Febuxostat is superior to allopurinol in delaying the progression of renal impairment in patients with chronic kidney disease and hyperuricemia.

Objective: This study aimed to compare efficacy of renal-protective function between febuxostat and allopurinol in patients with chronic kidney disease (CKD) and hyperuricemia (HUA).

Methods: Totally 152 CKD stage 2-3 patients complicated with HUA were recruited. According to their uric acid-lowering therapy, there were 67 patients included in febuxostat group and 85 in allopurinol group, respectively. Estimated glomerular filtration rate (eGFR), serum creatinine (Scr), 24-h proteinuria, serum uric acid (SUA) were measured at M0, M1, M3 and M6 after the treatment. Primary outcome was proportion of patients showing ≥ 10% decline in eGFR from baseline at M6.

Results: The eGFR at M6 was numerically higher at M6 and eGFR change (M6-M0) was increased in febuxostat group compared with allopurinol group. Most importantly, the proportion of patients showing a ≥ 10% decline in eGFR from baseline at M6 was reduced in febuxostat group compared with allopurinol group. Multivariate logistic regression analyses further validated that febuxostat vs. allopurinol was an independent predictor for reduced risk of eGFR decline ≥ 10% from baseline. Besides, SUA change (M6-M0) was decreased, but Scr change (M6-M0) and 24-h proteinuria change (M6-M0) were similar in febuxostat group compared with allopurinol group.

Conclusions: Febuxostat presents a superior effect in delaying renal impairment progression compared with allopurinol in CKD patients complicated with HUA.