·To investigate the efficacy, safety and effect on renal function of low-dose febuxostat in the treatment of elderly patients with chronic kidney disease (CKD) complicated with asymptomatic hyperuricemia (HUA).Methods
·In this prospective cohort study, a total of 102 elderly patients who were hospitalized in the Wangjiangshan Branch, Zhejiang Province People's Hospital from February 2021 to July 2021 and met the enrollment conditions were selected. They were divided into low dose group (20 mg/d), normal dose group (40 mg/d) and control group (without urate-lowering drug, mainly lifestyle intervention). The total course of treatment was 3 months. The control rates of serum uric acid (SUA) were calculated in each group monthly. The changes of SUA, serum creatinine (Scr), creatinine clearance rate (Ccr) and estimated glomerular filtration rate (eGFR) were collected and calculated at baseline and after 1 and 3 months of treatment. Meanwhile, eGFR1 was calculated by the simplified diet in renal disease (MDRD) equation, and eGFR2 was calculated by the chronic kidney disease epidemiology collaboration (CKD-EPI) equation. At the same time, cardiovascular and cerebrovascular events, gout attack, allergy and other adverse events caused by febuxostat were recorded. χ2 test was used to compare the differences in gender composition, basic disease and drug use among the three groups. One-way ANOVA was used to compare the differences in SUA, Scr, Ccr, eGFR1 and eGFR2 among the three groups.Results
·After 1, 2 and 3 months of treatment, the control rates of SUA in the low dose group and normal dose group were 93.8%, 93.8%, 90.6% and 93.8%, 93.8%, 96.9%, respectively. The SUA levels in the above two groups were significantly decreased, compared with the control group (all P=0.000). Ccr, eGFR1, eGFR2 in the low dose group were higher than those at baseline (P=0.006, P=0.013, P=0.015) and those in the control group (P=0.019, P=0.020, P=0.021). There were no significant differences in the decrease of SUA between the normal dose group and the low dose group, but they were significantly greater than those in the control group (all P=0.000). The increase of Ccr, eGFR1 and eGFR2 in the low dose group was significantly higher than that in the control group (P=0.004, P=0.002, P=0.003), but the difference was not statistically significant compared with the normal dose group. Severe adverse events specific to febuxostat were not observed.Conclusion
·Low dose and normal dose of febuxostat both have a similar urate-lowering efficacy in elderly patients with CKD complicated with asymptomatic HUA, getting a high control rate of SUA and improving renal function without serious adverse events. It is suggested a low dose of febuxostat at the beginning of the clinical intervention of asymptomatic HUA.