Febuxostat and Renal Outcomes in Stage 3-4 CKD Patients with Asymptomatic Hyperuricemia: A Prospective Observational Study

Background:
Chronic kidney disease (CKD) is commonly accompanied by
asymptomatic hyperuricemia, which has been linked to faster renal
deterioration.
Objective:
This study evaluated whether febuxostat provides renal benefit
compared with standard care in adults with stage 3–4 CKD and elevated
serum uric acid.
Methods:
This prospective observational study was conducted in the Department
of Nephrology at the National Institute of Kidney Diseases & Urology
(NIKDU), Dhaka, from February to July 2016, on 150 adults with
chronic kidney disease (CKD) Stage 3-4 and asymptomatic
hyperuricemia (serum uric acid ≥7 mg/dL), allocated in equal numbers
by a closed-envelope technique to either a Febuxostat group (40 mg
once daily after breakfast) or a conventional-therapy group receiving
standard CKD care without Febuxostat (75 patients in each group).
Participants were followed at baseline, 2 months, and 4 months with
repeat clinical and biochemical assessments. The primary outcome was
a ≥10% decline from baseline eGFR at 4 months. Secondary outcomes
included between-group differences in CKD stage distribution, mean
eGFR, and serum creatinine at 2 and 4 months, change in serum uric
acid, and significant adverse events (myocardial infarction, stroke, heart
failure, mortality).
Results:
Over four months, febuxostat was associated with better preservation of
kidney function: eGFR remained higher, creatinine rose more slowly,
and progression to CKD stage 5 was markedly lower. The primary
endpoint, a ≥10% eGFR decline, occurred far less frequently with
febuxostat, corresponding to a substantially reduced adjusted risk.
Serum uric acid decreased to near-target levels, and cardiovascular
events were infrequent and comparable between groups.
Conclusion:
These findings indicate the short-term renoprotective potential of
febuxostat in selected CKD patients, underscoring the need for longer
controlled trials.