A Meta-Analysis for Comparing the Effects of Febuxostat and Allopurinol on Kidney Function in Hyperuricemia Patients Complicated with Chronic Kidney Disease

Abstract

Background. This study was designed to assess the effects of febuxostat on the uric acid level and kidney function of hyperuricemia (HUA) patients complicated with chronic kidney disease (CKD). Methods. A computer-based search was conducted on the China National Knowledge Infrastructure (CNKI), Wanfang, PubMed, and Web of Science databases from the inception of the databases to April 2023 to identify clinical randomized controlled trials on HUA and CKD, with comparisons between febuxostat and allopurinol as variables of interest. The meta-analysis was conducted using Stata v17.0. Results. Eighteen studies were included in this meta-analysis, encompassing a total of 1877 patients. These patients were segregated into a control group (treated with allopurinol or placebo) consisting of 1039 individuals and an experimental group (treated with febuxostat alone or a combination of febuxostat with other therapies) comprising 838 patients. The meta-analysis revealed that patients in the experimental group, treated with febuxostat, exhibited a significantly higher estimated glomerular filtration rate (eGFR) than those in the control group treated with allopurinol (weighted mean difference (WMD): 2.897, 95% CI: 1.336 to 4.458, $P$  < 0.001). In addition, the experimental group demonstrated significantly lower levels of serum creatinine (WMD: −17.810, 95% CI: −24.147 to −11.474, $P$  < 0.001), serum uric acid (WMD: −91.891, 95% CI: −117.609 to −66.173, $P$  < 0.001), and blood urea nitrogen (WMD: −1.284, 95% CI: −1.837 to −0.731, $P$  < 0.001). However, there was no significant difference in 24-hour urinary protein quantity (WMD: −0.198, 95% CI: −0.413 to 0.016, $P$  = 0.070) between the two groups. Conclusion. These findings suggest that febuxostat may offer a more beneficial therapeutic option for managing CKD in hyperuricemic patients. However, the observed heterogeneity and the limited diversity of the study population warrant cautious interpretation of these results.