Comparative Renoprotective Effect of Febuxostat and Allopurinol in Predialysis Stage 5 Chronic Kidney Disease Patients: A Nationwide Database Analysis

Yun Shiuan O. Hsu; I. Wen Wu; Shang Hung Chang; Cheng Chia Lee; Chung Ying Tsai; Chan Yu Lin; Wan Ting Lin; Yu Tung Huang; Chao Yi Wu; George Kuo; Chih Yen Hsiao; Hsing Lin Lin; Chih Chao Yang; Tzung Hai Yen; Yung Chang Chen; Cheng Chieh Hung; Ya Chong Tian; Chang Fu Kuo; Chih Wei Yang; Gerard F. Anderson; Huang Yu Yang

doi:10.1002/cpt.1697

Comparative Renoprotective Effect of Febuxostat and Allopurinol in Predialysis Stage 5 Chronic Kidney Disease Patients: A Nationwide Database Analysis

Yun Shiuan O. Hsu, I. Wen Wu, Shang Hung Chang, Cheng Chia Lee, Chung Ying Tsai, Chan Yu Lin, Wan Ting Lin, Yu Tung Huang, Chao Yi Wu, George Kuo, Chih Yen Hsiao, Hsing Lin Lin, Chih Chao Yang, Tzung Hai Yen, Yung Chang Chen, Cheng Chieh Hung, Ya Chong Tian, Chang Fu Kuo, Chih Wei Yang, Gerard F. AndersonHuang Yu Yang

Bloomberg School of Public Health

Research output: Contribution to journal › Article › peer-review

3 Scopus citations

Abstract

Hyperuricemia has been associated with chronic kidney disease (CKD) progression. The antihyperuricemic febuxostat's potential renoprotective effect has been demonstrated in stage 1–3 CKD. Large-scale studies comparing the renoprotective potential of febuxostat and allopurinol in advanced CKD are lacking. We exclusively selected 6,057 eligible patients with predialysis stage 5 CKD prescribed either febuxostat or allopurinol using the National Health Insurance Research Database in Taiwan during 2012–2015. There were 69.57% of allopurinol users and 42.01% febuxostat users who required long-term dialysis (P < 0.0001). The adjusted hazard ratio (HR) of 0.65 (95% confidence interval (CI) 0.60–0.70) indicated near 35% lower hazards of long-term dialysis with febuxostat use. The renal benefit of febuxostat was consistent across most patient subgroups and/or using the propensity score-matched cohort. The adjusted HR was 0.66 (95% CI, 0.61–0.70) for long-term dialysis or death. In conclusion, lower risk of progression to dialysis was observed in predialysis stage 5 CKD febuxostat users without compromising survival.

Original language	English (US)
Pages (from-to)	1159-1169
Number of pages	11
Journal	Clinical pharmacology and therapeutics
Volume	107
Issue number	5
DOIs	https://doi.org/10.1002/cpt.1697
State	Published - May 1 2020

ASJC Scopus subject areas

Pharmacology
Pharmacology (medical)

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Hsu, Y. S. O., Wu, I. W., Chang, S. H., Lee, C. C., Tsai, C. Y., Lin, C. Y., Lin, W. T., Huang, Y. T., Wu, C. Y., Kuo, G., Hsiao, C. Y., Lin, H. L., Yang, C. C., Yen, T. H., Chen, Y. C., Hung, C. C., Tian, Y. C., Kuo, C. F., Yang, C. W., ... Yang, H. Y. (2020). Comparative Renoprotective Effect of Febuxostat and Allopurinol in Predialysis Stage 5 Chronic Kidney Disease Patients: A Nationwide Database Analysis. Clinical pharmacology and therapeutics, 107(5), 1159-1169. https://doi.org/10.1002/cpt.1697

Hsu, YSO, Wu, IW, Chang, SH, Lee, CC, Tsai, CY, Lin, CY, Lin, WT, Huang, YT, Wu, CY, Kuo, G, Hsiao, CY, Lin, HL, Yang, CC, Yen, TH, Chen, YC, Hung, CC, Tian, YC, Kuo, CF, Yang, CW, Anderson, GF & Yang, HY 2020, 'Comparative Renoprotective Effect of Febuxostat and Allopurinol in Predialysis Stage 5 Chronic Kidney Disease Patients: A Nationwide Database Analysis', Clinical pharmacology and therapeutics, vol. 107, no. 5, pp. 1159-1169. https://doi.org/10.1002/cpt.1697

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title = "Comparative Renoprotective Effect of Febuxostat and Allopurinol in Predialysis Stage 5 Chronic Kidney Disease Patients: A Nationwide Database Analysis",

abstract = "Hyperuricemia has been associated with chronic kidney disease (CKD) progression. The antihyperuricemic febuxostat's potential renoprotective effect has been demonstrated in stage 1–3 CKD. Large-scale studies comparing the renoprotective potential of febuxostat and allopurinol in advanced CKD are lacking. We exclusively selected 6,057 eligible patients with predialysis stage 5 CKD prescribed either febuxostat or allopurinol using the National Health Insurance Research Database in Taiwan during 2012–2015. There were 69.57% of allopurinol users and 42.01% febuxostat users who required long-term dialysis (P < 0.0001). The adjusted hazard ratio (HR) of 0.65 (95% confidence interval (CI) 0.60–0.70) indicated near 35% lower hazards of long-term dialysis with febuxostat use. The renal benefit of febuxostat was consistent across most patient subgroups and/or using the propensity score-matched cohort. The adjusted HR was 0.66 (95% CI, 0.61–0.70) for long-term dialysis or death. In conclusion, lower risk of progression to dialysis was observed in predialysis stage 5 CKD febuxostat users without compromising survival.",

author = "Hsu, {Yun Shiuan O.} and Wu, {I. Wen} and Chang, {Shang Hung} and Lee, {Cheng Chia} and Tsai, {Chung Ying} and Lin, {Chan Yu} and Lin, {Wan Ting} and Huang, {Yu Tung} and Wu, {Chao Yi} and George Kuo and Hsiao, {Chih Yen} and Lin, {Hsing Lin} and Yang, {Chih Chao} and Yen, {Tzung Hai} and Chen, {Yung Chang} and Hung, {Cheng Chieh} and Tian, {Ya Chong} and Kuo, {Chang Fu} and Yang, {Chih Wei} and Anderson, {Gerard F.} and Yang, {Huang Yu}",

note = "Publisher Copyright: {\textcopyright} 2019 The Authors. Clinical Pharmacology & Therapeutics published by Wiley Periodicals, Inc. on behalf of American Society for Clinical Pharmacology and Therapeutics.",

year = "2020",

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doi = "10.1002/cpt.1697",

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T2 - A Nationwide Database Analysis

AU - Hsu, Yun Shiuan O.

AU - Wu, I. Wen

AU - Chang, Shang Hung

AU - Lee, Cheng Chia

AU - Tsai, Chung Ying

AU - Lin, Chan Yu

AU - Lin, Wan Ting

AU - Huang, Yu Tung

AU - Wu, Chao Yi

AU - Kuo, George

AU - Hsiao, Chih Yen

AU - Lin, Hsing Lin

AU - Yang, Chih Chao

AU - Yen, Tzung Hai

AU - Chen, Yung Chang

AU - Hung, Cheng Chieh

AU - Tian, Ya Chong

AU - Kuo, Chang Fu

AU - Yang, Chih Wei

AU - Anderson, Gerard F.

AU - Yang, Huang Yu

PY - 2020/5/1

Y1 - 2020/5/1

N2 - Hyperuricemia has been associated with chronic kidney disease (CKD) progression. The antihyperuricemic febuxostat's potential renoprotective effect has been demonstrated in stage 1–3 CKD. Large-scale studies comparing the renoprotective potential of febuxostat and allopurinol in advanced CKD are lacking. We exclusively selected 6,057 eligible patients with predialysis stage 5 CKD prescribed either febuxostat or allopurinol using the National Health Insurance Research Database in Taiwan during 2012–2015. There were 69.57% of allopurinol users and 42.01% febuxostat users who required long-term dialysis (P < 0.0001). The adjusted hazard ratio (HR) of 0.65 (95% confidence interval (CI) 0.60–0.70) indicated near 35% lower hazards of long-term dialysis with febuxostat use. The renal benefit of febuxostat was consistent across most patient subgroups and/or using the propensity score-matched cohort. The adjusted HR was 0.66 (95% CI, 0.61–0.70) for long-term dialysis or death. In conclusion, lower risk of progression to dialysis was observed in predialysis stage 5 CKD febuxostat users without compromising survival.

AB - Hyperuricemia has been associated with chronic kidney disease (CKD) progression. The antihyperuricemic febuxostat's potential renoprotective effect has been demonstrated in stage 1–3 CKD. Large-scale studies comparing the renoprotective potential of febuxostat and allopurinol in advanced CKD are lacking. We exclusively selected 6,057 eligible patients with predialysis stage 5 CKD prescribed either febuxostat or allopurinol using the National Health Insurance Research Database in Taiwan during 2012–2015. There were 69.57% of allopurinol users and 42.01% febuxostat users who required long-term dialysis (P < 0.0001). The adjusted hazard ratio (HR) of 0.65 (95% confidence interval (CI) 0.60–0.70) indicated near 35% lower hazards of long-term dialysis with febuxostat use. The renal benefit of febuxostat was consistent across most patient subgroups and/or using the propensity score-matched cohort. The adjusted HR was 0.66 (95% CI, 0.61–0.70) for long-term dialysis or death. In conclusion, lower risk of progression to dialysis was observed in predialysis stage 5 CKD febuxostat users without compromising survival.

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Comparative Renoprotective Effect of Febuxostat and Allopurinol in Predialysis Stage 5 Chronic Kidney Disease Patients: A Nationwide Database Analysis

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