Meta-analysis Of Febuxostat And Allopurinol In The Treatment Of Chronic Kidney Disease With Hyperuricemia Patients

ObjectiveSerum uric acid is the terminal product of purine metabolism in humans,about 80 percent of uric acid is metabolized by the body’s DNA and/or RNA,and 20 percent is metabolized by animals or other purine-rich foods.2/3 of SUA produced daily by human body is excreted by the kidneys,and the remaining 1/3 is excreted by intestinal tract after enzymolysis by Escherichia coli.Chronic kidney disease patients suffer from hyperuricemia due to decreased glomerular filtration rate and other reasons.In recent years,more and more epidemiological studies have confirmed that hyperuricemia is closely related to kidney diseases such as chronic kidney disease,acute kidney injury,Ig A nephropathy,diabetic nephropathy,etc.It is an independent risk factor for kidney diseases,also is an independent risk factor for metabolic diseases,cardiovascular diseases,and stroke.So the control of serum uric acid level is of great significance.Xanthine oxidase inhibitors,commonly used clinically to inhibit uric acid synthesis,are febuxostat and allopurinol.This paper mainly provide evidences for clinical treatment and medication by comparing evaluating the efficacy and safety of febuxostat and allopurinol in the treatment of delaying kidney disease progression in chronic kidney disease with hyperuricemia patients.MethodsWe searched retrieval database online(including PUBMED,EMBASE,Cochrane Library,China National Knowledge Infrastructure,Wanfang Database,VIP Database,China Biomedical Journal Literature Database)with the limitted time from January 1th,2009,to January 31 th,2019,setting chronic kidney disease,hyperuricemia,febuxostat and allopurinol as subject words,then combining into different retrieval,without language limitation.We also searched relevant references and abstracts by manual testing to collect the randomized controlled trials comparing the treatment of febuxostat and allopurinol on delaying kidney disease progression in chronic kidney disease with hyperuricemia patients as many as possible.After making sure the literature,we set the inclusion and exclusion criteria,and follow the guidelines to selecte appropriate articles.After evaluating the methodology quality by two independet evaluators,data analyses were performed with the Cochrane Collaboration’s Rev Man5.3 software.Then we draw the final conclusion as the guidence for clinical treatment and medication.ResultsBy searching databases and manual retrieval,a total of 730 articles were included.After the removal of review,letters,non clinical trials and duplicate documents with unmatched condition obviously,there were 47 articles remaining.Reading through full texts,only 8 articles met the inclusion criteria with the high quality of 6 articles and low of2.8 RCTs enrolling 802 participants met our inclusion criteria.The results showed as follows.For CKD patients with hyperuricemia,both febuxostat and allopurinol could reduce the level of serum uric acid,but the level of uric acid in febuxostat group was lower than that in allopurinol group after treatment.Both febuxostat and allopurinol can improve e GFR of patients,but the e GFR level in febuxostat group is higher than that in allopurinol group after treatment.There was no significant difference in adverse reactions caused by the medicine between the two groups after treatment.ConclusionBoth febuxostat and allopurinol were effective in reducing serum uric acid levels.Compared with allopurinol,febuxostat was more effective in reducing serum uric acid levels.Febuxostat maintains e GFR levels in patients with chronic kidney disease with hyperuricemia and may delay progression of kidney disease,but allopurinol does not improve e GFR.Individual studies have respectively pointed out liver dysfunction during febuxostat treatment and adverse reactions such as skin rash and liver dysfunction during allopurinol treatment.However,it was unable to use the method of cost-benefit to carry out economic evaluation,it is still necessary to carry out more researches by large sample,long course and high quality RCT,which can provide more rigorous clinical evidence.