DOI: https://doi.org/10.53350/pjmhs22165160 ORIGINAL ARTICLE 160 P J M H S Vol. 16, No. 05, May 2022 Efficacy of Febuxostat with Allopurinol in Chronic Kidney Disease Patients: A Comparative Study MUHAMMAD AHMAD 1, IJAZ NABI 2 , SALMAN MEHMOOD 3 , NOUMAN HAMEED SHEIKH 4 , RANA ZAHID HAFEEZ 5 , RASHID IQBAL 6 1 Consultant Nephrologist, Nephrology department, Allied Hospital Faisalabad 2 Assistant professor, Faisalabad institute of cardiology, Faisalabad 3 Senior Registrar Nephrology, Allied Hospital Faisalabad 4 Senior Registrar Nephrology, DHQ Teaching Hospital/ Medical College, Gujranwala 5 Consultant Nephrologist, Mustashfa Al Noor, Makkah 6 PGR, Nephrology, Allied Hospital Faisalabad Corresponding author: Dr. Nouman Hameed Sheikh, Senior Registrar Nephrology ABSTRACT Aim: Efficacy of febuxostat with allopurinol in patients of chronic kidney disease Methods: 80 subjects with chronic kidney disease, 20 to 70 years of age with both gender were included. Patients of acute kidney injuries (AKI), acute nephritis, or rapidly progressive glomerulonephritis, liver dysfunction and alcohol abuse were excluded. Group A received febuxostat 40 mg/day for 3 months. Group B patients received allopurinol 100 mg/day for 3 months. Blood samples were sent to the laboratory for serum uric acid level. Results: The mean ± SD age of women in group A and B was 41.8 ± 12.8 and 41.2 ± 10.8 years respectively. Out of 80 cases, 53 (66.3%) were between 20 to 40 years of age. In this study, 55 cases (68.8%) were males and 25 (31.3%) were females. M:F ratio was 2.2:1. This study showed that febuxostat is more effective in reducing uric acid as compared to allopurinol i.e. 72.5% and 45% respectively with p-value of 0.012. Conclusion: Febuxostat is more effective in reducing uric acid as compared to allopurinol in chronic kidney disease cases. Keywords: chronic kidney disease, serum uric acid, febuxostat. INTRODUCTION Worldwide, chronic kidney disease (CKD) is highly prevalent 1 . It is one of the fastest growing global causes of death and will become the fifth leading global cause of death by 2040. 2 Prevalence of CKD in Pakistan is 12.5% 3 . An increase in serum urate concentration >6.8mg/dl is called as hyperurecemia and associated with many systemic disorders 4 . Hyperuricemia is a common complication of CKD. Data showed that it is an independent risk factor for CKD 5 . The objective of the study was to determine efficacy of febuxostat with allopurinol in patients of chronic kidney disease. METHODOLOGY After approval from hospital ethical committee, cases who fulfilled the inclusion criteria were enrolled and informed consent was taken. They were divided into two groups. Group A received febuxostat 40 mg/day for 3 months and group B allopurinol 100 mg/day for 3 months. Blood samples were sent for estimation of serum uric acid level after 3 months of treatment. All the data was analyzed using SPSS Version-25. RESULTS The detail of results given in tables 1,2,3,4,5,6,7. Table 1: Gender distribution . Gender Group A Group B Total Male 28(70%) 27(67.5%) 55(68.8%) Female 12(30%) 13(32.5%) 25(31.3%) Table 2: Efficacy of febuxostat with allopurinol in patients of CKD Efficacy Group A Group B Yes 29(72.5%) 18(45%) No 11(27.5%) 22(55%) P< 0.01 which is statistically significant Table 3: Stratification of efficacy with respect to age Age (years) Group A Group B p-value Yes No Yes No 20-45 19 07 11 16 0.018 46-70 10 04 07 06 0.345 ---------------------------------------------------------------------------------------------------- Received on 24-10-2021 Accepted on 13-04-2022 Table 4: Stratification of efficacy with respect to gender Gender Group A Group B p-value Yes No Yes No Male 20 08 12 15 0.043 Female 09 03 06 07 0.141 Table 5: Stratification of efficacy with respect to duration Duration (months) Group A Group B p-value Yes No Yes No ≤24 15 06 10 10 0.160 >24 14 05 08 12 0.034 Table 6: Stratification of efficacy with respect to BMI BMI (kg/m 2 ) Group A Group B p-value Yes No Yes No ≤27 13 05 09 18 0.011 >27 16 06 09 14 0.023 Table 7: Stratification of efficacy with respect to stage Stage Group A Group B p-value Yes No Yes No 1-2 13 05 08 09 0.129 3-4 16 06 10 13 0.047 DISCUSSION In this study, mean age of women in group A and B was 41.8 ± 12.8 and 41.2 ± 10.8 years respectively. Out of 80 cases, 53 cases (66.3%) were between 20 to 40 years of age. 55 cases (68.8%) were males and 25 (31.3%) were females with M:F ratio of 2.2:1. In this study, febuxostat is more effective in reducing uric acid than allopurinol for for 3 months i.e. 72.5% and 45% respectively (p < 0.01). In one study, efficacy of febuxostat and allopurinol for reduction of serum uric acid level after 3 months was 73.3% and 33.3% respectively 6 . Half life of Febuxostat is 4-18 hours and mostly metabolized in liver. The half life of allopurinol is lower than febuxostat. 7 Becker MA et al 7 in his study also showed better results of Febuxostat ( dose of 80-120 mg/day) as compared to allopurinol ( dose of 300mg/day). In allopurinol users, A significant reduction was observed in uric acid (from 8.7 to 7.1mg/dl)( p<0.01) 8 . Omori et al 9 observed that febuxostat decreased the damage of renal tubules thus preventing the damage of endotheliocyte. So febuxostat has dual action i.e. reducing uric acid and to prevent renal damage in CKD patients 10. Sakai et al 11 reported that the cases who did not respond to allopurinol were better treated with febuxostat for reducing uric