Switching from Allopurinol to Febuxostat: A Comparison of The Rate of Renal Functional Decline in Patients With Moderate and Severe Chronic Kidney Disease
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2018, Vol 10, Issue 4
Abstract
Allopurinol has been widely used as a urate-lowering agent in the treatment of hyperuricemia. However, patients with renal impairment require dose reduction according to their renal function. On the other hand, strict dose adjustment is not required for the use of febuxostat and the frequency of its use is increasing. The purpose of this study was to clarify the effects of the rate of renal functional decline and other examination data by switching from allopurinol to febuxostat in patients with moderate to high renal dysfunction. We examined the clinical records of patients treated at the Saga University Faculty of Medicine, Department of Nephrology between March 2008 and December 2016; patients who received orally-administered allopurinol for more than one year and who were able to change to febuxostat and were followed for more than two years were analyzed. The patients were divided into 3 groups: CKD(Chronic kidney desease) stage 3 (n = 12), CKD stage 4 (n = 10), and CKD stage 3 and 4 combined (n = 22), according to the renal function at the time of switching to febuxostat. There was no significant difference in the rate of renal functional decline (ΔeGFR: Aestimated glemerular filtration rate) in any group; however, the rate after the switch tended to be decreased in comparison to before the switch. Hyperuricemia has been reported to be related to the rapid progression of the renal functional decline in patients with chronic kidney disease (CKD) [1]. Furthermore, hyperuricemia is one of the causes of gout and kidney stone disease, and lifestyle diseases that cause cardiovascular disease, cerebrovascular disease, and arteriosclerosis. Allopurinol has been widely used as urate- lowering agent in the treatment of hyperuricemia. Allopurinol reduces the uric acid concentration by acting as a xanthine oxidase (XO) inhibitor. Allopurinol is metabolized by XO and aldehyde oxidase and to oxypurinol, which is also a XO inhibitor. Oxypurinol is predominantly excreted by the kidney; thus, the risk of adverse events is higher in CKD patients. febuxostat is a novel XO inhibitor that became clinically available in Japan in 2011. Although it was reported that febuxostat was safe and effective in patients with moderate to severe kidney dysfunction [2], few studies have examined the usefulness of switching from allopurinol to febuxostat in advanced CKD patients. The aim of the present study was to clarify the effects of the rate of renal functional decline and other factors in patients with moderate to severe renal dysfunction who switched from allopurinol to febuxostat. Patients & Methods We examined the clinical records of patients who were treated in the Department of Nephrology, Saga University Faculty of Medicine from March 2008 to December 2016. Patients who received orally-administered allopurinol for more than one year and who were able to change to febuxostat and who were followed for more than two years were analyzed. The doses of allopurinol before switching and the dosage of febuxostat after switching were not defined. Patients with mild renal dysfunction (CKD stage 1 or 2) and those with end-stage renal failure (CKD stage 5) were excluded. The patients (n=22) were divided into three groups according to their renal function when they switched to febuxostat: the CKD stage 3 group (S3, eGFR 30 ml/min/1.73m2 to 60 ml/min/1.73m2; n = 12), CKD stage 4 group (S4, eGFR 15ml/min/1.73m2 to 30 ml/ min/1.73m2; n = 10), CKD stage 3 and stage 4 combined group (S3+4). The primary outcome was the annual rate of change in the eGFR (ΔeGFR). The Wilcoxon signed rank sum test was used to compare the data before and after switching from allopurinol. P values of <0.05 were considered to indicate a significant difference. All statistical analyses were performed using the JMP Pro 12 software program.
Authors and Affiliations
Masatora Yamasaki, Motoaki Miyazono, Maki Yoshihara, Atsuhiko Suenaga, Masato Mizuta, Makoto Fukuda, Shuichi Rikitake, Yuuji Ikeda
Keywords
Related Articles
- EP ID EP587311
- DOI 10.26717/BJSTR.2018.10.001992
- Views 164
- Downloads 0
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