Efficacy and safety of febuxostat in 73 gouty patients with stage 4/5 chronic kidney disease: A retrospective study of 10 centers.
OBJECTIVE
The allopurinol dose is limited in chronic kidney disease, particularly stage 4/5 chronic kidney disease. Febuxostat has a hepatic metabolism and has been approved without dose adaptation in gouty patients with stage 1-3 chronic kidney disease. We aimed to study the safety and efficacy of febuxostat for stage 4/5 chronic kidney disease.


METHODS
In this retrospective study, we included patients with (1) a diagnosis of gout, (2) febuxostat treatment, (3) estimated glomerular filtration rate≤30mL/min/1.73m2(Modification of Diet in Renal Disease formula) at febuxostat initiation and (4) follow-up for at least 3 months after febuxostat initiation. Efficacy, safety and variation in estimated glomerular filtration rate were analyzed.


RESULTS
We included 73 patients (mean age 70.2±11.8, 61 men, 31 with vascular chronic kidney disease and 18 renal transplantation) with gout (baseline serum uric acid level=9.86±2.85mg/dL, mean gout duration 6.2±7.0 years) from 10 academic centers. Comorbidities included cardiac failure (17.8%), hypertension (98.6%), diabetes mellitus (30.1%), dyslipidemia (64.8%) and history of cardiovascular events (38.4%). At the last visit (mean follow-up 68.5±64.8 weeks), the daily dose of febuxostat was 40mg for 7 patients (10.5%), 80mg for 50 (74.6%) and 120mg for 10 (14.9%). Serum uric acid level was<6mg/dL for 49 patients (67%). Renal function improved for 18 patients, was unchanged for 24 and worsened for 31; 19 patients experienced flares and 1 patient, limb edema.


CONCLUSIONS
Febuxostat seemed efficient in gouty patients with stage 4/5 chronic kidney disease. However, safety data were not clear regarding renal function. Larger studies are needed to assess safety.
Service de rhumatologie, centre Viggo-Petersen, hôpital Lariboisière, Assistance publique-Hôpitaux de Paris, 75010 Paris, France.
Pierre-Antoine
PA
Juge
Service de rhumatologie, CHU de Bordeaux, groupe hospitalier Pellegrin, 33000 Bordeaux, France.
Marie-Elise
ME
Truchetet
Service de néphrologie, hôpital Saint-Louis, Assistance publique-Hôpitaux de Paris, 75010 Paris, France.
Evangeline
E
Pillebout
Service de rhumatologie, hôpital Bichat-Claude-Bernard, Assistance publique-Hôpitaux de Paris, 75018 Paris, France.
Sébastien
S
Ottaviani
Service de néphrologie, hôpital Pontchaillou, 35033 Rennes cedex, France.
Cécile
C
Vigneau
Service de rhumatologie, CHU de Bordeaux, groupe hospitalier Pellegrin, 33000 Bordeaux, France.
Clotilde
C
Loustau
Service de rhumatologie, hôpital universitaire de Brest, 29200 Brest, France.
Divi
D
Cornec
Service de rhumatologie, hôpital Saint-Philibert, 59160 Lille, France.
Tristan
T
Pascart
Service de néphrologie, hôpital Necker-Enfants-Malades, Assistance publique-Hôpitaux de Paris, 75015 Paris, France.
Renaud
R
Snanoudj
Service de rhumatologie, hôpitaux universitaires Pitié-Salpêtrière-Charles-Foix, Assistance publique-Hôpitaux de Paris, 75013 Paris, France.
Florian
F
Bailly
Service de néphrologie, CHRU de Brest, 29200 Brest, France.
Emilie
E
Cornec-Le Gall
Service de rhumatologie, CHU de Bordeaux, groupe hospitalier Pellegrin, 33000 Bordeaux, France.
Thierry
T
Schaeverbeke
Service de rhumatologie, hôpital universitaire de Brest, 29200 Brest, France.
Alain
A
Saraux
Service de rhumatologie, hôpital Bichat-Claude-Bernard, Assistance publique-Hôpitaux de Paris, 75018 Paris, France.
Philippe
P
Dieudé
Service de rhumatologie, CHU Roger-Salengro, 59160 Lille, France.
René-Marc
RM
Flipo
Service de rhumatologie, centre Viggo-Petersen, hôpital Lariboisière, Assistance publique-Hôpitaux de Paris, 75010 Paris, France.
Pascal
P
Richette
Service de rhumatologie, centre Viggo-Petersen, hôpital Lariboisière, Assistance publique-Hôpitaux de Paris, 75010 Paris, France.
Frédéric
F
Lioté
Service de rhumatologie, centre Viggo-Petersen, hôpital Lariboisière, Assistance publique-Hôpitaux de Paris, 75010 Paris, France.
Thomas
T
Bardin
Service de rhumatologie, CHU de Rennes, 35033 Rennes cedex, France.
Gérard
G
Chalès
Service de rhumatologie, centre Viggo-Petersen, hôpital Lariboisière, Assistance publique-Hôpitaux de Paris, 75010 Paris, France; Inserm UMR 1132, université Paris Diderot, Sorbonne Paris Cité, 75475 Paris cedex 10, France. Electronic address: korngea@yahoo.fr.
Hang-Korng
HK
Ea
D000046:Academic Medical Centers; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D015897:Comorbidity; D000069465:Febuxostat / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D005602:France; D005919:Glomerular Filtration Rate; D006073:Gout / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D006074:Gout Suppressants / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology* / Q000473:pathology*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012737:Sex Factors; D018709:Statistics, Nonparametric; D015996:Survival Rate; D016896:Treatment Outcome
D006074:Gout Suppressants; D000069465:Febuxostat
Chronic kidney disease; Febuxostat; Gout