Febuxostat vs Allopurinol in Asymptomatic Hyperuricemia on Diabetic Kidney Disease Progression

Abstract Background The guidelines define CKD as either structural kidney affection or a decreased glomerular filtration rate (GFR) of less than 60 mL/min/1.73 m2 for at least 3 months. Whatever the underlying etiology, once the loss of nephrons and reduction of functional renal mass reaches a certain point, the remaining nephrons begin a process of irreversible sclerosis that leads to a progressive decline in the GFR. Aim of the Work to compare the safety and efficacy of febuxostat vs allopurinol in asymptomatic hyperuricemia in diabetic kidney disease patients. Patients and Methods A six-month prospective cohort study to compare the safety and effectiveness of febuxostat and allopurinol in managing asymptomatic hyperuricemia among patients with diabetic kidney disease. Results Febuxostat demonstrated superior efficacy compared to allopurinol in lowering serum uric acid levels in diabetic CKD patients with asymptomatic hyperuricemia over the 6- month study period. Additionally, febuxostat exhibited more pronounced renoprotective effects. While both groups experienced a decline in eGFR, the reduction was significantly less in the febuxostat group, indicating better preservation of kidney function. Similarly, although serum creatinine levels increased in both groups, the rise was more substantial in the allopurinol group. Furthermore, the albumin-creatinine ratio, a critical marker of kidney damage, showed significantly less deterioration in the febuxostat group. Both treatments were well-tolerated, with no reported serious adverse effects, and no alterations were observed in complete blood count tests in either group. Conclusion Febuxostat demonstrates superior efficacy compared to allopurinol in reducing serum uric acid levels in diabetic CKD patients with asymptomatic hyperuricemia. It provides enhanced renoprotective effects, contributing to better preservation of kidney function. Febuxostat exhibits a significant advantage in mitigating deterioration in the albumin-creatinine ratio. Its safety profile is favorable, with no significant adverse effects reported during use.