chronic kidney disease. pathophysiology, progression

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Introduction and Aims: Asymptomatic elevated uric acid levels are frequent in CKD. ... Methods: 56 patients with asymptomatic hyperuricemia and CKD 2-3 (GFR ...

Nephrology Dialysis Transplantation 30 (Supplement 3): iii472–iii489, 2015 doi:10.1093/ndt/gfv191.46

CHRONIC KIDNEY DISEASE. PATHOPHYSIOLOGY, PROGRESSION & RISK FACTORS - 2 SP326

FEBUXOSTAT IMPROVES GFR AND BP IN NON-DIABETIC ADULTS WITH CKD 2-3: 4 YEARS FOLLOW-UP

Dmytro D Ivanov1 and Mariia D Ivanova2 1 Shupyk National Medical Academy of Postgraduate Education, Nephrology and RRT, Kiev, Ukraine, 2National Medical University named by O.Bogomolets, Pathology Dept, Kiev, Ukraine Introduction and Aims: Asymptomatic elevated uric acid levels are frequent in CKD. Lowering uric acid with allopurinol improves GFR, BP and might decrease cardiovascular events in CKD patients. The aim of the study was to investigate the influence of febuxostat on GFR and BP in non-diabetic patients with CKD 2-3 with mild hypertension and no history of gout. Methods: 56 patients with asymptomatic hyperuricemia and CKD 2-3 (GFR 54±3 ml/ min) were enrolled in 14-month randomized prospective open-label study in parallel

groups: 20 on allopurinol 300 mg, 16 on febuxostat 80 mg and 20 free of treatment as control group. GFR by GFR-EPI, ambulatory BP monitoring, urine albumin-creatinine ratio, and C-reactive protein, fasting blood glucose were measured at baseline, 6 and at 14 months. A multiple regression model incorporating variables expected to influence GFR (gender, age, CRP level and systolic/diastolic BP), as well as serum uric acid was performed both before and after treatment. People were remaining on this therapy and follow-up investigation was performed in the end of 3 and 4th years. 41 from them were at the end of this trial/ 2 appeared with diabetes type 2. Results: Age, gender, GFR, level of microalbuminuria and ACE-I/ARB regime were similar in all groups at baseline. Allopurinol treatment as well as febuxostat resulted in a decrease in serum uric acid, a decrease in systolic BP, and an increase in GFR compared with baseline. Febuxostat treatment led to the most beneficial decrease in the level of uric acid (-290±27 μmol/l, P≤0,01 with control and P≤0,05 with allopurinol group), increased GFR (+14±3 ml/min, P≤0,01 with control and P≤0,05 with allopurinol group), blood pressure decrease (- 7±2/-3±1 mm hg, P≤0,05 with control and P=0,92 with allopurinol group), albuminuria (-138±22 mg, P≤0,01 with control and P≤0,05 with allopurinol group), and left ventricular hypertrophy control. Potential benefits of febuxostat were better tolerability compared with allopurinol group. Conclusions: At least 4-year treatment with febuxostat (better than allopurinol) improves GFR and BP in patients with asymptomatic hyperuricemia in non-diabetic CKD 2-3. More studies with febuxostat are necessary to assess the risk/benefit of lowering uric acid in non-diabetic adults with CKD and asymptomatic hyperuricemia.

© The Author 2015. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.

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