Febuxostat as a Renoprotective Agent for Treatment of Hyperuricemia: A Meta-analysis of Randomized Controlled Trials.

The objective of this meta-analysis of randomized controlled clinical trials (RCTs) was to evaluate the effects of febuxostat on kidney function in patients with hyperuricemia.We conducted electronic searches in PubMed, Embase and Cochrane Central Register of Controlled Trials from January 1960 to July 2019 to identify RCTs that examined the effects of febuxostat in adult patients with hyperuricemia on serum creatinine, estimated glomerular filtration rate (eGFR), albuminuria, blood pressure parameters, major cardiovascular events, diarrhea, joint pain, stroke, and arrhythmia.

Nine RCTs with 2141 participants were included in this meta-analysis. Compared to placebo, the febuxostat group showed a higher eGFR at 6 months with a weighted mean difference (WMD) of 2.86 mL/min/1.73 m2 (p < 0.001), as well as the end of studies (eGFR WMD 2.69 mL/min/1.73m² , p < 0.001). There was also lower serum creatinine (SrCr WMD = -0.04 mg/dL p < 0.001), reduction in systolic blood pressure (SBP WMD = -1.18 mmHg, p < 0.001), and diastolic blood pressure (DBP WMD = -1.14 mmHg, p = 0.04). There was no statistical difference between febuxostat and placebo in major cardiovascular events, diarrhea, joint symptoms, stroke events, and arrhythmia. Subgroup analysis among chronic kidney disease showed the febuxostat group had higher eGFR than the placebo group (eGFR WMD = 2.69 mL/min/1.73m² , p < 0.001).

Treating hyperuricemia with febuxostat may slow the progression of CKD irrespective of baseline renal function without significantly associated increased risks of major cardiovascular events, diarrhea, joint symptoms, arrhythmia, and stroke, compared to placebo. This article is protected by copyright. All rights reserved.