2014 Volume 3 Issue 3 Pages 15-20
Hyperuricemia often occurs in patients with chronic kidney disease and those on hemodialysis (HD). This study assessed the clinical efficacy and individual differences of the response to febuxostat, a non-purine selective xanthine oxidase inhibitor, in HD patients with hyperuricemia.Patients on maintenance HD who had a serum uric acid (SUA) level higher than 7.0 mg/dL were treated with febuxostat (10 mg/day). SUA levels were evaluated before and after 1 month of treatment in 27 patients, including 13 newly treated patients (new group) and 14 patients who were switched from allopurinol (switched group). In the new group, the SUA level decreased significantly from 9.7 mg/dL (7.4 – 11.9) to 5.0 mg/dL (3.4 – 7.1) with febuxostat treatment. In the switched group, the SUA level also decreased significantly from 9.1 mg/dL (7.0 – 10.0) to 6.1 mg/dL (5.1 – 10.0). However, the percent change of SUA after febuxostat administration was significantly smaller in the switched group than the new group. There was a significant negative correlation between the percent change of SUA and baseline blood urea nitrogen (BUN) in both groups. We divided the switched group into high responder and low responder based on the median percent change of SUA after febuxostat treatment (-22.7%), and found that the baseline BUN and normalized protein catabolic rate (nPCR) were significantly lower in low responder than high responder.The initial adequate dose of febuxostat for HD patients is 10 mg/day and caution is necessary to avoid a marked decrease of SUA. In patients switched from allopurinol, the response to febuxostat is good, but weaker than in newly treated patients. HD patients with a lower BUN or nPCR (both indicating poor nutritional status) may show a limited response to febuxostat.
