Comparison between the Effects of Allopurinol and Febuxostat on the Survival of Patients on Maintenance Hemodialysis

Am J Nephrol. 2023;54(3-4):117-125. doi: 10.1159/000530972. Epub 2023 May 18.

Abstract

Introduction: There were insufficient pieces of evidence regarding the effect of the two drugs (allopurinol and febuxostat) on patient survival in hemodialysis (HD) patients. Herein, we aimed to compare the efficacy of uric acid-lowering drugs (ULDs) or the type of the drug on patient survival using a representative sample of maintenance HD patients in South Korea.

Methods: This study used data from a national HD quality assessment program and the claims data. Use of ULDs was defined as more than one prescription during the 6 months of each HD quality assessment period. The patients were divided into three groups. Patients who were not prescribed allopurinol or febuxostat were included in group 1 (n = 43,251); patients who were prescribed allopurinol were included in group 2 (n = 9,987); and patients who were prescribed febuxostat were included in group 3 (n = 2,890).

Results: Kaplan-Meier curves showed that the survival rate was greatest in group 3 and worst in group 1 among the three groups. Multivariable analysis showed that group 2 had better patient survival compared to group 1; however, there was no significant difference in patient survival between groups 2 and 3. In addition, patients with hyperuricemia or gout had better patient survival compared to those without these diseases.

Conclusions: Our study showed that survival in patients receiving ULDs was not inferior to that of those not receiving ULDs. Patient survival between patients on HD receiving allopurinol and those receiving febuxostat was similar.

Keywords: Allopurinol; Febuxostat; Hemodialysis; Patient survival; Uric acid.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Allopurinol* / therapeutic use
  • Febuxostat* / therapeutic use
  • Gout Suppressants* / therapeutic use
  • Gout* / drug therapy
  • Humans
  • Hyperuricemia / drug therapy
  • Renal Dialysis*
  • Treatment Outcome
  • Uric Acid

Substances

  • Allopurinol
  • Febuxostat
  • Gout Suppressants
  • Uric Acid

Grants and funding

This work was supported by the Medical Research Center Program through the National Research Foundation (NRF) of Korea, funded by the Ministry of Science, ICT, and Future Planning (2022R1A5A2018865), the Basic Science Research Program through the NRF of Korea, funded by the Ministry of Education (2022R1I1A3072966), and the NRF grant funded by the Korea government (MSIT) (2022R1F1A1076151). The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.