Renoprotective effects of febuxostat compared with allopurinol in patients with hyperuricemia: A systematic review and meta-analysis

Sollip Kim, Hyun Jung Kim, Hyeong Sik Ahn, Se Won Oh, Kum Hyun Han, Tae Hyun Um, Chong Rae Cho, Sang Youb Han

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16 Citations (Scopus)


Background: Hyperuricemia is reported to be related to rapid progression of renal function in patients with chronic kidney disease (CKD). Allopurinol, a uric acid lowering agent, protects renal progression. However, it is not widely used in patients with CKD because of its serious adverse event. Febuxostat can be alternatively used for patients who are intolerable to allopurinol. We aimed to determine renoprotective effect and urate-lowering effect between the two drugs. Methods: We performed a systematic review and meta-analysis of randomized controlled trials to assess the effects of febuxostat compared to allopurinol in patients with hyperuricemia. MEDLINE, Embase, and Cochrane Library databases were searched to identify research publications. Results: Four relevant publications were selected from among 3,815 studies. No significant differences were found in the changes in serum creatinine from baseline between the febuxostat and allopurinol groups. Changes in estimated glomerular filtration rate (eGFR) were observed between the two groups at 1 month (mean difference 1.65 mL/ min/1.73 m2, 95% confidence interval [CI] 0.38, 2.91 mL/min/1.73 m2; heterogeneity χ2 = 1.25, I2 = 0%, P = 0.01); however, the changes in eGFR were not significantly different at 3 months. A significant difference did exist in the changes in albuminuria levels from baseline between the febuxostat and allopurinol groups (mean difference -80.47 mg/gCr, 95% CI -149.29, -11.64 mg/gCr; heterogeneity χ2 = 0.81, I2 = 0%, P = 0.02). A significant difference was also observed in the changes in serum uric acid from baseline between the febuxostat and allopurinol groups (mean difference -0.92 mg/dL, 95% CI -1.29, -0.56 mg/dL; heterogeneity χ2 = 6.24, I2 = 52%, P < 0.001). Conclusion: Febuxostat might be more renoprotective than allopurinol.

Original languageEnglish
Pages (from-to)274-281
Number of pages8
JournalKidney Research and Clinical Practice
Issue number3
Publication statusPublished - 2017 Sep 1



  • Chronic kidney disease
  • Febuxostat
  • Gout
  • Hyperuricemia
  • Meta-analysis

ASJC Scopus subject areas

  • Nephrology
  • Urology

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