title: Comparison of febuxostat and allopurinol for hyperuricemia in cardiac surgery patients with chronic kidney disease (NU-FLASH trial for CKD).
abstract: BACKGROUND
  The NU-FLASH trial demonstrated that febuxostat was more effective for hyperuricemia than allopurinol. This time, we compared these medications in patients with chronic kidney disease (CKD) from the NU-FLASH trial.
  
  
  RESULTS
  In the NU-FLASH trial, 141 cardiac surgery patients with hyperuricemia were randomized to a febuxostat group or an allopurinol group. This study analyzed 109 patients with an estimated glomerular filtration rate (eGFR) ≤60 mL/min/1.73 m(2), and also analyzed 87 patients with stage 3 CKD. The primary endpoint was the serum uric acid level. Secondary endpoints included serum creatinine, urinary albumin, cystatin-C, oxidized low-density lipoprotein, eicosapentaenoic acid/arachidonic acid ratio, total cholesterol, triglycerides, low-density lipoprotein, high-density lipoprotein, and high-sensitivity C-reactive protein. Among patients with an eGFR≤60 mL/min/1.73 m(2), uric acid levels were significantly lower in the febuxostat group than the allopurinol group from 1 month of treatment onward. The serum creatinine, urinary albumin, cystatin-C, oxidized low-density lipoprotein, eicosapentaenoic acid/arachidonic acid ratio, and high-sensitivity C-reactive protein were also significantly lower in the febuxostat group. Similar results were obtained in the patients with stage 3 CKD.
  
  
  CONCLUSIONS
  In cardiac surgery patients with renal dysfunction, febuxostat reduced uric acid earlier than allopurinol, had a stronger renoprotective effect than allopurinol, and also had superior antioxidant and anti-inflammatory effects.
authors: Department of Cardiovascular Surgery, Nihon University School of Medicine, Tokyo, Japan. Electronic address: asezai.med@gmail.com.
authors: Akira
authors: A
authors: Sezai
authors: Department of General Medicine, Nihon University School of Medicine, Tokyo, Japan.
authors: Masayoshi
authors: M
authors: Soma
authors: Department of Cardiovascular Surgery, Nihon University School of Medicine, Tokyo, Japan.
authors: Kin-ichi
authors: K
authors: Nakata
authors: Department of Cardiovascular Surgery, Nihon University School of Medicine, Tokyo, Japan.
authors: Shunji
authors: S
authors: Osaka
authors: Department of Cardiovascular Surgery, Nihon University School of Medicine, Tokyo, Japan.
authors: Yusuke
authors: Y
authors: Ishii
authors: Department of Cardiovascular Surgery, Nihon University School of Medicine, Tokyo, Japan.
authors: Hiroko
authors: H
authors: Yaoita
authors: Department of Cardiovascular Surgery, Nihon University School of Medicine, Tokyo, Japan.
authors: Hiroaki
authors: H
authors: Hata
authors: Department of Cardiovascular Surgery, Nihon University School of Medicine, Tokyo, Japan.
authors: Motomi
authors: M
authors: Shiono
mesh_terms: D000368:Aged; D000419:Albuminuria / Q000652:urine; D000493:Allopurinol / Q000627:therapeutic use*; D002097:C-Reactive Protein; D006348:Cardiac Surgical Procedures; D002784:Cholesterol; D003404:Creatinine / Q000097:blood; D055316:Cystatin C; D000069465:Febuxostat / Q000627:therapeutic use*; D005260:Female; D006074:Gout Suppressants / Q000627:therapeutic use*; D006801:Humans; D033461:Hyperuricemia / Q000188:drug therapy* / Q000209:etiology; D008075:Lipoproteins, HDL; D008077:Lipoproteins, LDL; D008297:Male; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000150:complications* / Q000652:urine; D014280:Triglycerides; D014527:Uric Acid / Q000097:blood
chemical_list: D055316:Cystatin C; D006074:Gout Suppressants; D008075:Lipoproteins, HDL; D008077:Lipoproteins, LDL; D014280:Triglycerides; C099252:oxidized low density lipoprotein; D000069465:Febuxostat; D014527:Uric Acid; D000493:Allopurinol; D002097:C-Reactive Protein; D002784:Cholesterol; D003404:Creatinine
keywords: Allopurinol; Chronic kidney disease; Febuxostat; Hyperuricemia