Febuxostat Lowers Serum Uric Acid More Effectively in Gout Patients With CKD

A study found that febuxostat more effectively lowered serum uric acid levels in gout patients with chronic kidney disease (CKD), who achieved higher target control despite slightly lower doses.1

“Therefore, an individualized dosing strategy based on [serum urate] response, rather than renal function alone, may optimize treatment outcomes in these patients,” wrote study investigator Yoon-Jeong Oh, from the division of rheumatology, department of internal medicine at Uijeongbu Eulji Medical Center, Eulji University School of Medicine in South Korea, and colleagues.1

Gout is highly prevalent among patients with CKD. According to the National Kidney Foundation, a bidirectional relationship exists between the 2 conditions: each raises the risk of the other.2

Both diseases are also increasing in prevalence worldwide. Gout, now considered the most common inflammatory arthropathy in adults, more than doubled in prevalence between the 1960s - 1990s and currently affects an estimated 3.9% (8.3 million) of US adults, including 6.1 million men and 2.2 million women. CKD affects approximately 14.8% of US adults and 11% to 13% globally.2

Gout and CKD have distinct risk factors. High serum uric acid, male sex, age over 65 years, and postmenopausal status raise gout risk, whereas diabetes, hypertension, family history of kidney failure, and being of African American, Hispanic, Pacific Islander, or American Indian descent increase CKD risk.2

In this prospective multicenter study, investigators assessed longitudinal changes in serum urate levels and febuxostat dosage according to renal function among 112 patients with comorbid gout and CKD.1 Participants were identified in the Urate Lowering TheRApy (ULTRA) registry between November 2021 and December 2023. The study excluded patients with less than a year of follow-up, no febuxostat treatment, or missing data.

The team compared serum urate levels and febuxostat doses at baseline, 6 months, and 12 months between the CKD arm (patients with comorbid gout and CKD) and the “normal” arm (patients with gout only).1

At baseline, serum urate levels did not differ between the CKD and normal arms. However, after febuxostat therapy, investigators noted that patients with both CKD and gout experienced significant improvements in serum urate levels.

Despite receiving lower febuxostat doses than the gout-only arm (6 months: 40.61 ± 22.07 mg vs. 47.54 ± 19.43 mg, P =.110; 12 months: 40.59 ± 21.73 mg vs. 48.49 ± 19.70 mg, P =.064, patients in the gout/CKD arm had significantly lower serum urate levels at 6 months (4.45 ± 1.84 mg/dL vs. 5.62 ± 1.62 mg/dL, P =.001) and 12 months (4.81 ± 1.81 mg/dL vs. 5.60 ± 1.94 mg/dL, P =.041). The analysis also found that a greater proportion of CKD arm patients achieved serum urate < 6 mg/dL at 6 months compared with the gout-only arm (91.2% vs 68.6%; P =.014).1

New Data Reinforces Febuxostat’s Effectiveness in Gout with Kidney Disease

This study adds to previous research showing the benefit of febuxostat for renal complications in patients with gout. A meta-analysis published in spring 2024 found that febuxostat was linked to a decreased risk of kidney events, including serum creatinine doubling, progression to end-stage kidney disease, or dialysis, and a slow decline in the estimated glomerular filtration rate (eGFR) in patients with gout (P =.006 and P =.003, respectively).3

“Febuxostat may be an effective drug for delaying the progression of kidney function deterioration in patients with gout or hyperuricemia,” wrote investigators, led by Xiu Hong Yang, from Shanghai Pudong Hospital and Huadong Hospital at Fudan University.3

References

1. Oh YJ, Choi HJ, Kim SH, et al. Febuxostat effectively and safely reduces serum urate in gout patients with chronic kidney disease: A prospective multicenter ULTRA registry study. J Rheumatol. Published online December 1, 2025. doi:10.3899/jrheum.2025-0881

2. Quick Facts: Gout and Chronic Kidney Disease. National Kidney Foundation. Published August 19, 2024. https://www.kidney.org/kidney-topics/quick-facts-gout-and-chronic-kidney-disease

3. Derman C. Febuxostat Use Is Linked to Reduced Risk of Kidney Events for Patients with Gout. HCPLive. Published May 14, 2024. Accessed December 11, 2025. https://www.hcplive.com/view/febuxostat-use-is-linked-to-reduced-risk-of-kidney-events-of-patients-with-gout