Efficacy and safety of febuxostat for treating hyperuricemia in patients with chronic kidney disease and in renal transplant recipients: A systematic review and meta-analysis

Febuxostat is potent and well-tolerated in the management of chronic gout. However, its clinical efficacy and safety in the treatment of hyperuricemia in patients with chronic kidney disease (CKD) and in renal transplant recipients have remained to be fully determined. The MEDLINE, EMBASE and Cochrane Library databases were searched for relevant articles. Data were extracted and pooled results were estimated from the standard mean difference (SMD) with 95% confidence intervals (95% CIs). The quality of the studies included was assessed, and their publication bias was examined. Four prospective randomized controlled trials and two retrospective observational studies were included in the systematic review and meta-analysis. Febuxostat administration significantly reduced the serum uric acid concentration in patients with CKD and in renal transplant recipients when compared with allopurinol or placebo in the short-term (1 month: SMD, -2.24; 95% CI, -3.59 to -0.89; P-value of SMD=0.001; I-2, 92.4%; 3 months: SMD, -1.20; 95% CI, -2.04 to -0.36; P-value of SMD=0.005; I-2, 88.9%; 6 months: SMD, -1.49; 95% CI, -2.68 to -0.30; P-value of SMD=0.014; I-2, 92.9%). Furthermore, the increase in the estimated glomerular filtration rate in the febuxostat group was significantly higher than that in the control group (SMD, 0.30; 95% CI, 0.031 to 0.58; P-value of SMD=0.029; I-2, 0.0%). No significant difference in the changes in serum creatinine (Scr), low-density lipoprotein (LDL) and high-density lipoprotein (HDL) was identified between the two groups (Scr: SMD, -0.17; 95% CI, -0.97 to 0.63; P-value of SMD=0.67; I-2, 79.2%; LDL: SMD, -0.21; 95% CI, -0.49 to 0.07; P-value of SMD=0.13; I-2, 34.1%; HDL: SMD, -0.05; 95% CI, -0.70 to 0.61; P-value of SMD=0.89; I-2, 69.2%). In conclusion, febuxostat is a potent and well-tolerated agent for the short-term management of hyperuricemia in patients with CKD and in renal transplant recipients. However, these data should be interpreted with caution due to the varied design of the studies included in the present meta-analysis.