereas the eGFR slope was negative during allopurinol treatment, it became positive after the switch to febuxostat. The change in eGFR slope before and after febuxostat treatment was significant for all patients (p < 0.01), for male patients (p < 0.05), and for patients with a baseline eGFR of <15 mL/min/1.73 m2 (p < 0.05).
  
  
  CONCLUSIONS
  In patients with CKD, febuxostat reduces serum uric acid concentrations effectively and may suppress the progressive decline in renal function.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Nippon Medical School Musashikosugi Hospital , Kawasaki , Japan .
authors.forename: Yukinao
authors.initials: Y
authors.lastname: Sakai
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Otsuka
authors.forename: Dai
authors.initials: D
authors.lastname: Ohno
authors.forename: Tsuneo
authors.initials: T
authors.lastname: Murasawa
authors.forename: Naoki
authors.initials: N
authors.lastname: Sato
authors.forename: Shuichi
authors.initials: S
authors.lastname: Tsuruoka
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000493:Allopurinol / Q000627:therapeutic use; D003404:Creatinine / Q000097:blood; D004791:Enzyme Inhibitors / Q000627:therapeutic use*; D000069465:Febuxostat; D005919:Glomerular Filtration Rate; D006801:Humans; D033461:Hyperuricemia / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D007668:Kidney / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000150:complications* / Q000503:physiopathology*; D012189:Retrospective Studies; D013844:Thiazoles / Q000627:therapeutic use*; D014527:Uric Acid / Q000097:blood
chemical_list: D004791:Enzyme Inhibitors; D013844:Thiazoles; D000069465:Febuxostat; D014527:Uric Acid; D000493:Allopurinol; D003404:Creatinine