Zeng Xiang Xia, Tang Yunliang, Hu Kaixiang, Zhou Xi, Wang Jiao, Zhu Lingyan, Liu Jianying, Xu Jixiong
Department of Endocrinology and Metabolism, First Affiliated Hospital of Nanchang University Department of Endocrinology and Metabolism, The Third Hospital of Nanchang, Nanchang, Jiangxi, China.
Medicine (Baltimore). 2018 Mar;97(13):e0161. doi: 10.1097/MD.0000000000010161.
To investigate the efficacy of febuxostat in hyperuricemic patients with chronic kidney disease (CKD), relevant randomized clinical trials (RCTs) were analyzed.
We used PubMed, Medline, ISI Web of Science, CBMdisc, and Cochrane Library databases to conduct a systematic literature research. A fixed-effects model was used to evaluate the standardized mean differences (SMDs) with 95% confidence intervals (CIs). We conducted subgroup analysis, sensitivity analysis, and analyzed publication bias, to comprehensively estimate the renoprotective effects of febuxostat in hyperuricemic patients with CKD.
Among 296 retrieved studies, 5 relevant RCTs were included in the meta-analysis. The result showed that serum estimated glomerular filtration rate (eGFR) was improved after febuxostat treatment in hyperuricemic patients with CKD, with an SMD (95% CI) of 0.24 [-0.17 to 0.43] and P = .67 (fixed-effects model). No heterogeneity was observed across studies (I = 0% and P = .67). Subgroup analysis suggested that treatment-related reductions in serum eGFR levels were not related to drug doses, intervention times, or region.
The present meta-analysis suggests that febuxostat may slow the progression of mild-to-moderate CKD. Given the limited number of included studies, additional large sample-size RCTs are required to determine the long-term renoprotective effects of febuxostat in hyperuricemic patients with CKD.
为研究非布司他在慢性肾脏病（CKD）高尿酸血症患者中的疗效，对相关随机临床试验（RCT）进行了分析。
我们使用PubMed、Medline、ISI Web of Science、CBMdisc和Cochrane图书馆数据库进行系统的文献研究。采用固定效应模型评估标准化均数差（SMD）及95%置信区间（CI）。我们进行了亚组分析、敏感性分析，并分析了发表偏倚，以全面评估非布司他在CKD高尿酸血症患者中的肾脏保护作用。
在检索到的296项研究中，有5项相关RCT纳入了荟萃分析。结果显示，非布司他治疗CKD高尿酸血症患者后，血清估计肾小球滤过率（eGFR）有所改善，SMD（95%CI）为0.24[-0.17至0.43]，P = 0.67（固定效应模型）。各研究间未观察到异质性（I² = 0%，P = 0.67）。亚组分析表明，治疗相关的血清eGFR水平降低与药物剂量、干预时间或地区无关。
本荟萃分析表明，非布司他可能减缓轻至中度CKD的进展。鉴于纳入研究数量有限，需要更多大样本RCT来确定非布司他在CKD高尿酸血症患者中的长期肾脏保护作用。
