SuO025FEBUXOSTAT IMPROVES GFR AND BP IN NON-DIABETIC ADULTS WITH CKD 2-3: 6 YEARS TREATMENT AND FOLLOW-UP

Abstract

INTRODUCTION AND AIMS: Asymptomatic elevated uric acid levels are frequent in CKD. Lowering uric acid with allopurinol improves eGFR, BP and might decrease cardiovascular events in CKD patients. The aim of the study was to investigate the influence of febuxostat on eGFR and BP in non-diabetic patients with CKD 2-3 with mild hypertension and no history of gout in 6 years follow-up. METHODS: Since 2011 56 patients with asymptomatic hyperuricemia and CKD 2-3 (GFR 5463 ml/min) has been enrolling in randomized prospective open-label study in parallel groups: 20 on allopurinol 300 mg, 16 on febuxostat 80 mg and 20 free of treatment as control group. eGFR-EPI, ambulatory BP monitoring, urine albumin-creatinine ratio, and C-reactive protein, fasting blood glucose has been measuring at baseline, and every 6 months. A multiple regression model incorporating variables expected to influence GFR (gender, age, CRP level and systolic/diastolic BP), as well as serum uric acid was performed for people were remaining on this therapy. 38 from them are being analyzed at 6 years follow-up. RESULTS: Age, gender, GFR, level of microalbuminuria and ACE-I/ARB regime were similar in all groups at baseline. Allopurinol treatment as well as febuxostat resulted in a decrease in serum uric acid, a decrease in systolic BP, and an increase in GFR compared with baseline. Febuxostat treatment led to the most beneficial decrease in the level of uric acid (-220617 mmol/l, P≥0,01 with control and P≥0,05 with allopurinol group), increased GFR (+1162 ml/min, P≥0,01 with control and P≥0,05 with allopurinol group), blood pressure decrease (-762/-361mmhg, P≥0,05 with control and P=0,92 with allopurinol group), albuminuria (-126620 mg, P≥0,01 with control and P≥0,05 with allopurinol group. Potential benefits of febuxostat were better tolerability compared with allopurinol group with target levels of uricemia less 180 mmol/l in 32% of people. CONCLUSIONS: At least 6-year treatment with febuxostat (better than allopurinol) improves GFR and BP in patients with asymptomatic hyperuricemia in non-diabetic CKD 2-3. More studies with febuxostat are necessary to assess the risk/benefit of lowering uric acid in non-diabetic adults with CKD and asymptomatic hyperuricaemia in target group less 180 mmol/l.