Urate-lowering efficacy and renal safety of febuxostat in patients with hyperuricemia and stage 4–5 chronic kidney disease not yet on dialysis: A meta-analysis of observational studies

The efficacy and safety of febuxostat in patients with stage 4–5 chronic kidney disease (CKD) remains unclear. We evaluated the urate-lowering efficacy and renal safety of febuxostat in patients with stage 4–5 CKD not yet on dialysis, through a meta-analysis of observational studies. We performed a systematic search in PubMed, Ovid MEDLINE, Embase, and the Cochrane Library databases for observational studies of patients with advanced CKD starting febuxostat. Articles describing changes in serum urate levels and/or renal function assessed by the estimated glomerular filtration rate (eGFR) were included. Among 148 retrieved studies, five relevant observational studies with 327 patients were included in the meta-analysis. Febuxostat was administered daily at 10–120 mg for 3–12 months. Serum urate reduced in response to febuxostat (weighted mean difference, -1.85 mg/dL; 95% CI, -2.04–-1.67 mg/dL; I2; 0%). Three studies involving 145 patients included eGFR assessments. Renal function, assessed through the eGFR, did not change after febuxostat use (weighted mean difference, 0.11 mL/min/1.73m2; 95% CI, -0.25–0.47 mL/min/1.73m2; I2; 45%). Overall, febuxostat has acceptable urate-lowering efficacy and renal safety in patients with hyperuricemia and stage 4–5 CKD who are not yet on dialysis.