Febuxostat Improves Uric Acid Control in Gout Patients With CKD: Study
A new study published in The Journal of Rheumatology showed that despite using lower dosages, febuxostat more successfully reduced serum uric acid levels in individuals with gout and chronic kidney disease (CKD) than in those with gout alone.
Chronic kidney disease and gout often combine, making safe and effective urate-lowering medication difficult to achieve. In these individuals, persistent hyperuricemia raises the risk of progressive renal impairment and repeated flare-ups of gout. Febuxostat is a selective xanthine oxidase inhibitor that is mostly processed in the liver and provides a non-purine substitute for conventional medications.
Febuxostat is a viable treatment for gout patients with CKD due to its pharmacological characteristics. Optimizing long-term care in this high-risk group requires assessing its safety and efficacy in lowering serum urate. This study assessed changes over time in febuxostat dose and serum urate (SU) levels based on renal function.
After excluding patients with less than a year of follow-up, non-febuxostat medication, or missing data, 112 of the 405 patients in the Urate Lowering medication (ULTRA) registry between November 2021 and December 2023 were examined. At baseline, 6 months, and 12 months, the two groups' SU levels and febuxostat dosages were compared.
There was no difference in baseline SU levels between the CKD and normal groups. Following febuxostat treatment, SU levels were considerably lower in the CKD group when compared to the normal group (at 6 months: 4.45 ± 1.84 mg/dL vs. 5.62 ± 1.62 mg/dL, p = 0.001; at 12 months: 4.81 ± 1.81 mg/dL vs. 5.60 ± 1.94 mg/dL, p = 0.041).
Although these changes were not statistically significant, the mean doses of febuxostat were lower in the CKD group than in the normal group (at 6 months: 40.61 ± 22.07 mg vs. 47.54 ± 19.43 mg, p = 0.110; at 12 months: 40.59 ± 21.73 mg vs. 48.49 ± 19.70 mg, p = 0.064). Furthermore, compared to the normal group, a greater percentage of patients in the CKD group achieved SU <6 mg/dL at 6 months.
Overall, a customized dose approach based on SU response rather than only renal function may maximize therapeutic results. Individualized dosage plans for the best urate management are supported by these findings. The study also emphasizes the strong, reciprocal association between gout and CKD, with both conditions becoming more common worldwide and each raising the risk of the other.
Reference:
Oh, Y.-J., Choi, H. J., Kim, S.-H., Ha, Y.-J., Choi, I. A., Kim, M. J., Shin, K., Kim, H.-O., Lee, S. W., Ahn, J. K., Lee, C. H., Kim, S. H., Son, K. M., Moon, K. W., & Son, C.-N. (2025). Febuxostat effectively and safely reduces serum urate in gout patients with chronic kidney disease: A prospective multicenter ULTRA registry study. The Journal of Rheumatology, jrheum.2025-0881. https://doi.org/10.3899/jrheum.2025-0881
