Effect of Febuxostat in Delaying the Decline of Glomerular Filtration Rate among Hyperuricemic Patients with Chronic Kidney Disease: A Meta-analysis Group III
Elannie Barayuga, MD, Felix Basallaje III, MD, Lia Anna Comia, MD Bernard Dabbay, MD, Raymond Libongcogon, MD, Mary Grace San Pedro, MD, Hazel Sandigan, MD
Anthony Russel Villanueva, MD*
Background: Febuxostat, a novel non-purine xanthine-oxidase inhibitor, has been reported to be promising for patients with hyperuricemia, especially in those with Chronic Kidney Disease (CKD), because of reported fewer adverse events when compared to Allopurinol. Also, its action in preventing uric acid synthesis serves as a protective mechanism for the kidneys and hence a benefit for patients with CKD. A meta-analysis was done to determine the effect of Febuxostat in delaying the decline of eGFR among hyperuricemic patients with Stage III to V CKD not undergoing dialysis.
Methods: Two randomized controlled trials published in 2014 and 2015, representing a total of 149 participants were included in this meta-analysis. The efficacy of Febuxostat in delaying kidney damage was assessed by measuring the mean difference between the baseline and post-treatment eGFR in the subjectpopulations. CochraneCollaborationReviewManagerwasusedfordataanalysis.
Results: Meta-analysis of the two RCTs showed that both studies have pooled estimates of eGFR in favor of control (Allopurinol) and had a mean difference of 2.89 ml/min/1.73m2 with 95% confidence interval of – 2.22 to 7.99 ml/min/1.73m2. Confidence interval of the pooled estimate showed that therewasno significantdifferencebetweenthetreatmentandcontrolgroups.
Conclusion: Febuxostat may retard the decline of eGFR in patients with CKD. However, limited evidence shows that febuxostat delays the decline of glomerular filtration rate among CKD patients.
Keywords: febuxostat, hyperuricemia, glomerular filtration rate, chronic kidney disease
*Adviser/Consultant, Department of Internal Medicine