Preliminary Evaluation For Febuxostat In The Treatment Of Chronic Renal Failure With Hyperuricemia

Background: Hyperuricemia(HUA)is often seen in patients with chronic renal failure(CRF).Hyperuricemia aggravates renal function damage and accelerates renal insufficiency in uremic phase.The renoprotective effect of Xanthine oxidase inhibitors(XOIs)in patients with chronic renal failure has been confirmed.The serious side effects of allopurinol limit its clinical application,and its efficacy in patients with chronic renal insufficiency decreases with the dose decreasing.Uric acid lowing effect of febuxostat has be confirmed better than allopurinol,however it's renal protective effect on chronic renal failure patients with hyperuricemia remains controversial.Objective: The aim of this article is to preliminary evaluate it's renal protective effect of febuxostat in the treatment of CRF with HUA,and whether it's more efficiency than allopurinol.Methods: Chinese and English retrieval strategy was mad first.We searched trials through VIP,Wan Fang,CNKI,CBM,Pubmed,The Cochrane library and EMBASE databases published before January 2018.These trials are all randomized controlled trials(RCTs)concerned about febuxostat in the treatment of CRF complicated with HUA.Articles were selected according to the inclusion and exclusion criteria by 2 researchers.Then use the Jadad scale and the bias risk assessment tool provided by the Cochrane manual to evaluate the included literature,and then extract the relevant data from it.Revman 5.3 software was used to conduct the Meta-analysis.Results: All databases have retrieved 138 documents.Finally,10 RCTs were included in this study,involving 772 participants(388 in the experimental group vs.384 in the control group).The meta-analysis showed that comparing with control group,there was a significant difference in serum uric acid[SMD=-2.35,95%CI(-2.84,-1.86),P<0.00001],serum urea nitrogen[MD=-2.42,95%CI(-3.90,-0.94),P=0.001],serum creatinine [SMD=-0.72,95%CI(-1.17,-0.26),P=0.002] and estimated glomerular filtration rate(e GFR)[MD=3.35,95%CI(1.50,5.20),P=0.0004].And while comparing with allopurinol group,there was also a significant difference in serum uric acid[SMD=-1.96,95%CI(-2.35,-1.58),P<0.00001],serum urea nitrogen[MD=-2.70,95%CI(-4.37,-1.03),P=0.002],serum creatinine [SMD=-0.72,95%CI(-1.23,-0.21),P=0.005] and estimated glomerular filtration rate(e GFR)[MD=3.98,95%CI(1.71,6.25),P=0.0006].An analysis of the included studies showed that febuxostat could also reduce urinary albumin.However there was no significant difference in hemoglobin [MD=2.10,95%CI(-1.64,5.85),P=0.27]?albumin [MD=-0.75,95%CI(-1.93,0.43),P=0.21]?white blood cell [MD=0.30,95%CI(-0.17,0.78),P=0.21]?total cholesterol [SMD=0.12,95%CI(-0.15,0.39),P=0.38] ? triglyceride [SMD=0.05,95%CI(-0.23,0.32),P=0.74].This Meta-analysis also showed that the adverse reaction of febuxostat in treatment of CRF complicated with HUA was low[OR=0.35,95%CI(0.18,0.68),P=0.002],and lower than allopurinol was[OR=0.27,95%CI(0.13,0.56),P=0.0004].Conclusion: Febuxostat also has renal protective effect while reduce uric acid in chronic renal failure complicated with hyperuricemia patients,and it's better than allopurinol.