Hyperuricaemia: febuxostat may exert a renoprotective effect

Takeaway

• In patients with hyperuricaemia, febuxostat may slow the progression of chronic kidney disease (CKD), irrespective of baseline renal function without increasing the risk for major cardiovascular events, stroke, arrhythmias, joint pain and diarrhoea.

Why this matters

• Findings warrant future studies to better define the renoprotective effects and role of febuxostat in patients with hyperuricaemia.

Study design

• 9 randomised controlled trials (n=2141) met eligibility criteria after a search across electronic databases.
• Funding: None disclosed.

Key results

• Febuxostat vs placebo group had a higher estimated glomerular filtration rate (eGFR) at 6 months (weighted mean difference [WMD], 2.86 mL/min/1.73 m²; I²=96.6%) and end of study (WMD, 2.69 mL/min/1.73 m²; I²=98.0%; P<.001 for both).
• Febuxostat vs placebo group had lower:
  • serum creatinine (WMD, −0.04 mg/dL; P<.001); and
  • systolic (WMD, −1.18 mmHg; P<.001) and diastolic (WMD, −1.14 mmHg; P=.04; I²=65.9%) blood pressure.
• No significant difference in major cardiovascular events, diarrhoea, joint symptoms, stroke events and arrhythmia between the febuxostat and placebo groups.
• In the subgroup analysis, febuxostat vs placebo was associated with a significantly higher eGFR in patients with CKD (WMD, 2.69 mL/min/1.73 m²; P<.001; I²=98.6%).

Limitations

• Heterogeneity among studies.