Zhang Peiyu, Chen Mo, Wang Jundi, Hu Shunjie, Lu Xiaoyong, Wu Huaxiang
Department of Rheumatology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Street, Jiefang Road, Hangzhou, China.
Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Rheumatol Ther. 2022 Oct;9(5):1421-1434. doi: 10.1007/s40744-022-00480-7. Epub 2022 Sep 3.
The aim of this study is to explore the efficacy and renal safety of febuxostat in gout and stage 2-4 chronic kidney disease (CKD) and factors that correlated with target serum urate (SU).
A single-center retrospective study including male patients with gout and CKD was conducted. SU, the rate of SU < 360 µmol/L (RAT), and renal safety were analyzed in subjects who received febuxostat over 44 weeks. Factors that correlated with target SU were also explored.
Between January 2017 and March 2021, 102 patients (stage 2 CKD: n = 27; stage 3 CKD: n = 70; stage 4 CKD: n = 5) were enrolled. The SU level reduced significantly over 44 weeks (600.76 ± 95.42 versus 405.52 ± 111.93 µmol/L; P < 0.05), and RAT increased to 39.20%. The overall estimated glomerular filtration rate (eGFR) level improved over 44 weeks (52.05 ± 11.68 versus 55.46 ± 14.49 mL/min/1.73 cm, P < 0.05). An obvious improvement of eGFR was observed in stage 3 CKD, in patients with ≤ 1 risk factor (hypertension, diabetic mellitus, hyperlipidemia, or usage of non-steroidal anti-inflammatory drugs), and in patients with terminal SU < 360 µmol/L (P < 0.05). Logistic regression analysis indicated that baseline SU level and body weight were correlated with RAT. Further analysis revealed that patients with SU < 600 μmol/L and body weight ≤ 70 kg reached higher RAT (56.7%).
Febuxostat demonstrated efficacy and renal safety in patients with gout and CKD in clinical practice. Achieving the target SU could obviously improve renal function. Baseline SU level and body weight could affect the achievement of target SU.
本研究旨在探讨非布司他在痛风和2-4期慢性肾脏病（CKD）患者中的疗效及肾脏安全性，以及与血清尿酸（SU）达标相关的因素。
开展一项单中心回顾性研究，纳入痛风合并CKD的男性患者。对接受非布司他治疗超过44周的受试者的SU、SU<360 μmol/L的比例（RAT）及肾脏安全性进行分析。同时探究与SU达标相关的因素。
2017年1月至2021年3月，共纳入102例患者（2期CKD：n = 27；3期CKD：n = 70；4期CKD：n = 5）。44周内SU水平显著降低（600.76±95.42 vs 405.52±111.93 μmol/L；P<0.05），RAT升至39.20%。44周内总体估算肾小球滤过率（eGFR）水平有所改善（52.05±11.68 vs 55.46±14.49 mL/min/1.73 m²，P<0.05）。在3期CKD患者、存在≤1个危险因素（高血压、糖尿病、高脂血症或使用非甾体抗炎药）的患者以及SU终末值<360 μmol/L的患者中观察到eGFR有明显改善（P<0.05）。Logistic回归分析表明，基线SU水平和体重与RAT相关。进一步分析显示，SU<600 μmol/L且体重≤70 kg的患者达到更高的RAT（56.7%）。
在临床实践中，非布司他在痛风合并CKD患者中显示出疗效和肾脏安全性。实现SU达标可明显改善肾功能。基线SU水平和体重会影响SU达标情况。
