Febuxostat may offer superior renal-protective effects compared with allopurinol in patients with stage 3 chronic kidney disease (CKD) and hyperuricemia, according to preliminary study findings.

Investigators randomly assigned 120 patients with CKD and hyperuricemia but without active gout to receive low-dose febuxostat (20 mg per day) or allopurinol (200 mg per day). A significantly lower proportion of the febuxostat than allopurinol group experienced a more than 10% decline in estimated glomerular filtration rate (eGFR) at 6 months: 21.7% vs 45.0%, Bin Cao, MB, of Ankang Hospital of Traditional Chinese Medicine in China, and colleagues reported in the Journal of Clinical Pharmacy and Therapeutics. The mean eGFR at 6 months was significantly higher in the febuxostat than allopurinol group.

In subgroup analyses, these effects were seen among patients with stage 3 but not stage 2 CKD. Among patients with stage 3 CKD, a significantly lower proportion of the febuxostat than allopurinol group had a more than 10% decline in eGFR at 6 months: 20.5% vs 51.4%. The mean eGFR at 6 months was higher with febuxostat than allopurinol.

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Low-dose febuxostat and allopurinol similarly reduced serum uric acid levels in the full cohort.

Rates of adverse events including diarrhea, skin rashes, dysregulated hepatic function, end-stage kidney disease, and cardiovascular events did not differ significantly between the febuxostat and allopurinol group. The investigators noted that dosages of both drugs were lower than typically used in clinical practice.

According to the investigators, these trial data suggest that low-dose febuxostat is more effective in delaying renal decline in the short term compared with allopurinol. Larger studies with longer follow-up periods are needed.


Yang N, Cao B. Low-dose febuxostat exhibits a superior renal-protective effect and non-inferior safety profile compared to allopurinol in chronic kidney disease patients complicated with hyperuricemia: A double-centre, randomized, controlled study. J Clin Pharm Ther. 2022 Dec;47(12):2214-2222. doi:10.1111/jcpt.13794