Effects of Switching from Allopurinol to Febuxostat in Chronic Kidney Disease Patients
Pp. 325-333 (9)
Shunsuke Takahashi, Ayumu Nakashima, Asako Urabe, Yosuke Osaki and Takao Masaki
Febuxostat, a new xanthine oxidase (XO) inhibitor, could become the
standard for managing uric acid levels in patients with chronic kidney disease (CKD).
However, little has been reported regarding patients with severe renal impairment.
Further, the conversion rate for switching patients from allopurinol to febuxostat
We studied 65 CKD patients being administered allopurinol for hyperuricemia and then
switched them to febuxostat at a conversion ratio of 100 mg allopurinol: 10 mg
febuxostat. Serum uric acid and creatinine levels were measured before and 4–8 weeks
after the switch.
Sixty-three patients remained after excluding those who had discontinued treatment.
There was no significant difference in serum uric acid and creatinine levels before and
after the switch. Further, no significant differences were observed in serum uric acid
levels before and after the switch when patients were stratified into diabetic and nondiabetic
groups or when classified per gender. We divided patients into G1–G3b and
G4–G5 groups depending on the stage of CKD; there were no significant differences in
the G1–G3b group after the switch, but there was a significant decrease in serum uric
acid levels in the G4–G5 group (p < 0.05).
We demonstrated that 100 mg allopurinol and 10 mg febuxostat had equivalent
hypouricemic effects in CKD patients and that these drugs did not affect serum
creatinine levels. Thus, 10 mg febuxostat may have greater hypouricemic effects in
patients with advanced CKD.
Alopurinol, Chronic kidney disease, Febuxostat, Uric acid, Xanthine
Department of Nephrology, National Hospital Organization, Kure Medical Center and Chugoku Cancer Center, 3-1 t Aoyama-cho, Kure 737-0023, Japan.