Kidney Week

Abstract: TH-PO936

Febuxostat vs. Allopurinol in CKD Patients: Observational Study on Cardiovascular Events and Deaths

Session Information

• Health Maintenance, Nutrition, Metabolism - I
  November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Health Maintenance, Nutrition, and Metabolism

• 1500 Health Maintenance, Nutrition, and Metabolism

Authors

• Otani, Miho, Osaka Koritsu Daigaku Igakubu Daigakuin Igaku Kenkyuka, Osaka, Osaka, Japan

Miho Otani,

• Shinomiya, Sae, Osaka Koritsu Daigaku Igakubu Daigakuin Igaku Kenkyuka, Osaka, Osaka, Japan

Sae Shinomiya,

• Ihara, Yasutaka, Osaka Koritsu Daigaku Igakubu Daigakuin Igaku Kenkyuka, Osaka, Osaka, Japan

Yasutaka Ihara,

• Kawai, Ryota, Osaka Koritsu Daigaku Igakubu Daigakuin Igaku Kenkyuka, Osaka, Osaka, Japan

Ryota Kawai,

• Yoshida, Hisako, Osaka Koritsu Daigaku Igakubu Daigakuin Igaku Kenkyuka, Osaka, Osaka, Japan

Hisako Yoshida,

• Tsuruya, Kazuhiko, Nara Kenritsu Ika Daigaku Igakubu Igakuka Daigakuin Igaku Kenkyuka, Kashihara, Nara, Japan

Kazuhiko Tsuruya,

• Shintani, Ayumi, Osaka Koritsu Daigaku Igakubu Daigakuin Igaku Kenkyuka, Osaka, Osaka, Japan

Ayumi Shintani,

Group or Team Name

• Osaka Metropolitan University, Dept of Medical Statistics.

Background

Recent trials have investigated the effects of urate-lowering agents, such as febuxostat and allopurinol. The CARES trial (2018) reported higher all-cause deaths with febuxostat compared to allopurinol. Then the FAST trial (2020) showed that febuxostat did not increase cardiovascular events nor deaths compared to allopurinol. However, these trials did not include severe chronic kidney disease patients, leaving uncertainty regarding febuxostat's efficacy in this population. Moreover, high prevalence of hyperuricemia in severe chronic kidney disease patients, we aimed to assess febuxostat's impact on cardiovascular events and deaths in this population.

Methods

We conducted an observational study using Japanese nationwide administrative data. Patients aged over 60 years with chronic kidney disease (eGFR<60ml/min/1.73 m²), including severe CKD (eGFR <30), prescribed either febuxostat or allopurinol were identified. The outcomes were cardiovascular events (myocardial infarction, cerebral infarction, unstable angina requiring urgent revascularization) and all-cause deaths. We did intention-to-treat analysis, in which we ignored switching of drugs, using Cox proportional hazard regression models.

Results

A total of 4,793 patients were enrolled: febuxostat group (n = 3,783; median age 74 years; 2,479 [65.5%] men; 1,455 [38.5%] with diabetes; median eGFR 22.8ml/min/1.73m²; median urate 8.3mg/dl) or allopurinol group (n = 596; median age 75 years; 426 [71.5%] men; 185 [31%] with diabetes; median eGFR 28.5ml/min/1.73m²; median urate 7.3mg/dl). With respect to cardiovascular events and deaths, febuxostat (1032 patients [0.035 events per 100 patient-years]) was superior to allopurinol (227 patients [0.042 events per 100 patient-years]; adjusted HR 0.861 [95% CI 0.741 – 1.001]).

Conclusion

This analysis using Japanese nationwide data suggested that febuxostat seemed to decrease cardiovascular events and deaths compared to allopurinol in chronic kidney disease patients.