Efficacy and tolerability of febuxostat in gout patients on dialysis

Abstract

Background: There are no sufficient data available on the use of febuxostat in patients undergoing dialysis. Aim: To investigate the efficacy and tolerability of febuxostat in gout patients on dialysis. Methods: We retrospectively reviewed clinical and laboratory data available from a referral centre from January 2012 to December 2018. We included gout patients who initiated febuxostat during dialysis. Data regarding serum uric acid levels before and after the febuxostat treatment and clinical information such as gout attack after febuxostat initiation, as well as adverse events involving febuxostat treatment, were obtained from medical records. Results: Among 62 patients who were treated with febuxostat for over 3 months, 45 were undergoing haemodialysis (HD) and 17 were undergoing peritoneal dialysis (PD). The mean serum uric acid level was significantly reduced 3 months after treatment (3.71 ± 1.32 mg/dL) compared with that at the pretreatment level (9.36 ± 2.06 mg/dL) (P < 0.001). The serum uric acid level was observed to be significantly reduced at 3 months in both HD and PD patients and subsequently remained at a significantly reduced level for 12 months. Of the 62 patients, only two stopped febuxostat due to its adverse effects. Initial dose of 80 mg/day was associated with higher adverse events compared to dose of 20?40 mg/day (odds ratio 8.25, 95% confidence interval 1.90?35.97, P = 0.006). Conclusions: Febuxostat is efficacious and well tolerated in gout patients on dialysis. Febuxostat taken at dose of 20?40 mg/day might be appropriate initial dose in patients undergoing dialysis.